Currently submitted to: Interactive Journal of Medical Research
Date Submitted: Nov 18, 2025
Open Peer Review Period: Nov 26, 2025 - Jan 21, 2026
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The content validity of the CHANT’s French translation and cultural adaptation: a modified e-Delphi study
ABSTRACT
Background:
Climate change is a critical global health emergency with direct consequences for public health. As frontline health promoters and agents of change, nurses must develop specific competencies to implement sustainable practices and respond to climate-related health challenges.
Objective:
This overall work aimed to translate the Climate, Health, and Nursing Tool (CHANT) into French, culturally adapt it and conduct a content validation. The CHANT assesses nurses’ awareness, motivations, concerns and self-reported behaviours regarding climate change by evaluating both item-level content validity indices (I-CVI) and scale-level content validity indices (S-CVI). The secondary aim was to explore potential associations between the sociodemographic and professional characteristics of our expert panel members and their CVI ratings of the CHANT’s items.
Methods:
A descriptive, international study design was used, involving a three-round, modified e-Delphi technique to explore the relevance and comprehensiveness of each item and response option in the translated tool. The study was conducted between January and June 2025 in Switzerland’s French-speaking regions, France and Belgium. A panel of experts in nursing, planetary health and environmental science participated in the content validation process, contributing to an iterative refinement of the tool’s items. To ensure methodological transparency and rigour, this Delphi study was conducted and reported in accordance with the guidance on Conducting and REporting of DElphi Studies developed by Jünger et al. (2017).
Results:
Over three rounds, 57 experts evaluated the overall comprehensibility, relevance and response options of the CHANT’s 12 items. After Round 1, the comprehensibility I-CVI ranged from 0.786–1.0 across individual items, and the S-CVI for the full 12-item scale was 0.935. Complete consensus (100%) was achieved on every item. After Round 2, I-CVI ratings ranged from 0.71–1.0, and the S-CVI was 0.91, with 92% expert consensus. Item 2, suggested by the expert panel during Round 1, did not reach the predefined consensus threshold. In Round 3, I-CVI ratings ranged from 0.82–1.0, and the S-CVI remained at 0.935, confirming the expert panel’s continued consensus. The process concluded with a cognitive debriefing, during which the complete consensus on every item and response option was reaffirmed, as reflected by consistently high I-CVI and S-CVI ratings, thereby supporting the CHANT’s internal content validity.
Conclusions:
The rigorous validation of the CHANT’s French translation is a foundational step toward developing and strengthening climate-related competencies in nursing education and clinical practice. This validation supports the development and implementation of targeted strategies to strengthen eco-literacy in healthcare settings.
Citation
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