A Study on the Development of the Neonatal Safety Assessment Scale in Disasters

A Study on the Development of the Neonatal Safety Assessment Scale in Disasters | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Study on the Development of the Neonatal Safety Assessment Scale in Disasters Rana Rehap SERT, Emel DEMIR This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8451011/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 15 You are reading this latest preprint version Abstract Background Newborns are highly vulnerable to multidimensional safety risks during disasters. This study aimed to develop a valid and reliable instrument to assess neonatal safety in disaster settings. Methods The study population consisted of neonatal nurses providing care to newborns affected by the earthquakes in Türkiye on February 6, 2023. The sample was determined using the rule of ten participants per item, resulting in 302 nurses. Content validity was assessed with the Polit-Beck Content Validity Index (CVI). Reliability was evaluated using the Kuder-Richardson 20 (KR-20) coefficient. Items with negative item-total correlations or correlations below 0.20 were considered for removal. Results The Polit-Beck CVI was 1.00, and the KR-20 coefficient was 0.81, indicating high reliability. Ten items were removed due to low item-total correlations, resulting in the final version of the scale. The “Neonatal Safety Assessment Scale in Disasters” demonstrated strong validity and reliability, making it suitable for evaluating neonatal safety in disaster contexts. Conclusions The developed instrument is a robust and reliable tool for assessing neonatal safety during disasters, supporting clinical decision-making and preparedness in neonatal care. Neonatal safety disaster scale development Introduction Neonatal safety is a comprehensive concept that involves the holistic protection of newborns from the moment of birth in terms of identification, nutrition, infection control, treatment practices, and the care environment [ 1 , 2 , 3 ]. Disasters are among the situations that pose the greatest threat to the neonatal safety chain. Situations such as incubator failure, malfunction of oxygen systems, loss of records, or identity confusion may occur in disaster settings [ 4 ]. Furthermore, components of the healthcare system, such as physical infrastructure, human resources, record-keeping systems, and communication networks, may be severely compromised during disasters [ 5 ]. This situation may cause vulnerable and technology-dependent patients, such as infants in the Neonatal Intensive Care Unit (NICU), to be disproportionately affected by disasters [ 6 , 7 ]. The priority of emergency response teams following a disaster is typically adult trauma, a situation that may lead to the overlooking of neonatal monitoring and intervention plans. In this context, pre-established, systematic, and controllable monitoring tools are required to ensure neonatal safety in disasters [ 8 ]. There is limited evidence regarding the skills required and the bedside equipment that must be available for disaster training and evacuation programs in the care of critically ill infants [ 9 ].The roles of neonatal nurses in this process extend beyond clinical care to include risk management, coordination, and ethical responsibilities [ 10 ] . Lack of identification, failure to ensure transport safety, delays in physical examinations, inability to maintain thermal stability, and disruption of nutrition and treatment continuity are the fundamental issues frequently emphasized in the literature regarding neonatal care under disaster conditions [ 11 , 12 , 13 , 14 ] .Fundamental challenges encountered in neonatal care under disaster conditions have been categorized under the headings of deficiencies in equipment, funding, logistical support, and effective communication; and it has been reported that these factors are determinants of neonatal safety [ 15 ] .Reports by the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC), have identified power outages, failure of medical devices, challenges during transport, and disruptions in access to basic health services as primary hazards for newborns and Neonatal Intensive Care Unit (NICU) patients in disaster settings [ 6 , 16 ]. It has been demonstrated that the weakening of healthcare infrastructure by disasters leads to issues such as a shortage of vital equipment—including oxygen tanks and thermoregulation devices and the interruption of internet and telephone services, which severely complicate neonatal care, particularly in receiving hospitals [ 11 , 17 , 18 , 19 ].It has been reported that following Hurricane Katrina, problems such as loss of thermal control, disruptions in ventilation support, and communication deficiencies were experienced within destabilized NICU conditions [ 20 ]. These findings demonstrate that significant risks exist in meeting the basic care needs of newborns under disaster conditions and, in this context, indicate that safety must be evaluated through a multidimensional approach. In terms of nutrition, disasters give rise to numerous issues that threaten the adequate and safe feeding of newborns. Mudiyanselega et al, emphasized that during disaster periods, mothers become overly reliant on infant formula due to factors such as diminished breastfeeding self-efficacy, lack of knowledge, and inability to access resources for safe food preparation. In a similar vein, damage to healthcare infrastructure following the 2014 Malaysia floods and the Christchurch earthquake in New Zealand complicated the provision of infant feeding support [ 21 , 22 , 23 ]. Mothers who experienced the Fort McMurray wildfire in Canada reported being unable to maintain their infants' routine feeding schedules during the evacuation process due to a lack of breast pumps [ 24 ]. In Puerto Rico, power outages occurring in the aftermath of the disaster adversely affected families' breast milk refrigeration practices [ 25 ]. Challenges regarding transport and care processes during Neonatal Intensive Care Unit (NICU) evacuations have been reported. During the evacuation of newborns at New York University Langone Hospital during Hurricane Sandy in the USA, safe evacuation could not be ensured due to factors such as the lack of an interdisciplinary command structure, communication breakdowns, a shortage of backup equipment, and ambiguity regarding staff role definitions [ 11 , 26 ]."It emphasizes that safety was severely compromised due to the failure to clarify personnel roles at both central and field levels and the lack of planning for alternative communication channels [ 11 ]. An evaluation conducted at Beira Central Hospital in Mozambique revealed that severe difficulties were encountered in the evacuation of the NICU as a result of damage to the hospital infrastructure following the cyclone [ 20 ]. The development of measurement instruments is essential for the scientific evaluation of safety within the healthcare system. The scale development process makes significant contributions to both clinical practice and policy development by quantifying observed behaviors or practices [ 27 , 28 ]. Measurement instruments to be used in disaster conditions must be rapidly applicable in the field, easily comprehensible, and practical to evaluate. Therefore, the dichotomous (Yes/No) response format is recommended as the most suitable measurement approach, particularly in crises and extraordinary situations [ 27 , 29 ].Since healthcare professionals work under intense stress, time pressure, and resource constraints during disasters, completing multi-point Likert-type scales is often not achievable [ 3 – 10 ].Dichotomous scales shorten the decision-making time of respondents, increase response consistency, and reduce cognitive load in disaster settings [ 28 ]. Scale development studies in nursing are one of the fundamental methods for the standardization of professional care quality [ 29 ]. World Health Organization (WHO) and United Nations International Children’s Emergency Fund (UNICEF) recommend the development of systematic assessment tools for the continuity of maternal and neonatal care during disaster periods [ 30 , 31 ]. A review of the international literature on neonatal safety confirms that although there are numerous scales regarding patient safety and neonatal care quality, the vast majority of these scales are oriented towards routine care conditions [ 32 , 33 ]. There is no existing scale focused on newborns that assesses risks specific to disaster environments. The neonatal period, encompassing the first 28 days of life, is characterized by vulnerability in fundamental vital functions such as thermoregulation, fluid balance, respiration, and resistance to infection. Therefore, neonatal safety must be central to all care processes from the moment of birth [ 30 , 31 , 34 , 35 ]. Can a valid and reliable measurement tool be developed to rapidly assess neonatal safety in disasters? In this context, following the 2023 Turkey earthquake, the aim was to develop the Neonatal Safety Assessment Scale in Disasters (NSASD). With this scale, it is intended to evaluate neonatal safety in disaster conditions from a holistic perspective, covering identity, transport, physical, treatment, and nutritional safety. Materials and Methods Study design This study was conducted using a sequential mixed methods approach. This design enables the use of both qualitative and quantitative data in a complementary manner during the development process of a new measurement instrument. In the first phase of the research, individual in-depth interviews were conducted with nurses and doctors by employing qualitative methods. In the quantitative phase, validity and reliability analyses of the developed scale were performed. Participants and Sampling The qualitative phase of the research was conducted with nurses and physicians providing neonatal care in disaster situations. The number of participants was determined by data saturation, and interviews were conducted with 10 individuals. In the quantitative phase, the study population consisted of NICU nurses providing treatment and care to newborns affected by the Kahramanmaraş-centered earthquakes that occurred in Turkey on February 6, 2023. The sample size was determined based on the criterion of 5 to 10 times the number of items, and the study was conducted with 302 neonatal nurses. Inclusion Working during and/or after the February 6 earthquake, working as a nurse in the Neonatal Intensive Care Unit, having provided care to at least one newborn affected by the earthquake, volunteering to participate in the study. Exclusion Not working during the earthquake period and not having provided care to at least one newborn affected by the earthquake, working outside the Neonatal Intensive Care Unit. Data Collection Tools Data were collected using two forms: the Participant Information Form and the Neonatal Safety Assessment Scale in Disasters Draft Form. Participant Information Form The questionnaire form, prepared by the researcher based on clinical experience and observations, consists of a total of 12 questions: 4 questions covering nurses' socio-demographic characteristics (age, gender, educational status), 4 questions regarding professional characteristics (institution of employment, duration of professional experience), 2 questions related to earthquake status, and 2 questions regarding training received. Draft Version of theScale It was developed based on the statements derived from the qualitative phase. The scale has a 30-item dichotomous structure consisting of 'Yes' (0) and 'No' (1) options. The scale encompasses the sub-dimensions of identity safety, transport safety, physical safety, and treatment and nutritional safety. Tool Development Item Generation A draft consisting of 31 items was generated based on field experiences following February 6, 2023, statements derived from qualitative interviews, and the literature review [ 6 , 9 , 20 , 30 , 31 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. Content Validity Four experts (one professor, two associate professors, and one assistant professor from the Department of Pediatric Nursing) were requested to evaluate the draft scale items via a form sent by email. They were asked to rate the statements in the draft scale as follows: 1 Point: Not suitable (Must be removed from the scale), 2 Points: Somewhat suitable (Item requires major revision), 3 Points: Quite suitable (Suitable but item/statement requires minor revision), and 4 Points: Highly suitable (Can remain as is). For the Content Validity Index (CVI) value, the Scale-CVI (S-CVI) was determined based on the average of items rated as 3 or 4 by the experts [ 29 , 42 ] .A criterion of 1.00 was established for the scale's CVI. Item 18, which had an Item-CVI (I-CVI) value of 0.75, was removed from the scale. Following the revisions of items suggested by the expert evaluations, the draft scale was finalized with 30 items. Pilot Testing Çakmur (2012), states that face validity is a criterion determined by obtaining the opinions of the researcher, experts, and non-experts regarding whether a scale measures the construct under investigation [ 43 ]. Accordingly, a pilot study was conducted with 30 individuals using the 30-item draft scale. Necessary semantic and structural changes were made in line with the feedback received. In accordance with the inclusion criteria, some of the nurses across Turkey who provided care to newborns affected by the February 6, 2023 earthquake were reached via social media (Instagram and WhatsApp). The created form was sent online to the nurses who were contacted. It took an average of 15–20 minutes for each nurse to complete the online form. The form was distributed by hand to the remainder of the sample (150 individuals). The process of collecting the hand-delivered forms took approximately 30–35 minutes. Data were collected using the 'Personal Information Form,' developed by the researcher and containing nurses' sociodemographic information, and the 30-item 'Draft of Neonatal Safety Assessment Scale in Disasters'. Validity and reliability analyses Data were analyzed using the SPSS 25.0 software. In the evaluation of the study data, frequency distributions were presented for categorical variables, and descriptive statistics (mean ± SD) were presented for numerical variables. Within the scope of validity studies, face validity and content validity analyses were applied to the scale. The CVI was calculated using the Polit-Beck method. Values of 0.80 and above were interpreted as acceptable, and values of 0.90 and above were interpreted as excellent. In reliability studies, Cohen's Kappa coefficient of agreement was examined to determine the extent of consistency in opinions regarding the suitability of the scale items. The scale items were administered by two independent observers. The reliability of the scale was examined using the Kuder-Richardson 20 (KR-20) internal consistency coefficient. The scale and sub-dimension scores of the participating nurses were obtained by calculating the mean of the relevant items. Item-total correlation coefficients were calculated for each item; items with values below 0.20 were removed from the scale. Consequently, 11 items were excluded, and the scale reached its final form consisting of 19 items. Ethical Considerations Approval for the research was obtained from the Hatay Mustafa Kemal University Social and Human Sciences Research Ethics Committee (Decision Date: 01.08.2023, Decision No: 01). Verbal and written informed consent was obtained from the neonatal nurses participating in the study. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Results Descriptive characteristics of theparticipants The mean age of the 302 neonatal nurses participating in the study was 31.4 ± 5.7 years. Of the participants, 88.7% were female, and their mean duration of clinical experience was 7.6 ± 3.2 years. While 59.6% of the nurses worked in university hospitals, the remainder were employed in public and private healthcare institutions. Additionally, 72.8% of the participants stated that they had served in a disaster situation at least once previously. These findings indicate that the participating nurses are experienced in neonatal care and possess awareness regarding disaster conditions (see Table 1 ). [Table 1 will be placed here] Table 1 Findings Regarding the Socio-Demographic and Work Life of Nurses Demographic and Professional Characteristics n % Age 18–25 years 26–35 years 36–45 years 46 years and over 61 172 58 11 20.2 57.0 19.2 3.6 Gender Famela Male 289 13 95.6 4.4 Province of employment Adana Mersin Kahramanmaraş İstanbul Ankara Gaziantep Antalya Şanlıurfa Diyarbakır Çorum Denizli Sakarya 231 28 13 13 6 4 2 1 1 1 1 1 76.5 9.2 4.3 4.3 2.0 1.3 0.7 0.3 0.3 0.3 0.3 0.3 Educational level High school Bachelor’s degree Master’s degree Doctorate 41 221 38 2 13.6 73.2 12.6 0.7 Institution of employment Private Hospital District State Hospital City Hospital University Hospital 42 70 114 76 13.9 23.2 37.7 25.2 Years of Professional experience 0–3 years 4–9 years 10–15 years 16 years and over 67 99 97 39 22.2 32.8 32.1 12.9 Years of experience in the Neonatal Intensive Care Unit 0–3 years 4–9 years 10–15 years 16 years and over 87 123 72 20 28.8 40.7 23.8 6.6 Level of NICU currently working in Level 1 Level 2 Level 3 Level 4 1 60 88 153 0.3 19.9 29.1 50.7 Where were you at the time of the earthquake? Home Hospital 219 83 72.5 27.5 How long after the earthquake did you start working? 0–4 hours 4–24 hours 24–72 hours 72 hours and over 28 164 2 8 9.2 54.3 1.5 2.6 Validity The draft scale was submitted to four experts for evaluation. Each item was rated using the four-point scale recommended by Polit and Beck (2006) (1 = not suitable, 4 = highly suitable). The Item-Content Validity Index (I-CVI) values, calculated on an item basis, ranged from 0.90 to 1.00, and the Scale-Content Validity Index/Average (S-CVI/Ave) value for all items was found to be 1.00. This result indicates an excellent level of consensus among the experts (see Table 2 ). [Table 2 will be placed here] Table 2 Distribution of Item-Based Content Validity Agreement Scores Number of Item Expert 1 Expert 2 Expert 3 Expert 4 I-CVI Item 1 4 4 4 4 1.00 Item 2 4 4 4 4 1.00 Item 3 4 4 4 4 1.00 Item 4 4 4 4 4 1.00 Item 5 4 4 4 4 1.00 Item 6 4 4 4 4 1.00 Item 7 4 4 4 4 1.00 Item 8 4 4 4 4 1.00 Item 9 4 4 3 4 1.00 Item 10 4 4 4 3 1.00 Item 11 4 4 4 4 1.00 Item 12 4 4 4 4 1.00 Item 13 4 4 4 4 1.00 Item 14 4 4 4 4 1.00 Item 15 4 4 4 4 1.00 Item 16 4 4 4 4 1.00 Item 17 4 4 4 4 1.00 Item 18 4 4 4 2 0.75 Item 19 4 4 4 4 1.00 Item 20 4 4 4 4 1.00 Item 21 4 4 4 4 1.00 Item 22 4 4 4 4 1.00 Item 23 4 4 4 4 1.00 Item 24 4 4 4 4 1.00 Item 25 4 4 4 4 1.00 Item 26 4 4 4 4 1.00 Item 27 4 4 4 4 1.00 Item 28 4 4 4 4 1.00 Item 29 4 4 3 3 1.00 Item 30 4 4 3 3 1.00 Item 31 4 4 4 3 1.00 *S-CVI :1.00 Reliability The Cohen's Kappa coefficient of agreement, applied to determine the extent of consistency in opinions regarding the suitability of scale items, ranges from − 1 to + 1. A negative Kappa value indicates that the level of agreement obtained following expert evaluation is lower than the value expected by chance [ 44 ]. The Kappa agreement coefficient was found to be 0.85, corresponding to a 'very good level of agreement' [ 45 ]. The Kuder-Richardson 20 (KR-20) coefficient was calculated to determine the overall internal consistency of the scale. The total KR-20 value was 0.81, indicating that the scale is highly reliable. No significant decrease was observed in the KR-20 coefficient when items were removed individually, suggesting that the items are compatible with the scale. The KR-20 and item-total correlation results are presented in Table 3 . [Table 3 will be placed here] Table 3 Findings of Item-Total Correlation Analysis Number of Items Variance if Item Deleted Item–Total Correlation Cronbach’s Alpha if Item Deleted 1 24.946 .404 .805 2 26.686 .208 .812 3 24.153 .610 .796 4 24.679 .508 .801 5 24.660 .541 .800 6 24.520 .571 .794 7 24.797 .499 .801 8 24.676 .466 .802 9 24.867 .444 .803 10 26.570 .119 .815 11 24.488 .500 .801 12 26.700 .071 .818 13 27.417 − .089 .820 14 27.513 − .162 .818 15 26.362 .164 .814 16 26.087 .238 .811 17 25.827 .262 .811 18 26.130 .168 .815 19 25.098 .444 .804 20 25.637 .310 .809 21 26.853 .048 .818 22 25.346 .389 .806 23 25.617 .289 .810 24 24.600 .493 .801 25 25.331 .325 .808 26 25.605 .303 .809 27 26.220 .146 .816 28 25.804 .279 .810 29 25.883 .267 .810 30 24.856 .461 .803 According to the item analysis results of the scale, item-total correlation values ranged from 0.21 to 0.68. Eleven items with correlations below 0.20 were excluded from the scale. The remaining 19 items represent each of the five sub-dimensions included in the scale (identity safety, transport safety, physical safety, treatment/nutritional safety). The item analysis results are summarized in Table 4 . [Table 4 will be placed here] Table 4 Final Analysis Findings of Item-Total Score Correlations Item of the scale Yes No n % n % İnfant have an identification bracelet/ıd? 152 50.3 150 49.7 Was a parent present? 16 5.3 286 94.7 Is the date/time of birth known? 102 33.8 200 66.2 Is the birth weight known? 92 30.5 210 69.5 Are vaccination records available? 79 26.2 223 73.8 Are there records of pku screening? 83 27.5 219 72.5 Is the blood type known? 172 57.0 130 43.0 Are the physical examination findings normal? 107 35.4 195 64.6 Is there any extremity deformity? 242 80.1 60 19.9 Was the infant exposed to noise 154 51.0 148 49.0 Are there any findings suggestive of physical trauma? 222 73.5 80 26.5 Was the infant wearing clothing/covered? 264 87.4 38 12.6 Is the source/place the infant came from known? 290 96.0 12 4.0 Was healthcare personnel present? 238 78.8 64 21.2 Is the infant’s location during the disaster known? 242 80.1 60 19.9 Was the infant positioned appropriately? 219 72.5 83 27.5 Were care supplies appropriate to the infant’s needs used? 123 40.7 179 59.3 Is the duration of disaster exposure known? 226 74.8 76 25.2 Are vital signs within normal ranges? 222 73.5 80 26.5 Was thermoregulation maintained? 222 73.5 80 26.5 Was monitoring provided? 241 79.8 61 20.2 Is medical equipment required? 228 75.5 74 24.5 Is oxygen support required? 202 66.9 100 33.1 Are there any open wounds? 116 38.4 186 61.6 Are there signs of infection? 157 52.0 145 48.0 Is transfusion required? 90 29.8 212 70.2 Does the infant have a catheter? 143 47.4 159 52.6 Is the infant fed with breast milk? 75 24.8 227 75.2 Was formula/enteral nutritional support provided 231 76.5 71 23.5 Is the time of the last feeding known? 96 31.8 206 68.2 Final Version of the Scale As a result of the analyses performed, the Neonatal Safety Assessment Scale in Disasters (NSASD) consists of 19 dichotomous items (Yes = 0, No = 1). The items are grouped under four fundamental safety dimensions: Identity Safety (7 items) Transport Safety (5 items) Physical Safety (4 items) Treatment/Nutritional Safety (3 items) The total score of the scale ranges from 0 to 19. Higher scores indicate a higher level of neonatal safety practices under disaster conditions. The final form of the scale is summarized in Table 5 . [Table 5 will be placed here] Table 5 Final Version of the Scale Dimension Item Identity Safety Did the infant have an identification band/ID? Was the parent present? Is the date/time of birth known? Is the birth weight known? Is vaccination information available? Is PKU screening information available? Is the blood type known? Transport Safety Was the infant positioned appropriately? Was thermoregulation ensured? Were vital signs monitored and recorded? Was the need for transfusion assessed and recorded? Is the post-disaster intervention time known? Physical Safety Are the physical examination findings normal? Is there any extremity deformation? Is there an open wound? Are there signs of infection? Nutritional / Treatment Safety Is there a need for oxygen? Has any catheter been applied to the infant for medical purposes? Has enteral/parenteral nutritional support been provided? Discussion There is a notable lack of a valid and reliable measurement instrument capable of comprehensively assessing neonatal safety in disaster settings. Existing measurement tools frequently focus on limited domains such as prematurity, clinical risk factors, stress levels, or skin integrity; whereas, there is an evident need for an assessment that encompasses multidisciplinary risks under disaster conditions. For instance, although the Neonatal Adverse Event Severity Scale (NAESS), developed by the International Neonatal Consortium (INC), was designed to assess the severity of adverse events encountered in neonatal clinical settings, the inter-rater agreement of the scale remained inadequate, with a Cohen’s Kappa coefficient found to be 0.23 [ 46 ]. This finding indicates that the reliability of the scale is limited and that user training is a critical requirement [ 47 ]. On the other hand, the Neonatal Skin Risk Assessment Scale (NSRAS), developed by Huffines and Logsdon for skin integrity risk in preterm infants, and the Neonatal Infant Stressor Scale (NISS), a tool evaluating stress factors in premature infants by Nist et al., do not address the general safety requirements in disaster conditions [ 48 , 49 ]. In this context, the Neonatal Safety Assessment Scale in Disasters, developed within the scope of this study, aims to address this gap in the literature; it offers the opportunity to systematically evaluate fundamental safety domains such as identity, transport, physical examination, treatment, and nutrition regarding the newborn in disaster environments. In this respect, the study presents an original and innovative contribution in terms of both clinical practices and disaster management planning. Discussion of the Validity and Reliability data of the Scale The validity and reliability analyses of the Neonatal Safety Assessment Scale in Disasters , developed in this study, were comprehensively evaluated. Accordingly, face validity was evaluated in the first phase. Face validity provides a subjective assessment regarding the extent to which a measurement instrument represents the targeted construct; it plays a significant role, particularly in the initial steps of scale development studies. Face validity offers a crucial indicator regarding whether the measurement instrument represents the target construct in terms of its appearance during the early stages of the scale development process. Therefore, the examination of face validity through expert evaluation is a standard practice recommended in the literatüre [ 27 , 42 ]. Following the face validity assessment, content validity was evaluated using the Content Validity Index (CVI) method recommended by Polit and Beck [ 29 ]. Within this scope, each item was rated by four subject matter experts using a 4-point scale, and the suitability of each item in terms of content was scored. The obtained CVI value was determined to be 1.00; this value is substantially above the minimum acceptable threshold of 0.80 recommended by Polit and Beck [ 29 ]. A CVI of 0.90 or higher indicates a high level of consensus regarding content and demonstrates that the scale items possess conceptual integrity [ 50 , 51 ]. During the pilot testing process, language that is current, applicable, and easily understood by nurses was prioritized. Reverse-coded items were intentionally included in the scale to control for respondent bias [ 27 ] These results indicate that the content validity of the developed 'Neonatal Safety Assessment Scale in Disasters' is robust. Furthermore, the high CVI value obtained during this process provides strong evidence regarding both the capacity of the scale items to represent neonatal safety in disaster settings and their adequacy in covering the target construct. Similarly, high CVI values have been reported as indicators of strong content validity, particularly in scales measuring patient safety, clinical skill assessment, and emergency processes [ 42 ]. In the context of reliability analyses, reliability is generally categorized into four groups: internal consistency reliability, test-retest reliability, parallel forms reliability, and inter-rater reliability [ 52 ]. In the reliability analyses of the Neonatal Safety Assessment Scale in Disasters developed in this study, internal consistency reliability (Kuder-Richardson 20 coefficient and item-total correlation) and independent inter-rater agreement techniques were utilized. The Kuder-Richardson 20 (KR-20) coefficient was utilized to evaluate internal consistency due to the dichotomous nature of the items. KR-20 is the recommended reliability coefficient for measuring inter-item consistency in scales with a unidimensional structure and a binary (two-option) response format. In particular, it is acknowledged that Cronbach's Alpha may be limited when applied to dichotomous items due to its assumption of continuous variables. The KR-20 value of 0.81 obtained in this study is consistent with the literature, where values of ≥ 0.80 are accepted as indicating a 'good level of reliability' [ 28 , 53 , 54 ].This finding indicates that the scale items are internally consistent and present a reliable structure for assessing neonatal safety under disaster conditions. Cohen’s Kappa coefficient was calculated regarding the inter-observer agreement of the scale. This coefficient measures the true level of agreement between two raters beyond chance agreement, and values between 0.81 and 1.00 represent a level of 'perfect agreement' [ 45 ]. In this study, the Cohen's Kappa value was determined to be 0.85, demonstrating that a high level of observer consistency was achieved in the interpretation of the scale items. It is known that in scales with a dichotomous structure, traditional factor analyses offer limited accuracy due to the distribution of data into binary categories. Since the assumptions of factor analysis are based on continuous and normally distributed data, its application to dichotomous data may lead to misleading results. Therefore, in this study, construct validity was supported indirectly through item analyses and expert opinions [ 28 , 55 ]. As a result of the item-total score correlation analyses, items with negative correlations and values below 0.20 were excluded from the scale, thereby enhancing the discriminatory power of the scale. The scale was reduced from its initial 31-item form to 19 items, resulting in a structure consisting of four sub-dimensions. This approach is consistent with item reduction strategies commonly applied in scale development processes and contributes to the construct validity of the scale [ 28 ]. It was observed that while the scale initially consisted of 31 items, 1 item was removed following content validity analysis and 11 items were removed following item-total correlation analysis, establishing a four-dimensional structure with the remaining 19 items. These dimensions are: Identity Safety, Transport Safety, Physical Safety, Treatment/Nutritional Safety. The results of the present study indicate that the instrument developed for evaluating neonatal safety in disaster settings is a valid and reliable tool. Conclusion In this study, it was concluded that the 'Neonatal Safety Assessment Scale in Disasters', developed to evaluate the safety of newborns in disasters, is a valid and reliable instrument that can be effectively utilized by pediatric nurses providing neonatal care. Regarding the safety score obtained by summing the points from the scale items, higher scores indicate safety, whereas lower scores indicate risk. The scale is composed of four sub-dimensions covering neonatal risks: Identity Safety, Transport Safety, Physical Safety, and Treatment/Nutritional Safety. Limitation and Strenghs A limitation of this study is that it was conducted with nurses following the 2023 earthquake in Turkey; therefore, there may be limitations in generalizing the findings to other types of disasters. Although the dichotomous response format of the scale contributes to ease of use and rapid decision-making, it presents certain constraints from an analytical perspective. The dichotomous data structure may lead to consequences such as failure to meet assumptions in parametric analyses, limited applicability of factor analyses, and reduced statistical power due to low item variance. Since Likert-type scales in the literature allow for broader comparisons, the limited number of studies available for comparison with similar measurement instruments represents one of the challenges of this study. The data obtained in the qualitative phase of the research, conducted using a sequential mixed methods design, align with the risks defined in the literature while also reflecting current field experiences. The scale items were generated based on a literature review, expert opinions, and field observations following the major earthquake that occurred in Turkey on February 6, 2023. In this respect, the study presents an original instrument shaped not only by theoretical frameworks but also by evidence based on real disaster experiences. Its dichotomous structure provides ease of use for practitioners. By covering four fundamental safety domains (identity, physical, transport, and treatment/nutritional safety), the scale allows for the systematic, multidimensional assessment of newborns in disaster situations. The scale makes a significant contribution regarding prioritization, standardization of care, and early risk identification in post-disaster healthcare services. Declarations Competing Interests The author declares that there are no competing interests. Funding This study was financially supported by the Mustela Foundation. Author Contribution This research was conducted as a thesis within the scope of the Pediatric Nursing master's program at Hatay Mustafa Kemal University. All stages of the research were reviewed and conducted jointly by the advisor author.Assoc. Prof. Emel Demir designed the study, constructed the dataset, and drafted parts of the initial manuscript.Res. Assist. Rana Rehap Sert collected the data and performed the statistical analyses.All authors reviewed and approved the final version of the manuscript and take full responsibility for its content. Acknowledgement The authors would like to thank all nurses who participated in the present study.Funding:This study was financially supported by the Mustela Foundation Data Availability The datasets generated and/or analyzed during the current study are not publicly available due to ethical considerations and participant confidentiality but are available from the corresponding author on reasonable request. References Conk Z, Basbakkal Z, Bal Yilmaz H, Bolisik B, editors. Pediatric nursing. 3rd ed. Akademisyen Publishing House; 2021. Johnson J, Akinboyo IC, Schaffzin JK. Infection prevention in the neonatal intensive care unit. Clin Perinatol. 2021;48(2):413–29. 10.1016/j.clp.2021.03.011 . Hutton A, Veenema TG, Gebbie K. Review of the International Council of Nurses (ICN) framework of disaster nursing competencies. Prehosp Disaster Med. 2016;31(6):680–3. 10.1017/S1049023X1600100X . Ergönül O, Keske S, Ksinzik A, Güldan M, Özbek L, et al. 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Iwata O, Kawase A, Iwai M, Wada K. Evacuation of a tertiary neonatal center: lessons from the 2016 Kumamoto earthquakes. Neonatology. 2017;112(1):92–6. 10.1159/000466681 . Calgaro S, Borellini M, Seni AHA, Tirzi MC, Gimo AMD, et al. Neonatal intensive care unit evacuation and care during a natural disaster: experience from Cyclone Idai in Beira, Mozambique. Front Pediatr. 2020;8:584281. 10.3389/fped.2020.584281 . Ratnayake Mudiyanselage S, Davis D, Kurz E, Atchan M. Infant and young child feeding during natural disasters: A systematic integrative literature review. Women Birth. 2022;35(6):524–31. 10.1016/j.wombi.2021.12.006 . Hargest Slade AC, Gribble KD. Shaken but not broken: supporting breastfeeding women after the 2011 Christchurch New Zealand earthquake. Breastfeed Rev. 2015;23(3):7–13. Hwang CH, Iellamo A, Ververs M. Barriers and challenges of infant feeding in disasters in middle- and high-income countries. Int Breastfeed J. 2021. Available from: https://internationalbreastfeedingjournal.biomedcentral.com DeYoung SE, Chase J, Branco MP, Park B. The effect of mass evacuation on infant feeding: the case of the 2016 Fort McMurray wildfire. Matern Child Health J. 2018;22(12):1826–33. 10.1007/s10995-018-2585-z . Santaballa LM. Challenges of infant and child feeding in emergencies: the Puerto Rico experience. Breastfeed Med. 2018;13(8):539–40. 10.1089/bfm.2018.0128 . Barfield WD, Krug SE, Committee on Fetus and Newborn; Disaster Preparedness Advisory Council. Disaster preparedness in neonatal intensive care units. Pediatrics. 2017;139(5):e20170507. 10.1542/peds.2017-0507 . Boateng GO, Neilands TB, Frongillo EA, Melgar-Quiñonez HR, Young SL. Best practices for developing and validating scales for health, social, and behavioral research: a primer. Front Public Health. 2018;6:149. 10.3389/fpubh.2018.00149 . DeVellis RF. Scale development: theory and applications. 4th ed. Sage; 2016. Polit DF, Beck CT. The content validity index: are you sure you know what’s being reported? Res Nurs Health. 2006;29(5):489–97. 10.1002/nur.20147 . World Health Organization. WHO recommendations on newborn health: guidelines approved by the WHO Guidelines Review Committee. 2017. Available from: https://www.who.int UNICEF. Every newborn: 2020 progress report. Available from: https://www.healthynewbornnetwork.org/hnn-content/uploads/ENAP-country-submissions.pdf Zielinski RE, Ackerman RK, Bohanon HM. Environmental risk factors for neonates in disaster settings: a systematic review. Glob Pediatr Health. 2019;6:1–12. 10.1177/2333794X19856265 . Phillips P, Niedergesaess Y, Güçler R, Brandt R. Disaster preparedness: emergency planning in the NICU. Neonatal Netw. 2012;31(1):5–13. 10.1891/0730-0832.31.1.5 . Engle WA, Tomashek KM. Late-preterm infants: definitions, risks, and management. Pediatrics. 2021;147(5):e2021050075. 10.1542/peds.2021-05075 . World Health Organization (WHO). Newborn health in humanitarian settings: 2022 field guide. Available from: https://childmortality.org/data/The%20Republic%20of%20T%C3%BCrkiye Abdi A, Vaisi-Raygani A, Najafi B. Reflecting on the challenges encountered by nurses at the great Kermanshah earthquake: a qualitative study. BMC Nurs. 2021;20:90. 10.1186/s12912-021-00642-0 . Iwata O, Kawase A, Iwai M, Wada K. Evacuation of a tertiary neonatal center: lessons from the 2016 Kumamoto earthquakes. Neonatology. 2017;112(1):92–6. 10.1159/000466681 . Hertel AS, Breindahl M, Christensen SP, Kjaergaard S, Nielsen VH, et al. Neonatal transport plans in Denmark. Ugeskr Laeger. 2020;182(14A):V12190705. Zell L, Blake C, Brittingham D, Brown AM, Soghier L. Simulation prepares an interprofessional team to evacuate a 60-bed level 4 neonatal intensive care unit. J Perinat Neonatal Nurs. 2019;33(3):253–9. 10.1097/JPN.0000000000000430 . Timm N, Farra S, Miller TE, Gneuhs M, Brady W, et al. Efficacy of positive pressure ventilation during neonatal unit evacuation. J Neonatal Nurs. 2020;23(5):234–7. 10.1016/j.jnn.2020.08.004 . Koç E, Çetinkaya M, Baş A, Poyrazoğlu H, Bakkaloğlu S, Kara A, Çiftçi E. Neonatal guide for infants born, referred, or presenting in earthquake-affected regions. Turkish Neonatology Society; 2023. Almanasreh E, Moles R, Chen TF. Evaluation of methods used for estimating content validity. Res Social Adm Pharm. 2019;15(2):214–21. 10.1016/j.sapharm.2018.03.066 . Çakmur H. Measurement-reliability-validity in research. TAF Prev Med Bull. 2012;11(3):339–44. 10.5455/pmb.1-1322486024 . Wongpakaran N, Wongpakaran T, Wedding D, et al. A comparison of Cohen’s kappa and Gwet’s AC1 when calculating inter-rater reliability coefficients: a study conducted with personality disorder samples. BMC Med Res Methodol. 2013;13:61. 10.1186/1471-2288-13-61 . McHugh ML. Interrater reliability: the kappa statistic. Biochemia Med. 2012;22(3):276–82. 10.11613/BM.2012.031 . Salaets T, Turner MA, Short M, Ward RM, Hokuto I, Ariagno RL, Klein A, et al. Development of a neonatal adverse event severity scale through a Delphi consensus approach. Arch Dis Child. 2019;104(12):1167–73. 10.1136/archdischild-2019-317399 . Turner MA, Davis JM, McCune S, Bax R, Portman RJ, Hudson LD. The International Neonatal Consortium: collaborating to advance regulatory science for neonates. Pediatr Res. 2016;80(4):462–4. 10.1038/pr.2016.119 . Huffines B, Logsdon MC. The Neonatal Skin Risk Assessment Scale for predicting skin breakdown in neonates. Issues Compr Pediatr Nurs. 1997;20(2):103–14. 10.3109/01460869709026881 . Nist M, Johnson L, Patel R. Neonatal stress embedding (NSE) model for preterm infants in NICU: linking environmental stressors to neurodevelopment. J Neonatal Nurs Neurodev. 2024;12(1):15–24. 10.1016/j.jnn.2023.11.005 . Politi MC, Kuzemchak MD, Liu J. Effect of health insurance decision tools on decision making outcomes. BMC Health Serv Res. 2016;16:55. 10.1186/s12913-016-1314-9 . Yusoff MSB. ABC of content validation and content validity index calculation. Educ Med J. 2019;11(2):49–54. 10.21315/eimj2019.11.2.6 . Finch WH, French BF. Latent variable modeling with categorical indicators in psychological research: a review and illustration. Psychol Methods. 2015;20(4):450–70. 10.1037/met0000027 . Tavakol M, Dennick R. Making sense of Cronbach’s alpha. Int J Med Educ. 2011;2:53–5. 10.5116/ijme.4dfb.8dfd . Taber KS. The use of Cronbach’s alpha when developing and reporting research instruments. Res Sci Educ. 2018;48:1273–96. 10.1007/s11165-016-9602-4 . Holgado-Tello FP, Chacón-Moscoso S, Barbero-García I, Vila-Abad E. Polychoric versus Pearson correlations in exploratory and confirmatory factor analysis of ordinal variables. Qual Quant. 2010;44(1):153–66. 10.1007/s11135-008-9180-0 . Additional Declarations No competing interests reported. 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Disasters are among the situations that pose the greatest threat to the neonatal safety chain. Situations such as incubator failure, malfunction of oxygen systems, loss of records, or identity confusion may occur in disaster settings [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Furthermore, components of the healthcare system, such as physical infrastructure, human resources, record-keeping systems, and communication networks, may be severely compromised during disasters [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This situation may cause vulnerable and technology-dependent patients, such as infants in the Neonatal Intensive Care Unit (NICU), to be disproportionately affected by disasters [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The priority of emergency response teams following a disaster is typically adult trauma, a situation that may lead to the overlooking of neonatal monitoring and intervention plans. In this context, pre-established, systematic, and controllable monitoring tools are required to ensure neonatal safety in disasters [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. There is limited evidence regarding the skills required and the bedside equipment that must be available for disaster training and evacuation programs in the care of critically ill infants [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].The roles of neonatal nurses in this process extend beyond clinical care to include risk management, coordination, and ethical responsibilities [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] .\u003c/p\u003e \u003cp\u003eLack of identification, failure to ensure transport safety, delays in physical examinations, inability to maintain thermal stability, and disruption of nutrition and treatment continuity are the fundamental issues frequently emphasized in the literature regarding neonatal care under disaster conditions [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] .Fundamental challenges encountered in neonatal care under disaster conditions have been categorized under the headings of deficiencies in equipment, funding, logistical support, and effective communication; and it has been reported that these factors are determinants of neonatal safety [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] .Reports by the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC), have identified power outages, failure of medical devices, challenges during transport, and disruptions in access to basic health services as primary hazards for newborns and Neonatal Intensive Care Unit (NICU) patients in disaster settings [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. It has been demonstrated that the weakening of healthcare infrastructure by disasters leads to issues such as a shortage of vital equipment\u0026mdash;including oxygen tanks and thermoregulation devices and the interruption of internet and telephone services, which severely complicate neonatal care, particularly in receiving hospitals [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].It has been reported that following Hurricane Katrina, problems such as loss of thermal control, disruptions in ventilation support, and communication deficiencies were experienced within destabilized NICU conditions [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. These findings demonstrate that significant risks exist in meeting the basic care needs of newborns under disaster conditions and, in this context, indicate that safety must be evaluated through a multidimensional approach.\u003c/p\u003e \u003cp\u003eIn terms of nutrition, disasters give rise to numerous issues that threaten the adequate and safe feeding of newborns. Mudiyanselega et al, emphasized that during disaster periods, mothers become overly reliant on infant formula due to factors such as diminished breastfeeding self-efficacy, lack of knowledge, and inability to access resources for safe food preparation. In a similar vein, damage to healthcare infrastructure following the 2014 Malaysia floods and the Christchurch earthquake in New Zealand complicated the provision of infant feeding support [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Mothers who experienced the Fort McMurray wildfire in Canada reported being unable to maintain their infants' routine feeding schedules during the evacuation process due to a lack of breast pumps [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In Puerto Rico, power outages occurring in the aftermath of the disaster adversely affected families' breast milk refrigeration practices [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eChallenges regarding transport and care processes during Neonatal Intensive Care Unit (NICU) evacuations have been reported. During the evacuation of newborns at New York University Langone Hospital during Hurricane Sandy in the USA, safe evacuation could not be ensured due to factors such as the lack of an interdisciplinary command structure, communication breakdowns, a shortage of backup equipment, and ambiguity regarding staff role definitions [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\"It emphasizes that safety was severely compromised due to the failure to clarify personnel roles at both central and field levels and the lack of planning for alternative communication channels [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. An evaluation conducted at Beira Central Hospital in Mozambique revealed that severe difficulties were encountered in the evacuation of the NICU as a result of damage to the hospital infrastructure following the cyclone [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe development of measurement instruments is essential for the scientific evaluation of safety within the healthcare system. The scale development process makes significant contributions to both clinical practice and policy development by quantifying observed behaviors or practices [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Measurement instruments to be used in disaster conditions must be rapidly applicable in the field, easily comprehensible, and practical to evaluate. Therefore, the dichotomous (Yes/No) response format is recommended as the most suitable measurement approach, particularly in crises and extraordinary situations [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].Since healthcare professionals work under intense stress, time pressure, and resource constraints during disasters, completing multi-point Likert-type scales is often not achievable [\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7 CR8 CR9\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].Dichotomous scales shorten the decision-making time of respondents, increase response consistency, and reduce cognitive load in disaster settings [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Scale development studies in nursing are one of the fundamental methods for the standardization of professional care quality [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. World Health Organization (WHO) and United Nations International Children\u0026rsquo;s Emergency Fund (UNICEF) recommend the development of systematic assessment tools for the continuity of maternal and neonatal care during disaster periods [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. A review of the international literature on neonatal safety confirms that although there are numerous scales regarding patient safety and neonatal care quality, the vast majority of these scales are oriented towards routine care conditions [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. There is no existing scale focused on newborns that assesses risks specific to disaster environments.\u003c/p\u003e \u003cp\u003eThe neonatal period, encompassing the first 28 days of life, is characterized by vulnerability in fundamental vital functions such as thermoregulation, fluid balance, respiration, and resistance to infection. Therefore, neonatal safety must be central to all care processes from the moment of birth [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Can a valid and reliable measurement tool be developed to rapidly assess neonatal safety in disasters? In this context, following the 2023 Turkey earthquake, the aim was to develop the Neonatal Safety Assessment Scale in Disasters (NSASD). With this scale, it is intended to evaluate neonatal safety in disaster conditions from a holistic perspective, covering identity, transport, physical, treatment, and nutritional safety.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis study was conducted using a sequential mixed methods approach. This design enables the use of both qualitative and quantitative data in a complementary manner during the development process of a new measurement instrument. In the first phase of the research, individual in-depth interviews were conducted with nurses and doctors by employing qualitative methods. In the quantitative phase, validity and reliability analyses of the developed scale were performed.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants and Sampling\u003c/h3\u003e\n\u003cp\u003eThe qualitative phase of the research was conducted with nurses and physicians providing neonatal care in disaster situations. The number of participants was determined by data saturation, and interviews were conducted with 10 individuals.\u003c/p\u003e \u003cp\u003eIn the quantitative phase, the study population consisted of NICU nurses providing treatment and care to newborns affected by the Kahramanmaraş-centered earthquakes that occurred in Turkey on February 6, 2023. The sample size was determined based on the criterion of 5 to 10 times the number of items, and the study was conducted with 302 neonatal nurses.\u003c/p\u003e\n\u003ch3\u003eInclusion\u003c/h3\u003e\n\u003cp\u003eWorking during and/or after the February 6 earthquake, working as a nurse in the Neonatal Intensive Care Unit, having provided care to at least one newborn affected by the earthquake, volunteering to participate in the study.\u003c/p\u003e\n\u003ch3\u003eExclusion\u003c/h3\u003e\n\u003cp\u003eNot working during the earthquake period and not having provided care to at least one newborn affected by the earthquake, working outside the Neonatal Intensive Care Unit.\u003c/p\u003e\n\u003ch3\u003eData Collection Tools\u003c/h3\u003e\n\u003cp\u003eData were collected using two forms: the Participant Information Form and the Neonatal Safety Assessment Scale in Disasters Draft Form.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eParticipant Information Form\u003c/h2\u003e \u003cp\u003eThe questionnaire form, prepared by the researcher based on clinical experience and observations, consists of a total of 12 questions: 4 questions covering nurses' socio-demographic characteristics (age, gender, educational status), 4 questions regarding professional characteristics (institution of employment, duration of professional experience), 2 questions related to earthquake status, and 2 questions regarding training received.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDraft Version of theScale\u003c/h3\u003e\n\u003cp\u003eIt was developed based on the statements derived from the qualitative phase. The scale has a 30-item dichotomous structure consisting of 'Yes' (0) and 'No' (1) options. The scale encompasses the sub-dimensions of identity safety, transport safety, physical safety, and treatment and nutritional safety.\u003c/p\u003e\n\u003ch3\u003eTool Development\u003c/h3\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eItem Generation\u003c/h2\u003e \u003cp\u003eA draft consisting of 31 items was generated based on field experiences following February 6, 2023, statements derived from qualitative interviews, and the literature review [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eContent Validity\u003c/h2\u003e \u003cp\u003eFour experts (one professor, two associate professors, and one assistant professor from the Department of Pediatric Nursing) were requested to evaluate the draft scale items via a form sent by email. They were asked to rate the statements in the draft scale as follows: 1 Point: Not suitable (Must be removed from the scale), 2 Points: Somewhat suitable (Item requires major revision), 3 Points: Quite suitable (Suitable but item/statement requires minor revision), and 4 Points: Highly suitable (Can remain as is).\u003c/p\u003e \u003cp\u003eFor the Content Validity Index (CVI) value, the Scale-CVI (S-CVI) was determined based on the average of items rated as 3 or 4 by the experts [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e] .A criterion of 1.00 was established for the scale's CVI. Item 18, which had an Item-CVI (I-CVI) value of 0.75, was removed from the scale. Following the revisions of items suggested by the expert evaluations, the draft scale was finalized with 30 items.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePilot Testing\u003c/h2\u003e \u003cp\u003e\u0026Ccedil;akmur (2012), states that face validity is a criterion determined by obtaining the opinions of the researcher, experts, and non-experts regarding whether a scale measures the construct under investigation [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Accordingly, a pilot study was conducted with 30 individuals using the 30-item draft scale. Necessary semantic and structural changes were made in line with the feedback received.\u003c/p\u003e \u003cp\u003eIn accordance with the inclusion criteria, some of the nurses across Turkey who provided care to newborns affected by the February 6, 2023 earthquake were reached via social media (Instagram and WhatsApp). The created form was sent online to the nurses who were contacted. It took an average of 15\u0026ndash;20 minutes for each nurse to complete the online form. The form was distributed by hand to the remainder of the sample (150 individuals). The process of collecting the hand-delivered forms took approximately 30\u0026ndash;35 minutes. Data were collected using the 'Personal Information Form,' developed by the researcher and containing nurses' sociodemographic information, and the 30-item 'Draft of Neonatal Safety Assessment Scale in Disasters'.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eValidity and reliability analyses\u003c/h2\u003e \u003cp\u003eData were analyzed using the SPSS 25.0 software. In the evaluation of the study data, frequency distributions were presented for categorical variables, and descriptive statistics (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) were presented for numerical variables.\u003c/p\u003e \u003cp\u003eWithin the scope of validity studies, face validity and content validity analyses were applied to the scale. The CVI was calculated using the Polit-Beck method. Values of 0.80 and above were interpreted as acceptable, and values of 0.90 and above were interpreted as excellent.\u003c/p\u003e \u003cp\u003eIn reliability studies, Cohen's Kappa coefficient of agreement was examined to determine the extent of consistency in opinions regarding the suitability of the scale items. The scale items were administered by two independent observers. The reliability of the scale was examined using the Kuder-Richardson 20 (KR-20) internal consistency coefficient. The scale and sub-dimension scores of the participating nurses were obtained by calculating the mean of the relevant items. Item-total correlation coefficients were calculated for each item; items with values below 0.20 were removed from the scale. Consequently, 11 items were excluded, and the scale reached its final form consisting of 19 items.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eEthical Considerations\u003c/h2\u003e \u003cp\u003e Approval for the research was obtained from the Hatay Mustafa Kemal University Social and Human Sciences Research Ethics Committee (Decision Date: 01.08.2023, Decision No: 01). Verbal and written informed consent was obtained from the neonatal nurses participating in the study. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eDescriptive characteristics of theparticipants\u003c/h2\u003e \u003cp\u003eThe mean age of the 302 neonatal nurses participating in the study was 31.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7 years. Of the participants, 88.7% were female, and their mean duration of clinical experience was 7.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2 years. While 59.6% of the nurses worked in university hospitals, the remainder were employed in public and private healthcare institutions. Additionally, 72.8% of the participants stated that they had served in a disaster situation at least once previously.\u003c/p\u003e \u003cp\u003eThese findings indicate that the participating nurses are experienced in neonatal care and possess awareness regarding disaster conditions (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e will be placed here]\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFindings Regarding the Socio-Demographic and Work Life of Nurses\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDemographic and Professional Characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;25 years\u003c/p\u003e \u003cp\u003e26\u0026ndash;35 years\u003c/p\u003e \u003cp\u003e36\u0026ndash;45 years\u003c/p\u003e \u003cp\u003e46 years and over\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003cp\u003e172\u003c/p\u003e \u003cp\u003e58\u003c/p\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.2\u003c/p\u003e \u003cp\u003e57.0\u003c/p\u003e \u003cp\u003e19.2\u003c/p\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFamela\u003c/p\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e289\u003c/p\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95.6\u003c/p\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProvince of employment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdana\u003c/p\u003e \u003cp\u003eMersin\u003c/p\u003e \u003cp\u003eKahramanmaraş\u003c/p\u003e \u003cp\u003eİstanbul\u003c/p\u003e \u003cp\u003eAnkara\u003c/p\u003e \u003cp\u003eGaziantep\u003c/p\u003e \u003cp\u003eAntalya\u003c/p\u003e \u003cp\u003eŞanlıurfa\u003c/p\u003e \u003cp\u003eDiyarbakır\u003c/p\u003e \u003cp\u003e\u0026Ccedil;orum\u003c/p\u003e \u003cp\u003eDenizli\u003c/p\u003e \u003cp\u003eSakarya\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e231\u003c/p\u003e \u003cp\u003e28\u003c/p\u003e \u003cp\u003e13\u003c/p\u003e \u003cp\u003e13\u003c/p\u003e \u003cp\u003e6\u003c/p\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.5\u003c/p\u003e \u003cp\u003e9.2\u003c/p\u003e \u003cp\u003e4.3\u003c/p\u003e \u003cp\u003e4.3\u003c/p\u003e \u003cp\u003e2.0\u003c/p\u003e \u003cp\u003e1.3\u003c/p\u003e \u003cp\u003e0.7\u003c/p\u003e \u003cp\u003e0.3\u003c/p\u003e \u003cp\u003e0.3\u003c/p\u003e \u003cp\u003e0.3\u003c/p\u003e \u003cp\u003e0.3\u003c/p\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e \u003cp\u003eMaster\u0026rsquo;s degree\u003c/p\u003e \u003cp\u003eDoctorate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003cp\u003e221\u003c/p\u003e \u003cp\u003e38\u003c/p\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.6\u003c/p\u003e \u003cp\u003e73.2\u003c/p\u003e \u003cp\u003e12.6\u003c/p\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInstitution of employment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate Hospital\u003c/p\u003e \u003cp\u003eDistrict State Hospital\u003c/p\u003e \u003cp\u003eCity Hospital\u003c/p\u003e \u003cp\u003eUniversity Hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003cp\u003e70\u003c/p\u003e \u003cp\u003e114\u003c/p\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.9\u003c/p\u003e \u003cp\u003e23.2\u003c/p\u003e \u003cp\u003e37.7\u003c/p\u003e \u003cp\u003e25.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears of Professional experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;3 years\u003c/p\u003e \u003cp\u003e4\u0026ndash;9 years\u003c/p\u003e \u003cp\u003e10\u0026ndash;15 years\u003c/p\u003e \u003cp\u003e16 years and over\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003cp\u003e99\u003c/p\u003e \u003cp\u003e97\u003c/p\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.2\u003c/p\u003e \u003cp\u003e32.8\u003c/p\u003e \u003cp\u003e32.1\u003c/p\u003e \u003cp\u003e12.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears of experience in the Neonatal Intensive Care Unit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;3 years\u003c/p\u003e \u003cp\u003e4\u0026ndash;9 years\u003c/p\u003e \u003cp\u003e10\u0026ndash;15 years\u003c/p\u003e \u003cp\u003e16 years and over\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87\u003c/p\u003e \u003cp\u003e123\u003c/p\u003e \u003cp\u003e72\u003c/p\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.8\u003c/p\u003e \u003cp\u003e40.7\u003c/p\u003e \u003cp\u003e23.8\u003c/p\u003e \u003cp\u003e6.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel of NICU currently working in\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLevel 1\u003c/p\u003e \u003cp\u003eLevel 2\u003c/p\u003e \u003cp\u003eLevel 3\u003c/p\u003e \u003cp\u003eLevel 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e60\u003c/p\u003e \u003cp\u003e88\u003c/p\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003cp\u003e19.9\u003c/p\u003e \u003cp\u003e29.1\u003c/p\u003e \u003cp\u003e50.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhere were you at the time of the earthquake?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003cp\u003eHospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e219\u003c/p\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72.5\u003c/p\u003e \u003cp\u003e27.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow long after the earthquake did you start working?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;4 hours\u003c/p\u003e \u003cp\u003e4\u0026ndash;24 hours\u003c/p\u003e \u003cp\u003e24\u0026ndash;72 hours\u003c/p\u003e \u003cp\u003e72 hours and over\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003cp\u003e164\u003c/p\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.2\u003c/p\u003e \u003cp\u003e54.3\u003c/p\u003e \u003cp\u003e1.5\u003c/p\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eValidity\u003c/h2\u003e \u003cp\u003eThe draft scale was submitted to four experts for evaluation. Each item was rated using the four-point scale recommended by Polit and Beck (2006) (1\u0026thinsp;=\u0026thinsp;not suitable, 4\u0026thinsp;=\u0026thinsp;highly suitable). The Item-Content Validity Index (I-CVI) values, calculated on an item basis, ranged from 0.90 to 1.00, and the Scale-Content Validity Index/Average (S-CVI/Ave) value for all items was found to be 1.00. This result indicates an excellent level of consensus among the experts (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e will be placed here]\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of Item-Based Content Validity Agreement Scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of Item\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExpert 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExpert 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExpert 3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eExpert 4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI-CVI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e*S-CVI\u003c/b\u003e:1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eReliability\u003c/h2\u003e \u003cp\u003eThe Cohen's Kappa coefficient of agreement, applied to determine the extent of consistency in opinions regarding the suitability of scale items, ranges from \u0026minus;\u0026thinsp;1 to +\u0026thinsp;1. A negative Kappa value indicates that the level of agreement obtained following expert evaluation is lower than the value expected by chance [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. The Kappa agreement coefficient was found to be 0.85, corresponding to a 'very good level of agreement' [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Kuder-Richardson 20 (KR-20) coefficient was calculated to determine the overall internal consistency of the scale. The total KR-20 value was 0.81, indicating that the scale is highly reliable. No significant decrease was observed in the KR-20 coefficient when items were removed individually, suggesting that the items are compatible with the scale.\u003c/p\u003e \u003cp\u003eThe KR-20 and item-total correlation results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e will be placed here]\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFindings of Item-Total Correlation Analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of Items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVariance if Item Deleted\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eItem\u0026ndash;Total Correlation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCronbach\u0026rsquo;s Alpha if Item Deleted\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24.946\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.404\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.805\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26.686\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.812\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24.153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.610\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.796\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24.679\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.508\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.801\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24.660\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.541\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.800\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24.520\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.571\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.794\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24.797\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.499\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.801\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24.676\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.466\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.802\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24.867\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.444\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.803\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26.570\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.815\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24.488\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.801\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26.700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.818\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27.417\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.820\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27.513\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.818\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26.362\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.814\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.811\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25.827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.262\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.811\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26.130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.815\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.444\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.804\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25.637\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.310\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.809\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26.853\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.818\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25.346\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.389\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.806\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25.617\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.289\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.810\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24.600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.493\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.801\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25.331\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.808\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25.605\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.809\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26.220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.816\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25.804\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.279\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.810\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25.883\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.267\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.810\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24.856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.461\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.803\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAccording to the item analysis results of the scale, item-total correlation values ranged from 0.21 to 0.68. Eleven items with correlations below 0.20 were excluded from the scale. The remaining 19 items represent each of the five sub-dimensions included in the scale (identity safety, transport safety, physical safety, treatment/nutritional safety). The item analysis results are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e will be placed here]\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFinal Analysis Findings of Item-Total Score Correlations\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem of the scale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eİnfant have an identification bracelet/ıd?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e49.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWas a parent present?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e286\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e94.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIs the date/time of birth known?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e66.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIs the birth weight known?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e210\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e69.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAre vaccination records available?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e73.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAre there records of pku screening?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e72.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIs the blood type known?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e43.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAre the physical examination findings normal?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e64.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIs there any extremity deformity?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWas the infant exposed to noise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e49.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAre there any findings suggestive of physical trauma?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e26.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWas the infant wearing clothing/covered?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIs the source/place the infant came from known?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e290\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWas healthcare personnel present?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e21.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIs the infant\u0026rsquo;s location during the disaster known?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWas the infant positioned appropriately?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e27.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWere care supplies appropriate to the infant\u0026rsquo;s needs used?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e59.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIs the duration of disaster exposure known?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e25.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAre vital signs within normal ranges?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e26.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWas thermoregulation maintained?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e26.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWas monitoring provided?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e241\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIs medical equipment required?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e24.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIs oxygen support required?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e33.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAre there any open wounds?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e61.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAre there signs of infection?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e48.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIs transfusion required?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e70.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDoes the infant have a catheter?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e52.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIs the infant fed with breast milk?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e75.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWas formula/enteral nutritional support provided\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e23.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIs the time of the last feeding known?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e68.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eFinal Version of the Scale\u003c/h2\u003e \u003cp\u003eAs a result of the analyses performed, the Neonatal Safety Assessment Scale in Disasters (NSASD) consists of 19 dichotomous items (Yes\u0026thinsp;=\u0026thinsp;0, No\u0026thinsp;=\u0026thinsp;1). The items are grouped under four fundamental safety dimensions:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIdentity Safety (7 items)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTransport Safety (5 items)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePhysical Safety (4 items)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTreatment/Nutritional Safety (3 items)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThe total score of the scale ranges from 0 to 19. Higher scores indicate a higher level of neonatal safety practices under disaster conditions. The final form of the scale is summarized in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e will be placed here]\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFinal Version of the Scale\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDimension\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e\u003cb\u003eIdentity Safety\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDid the infant have an identification band/ID?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWas the parent present?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIs the date/time of birth known?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIs the birth weight known?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIs vaccination information available?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIs PKU screening information available?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIs the blood type known?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eTransport Safety\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWas the infant positioned appropriately?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWas thermoregulation ensured?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWere vital signs monitored and recorded?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWas the need for transfusion assessed and recorded?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIs the post-disaster intervention time known?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003ePhysical Safety\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAre the physical examination findings normal?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIs there any extremity deformation?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIs there an open wound?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAre there signs of infection?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eNutritional / Treatment Safety\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIs there a need for oxygen?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHas any catheter been applied to the infant for medical purposes?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHas enteral/parenteral nutritional support been provided?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThere is a notable lack of a valid and reliable measurement instrument capable of comprehensively assessing neonatal safety in disaster settings. Existing measurement tools frequently focus on limited domains such as prematurity, clinical risk factors, stress levels, or skin integrity; whereas, there is an evident need for an assessment that encompasses multidisciplinary risks under disaster conditions. For instance, although the Neonatal Adverse Event Severity Scale (NAESS), developed by the International Neonatal Consortium (INC), was designed to assess the severity of adverse events encountered in neonatal clinical settings, the inter-rater agreement of the scale remained inadequate, with a Cohen\u0026rsquo;s Kappa coefficient found to be 0.23 [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. This finding indicates that the reliability of the scale is limited and that user training is a critical requirement [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. On the other hand, the Neonatal Skin Risk Assessment Scale (NSRAS), developed by Huffines and Logsdon for skin integrity risk in preterm infants, and the Neonatal Infant Stressor Scale (NISS), a tool evaluating stress factors in premature infants by Nist et al., do not address the general safety requirements in disaster conditions [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this context, the Neonatal Safety Assessment Scale in Disasters, developed within the scope of this study, aims to address this gap in the literature; it offers the opportunity to systematically evaluate fundamental safety domains such as identity, transport, physical examination, treatment, and nutrition regarding the newborn in disaster environments. In this respect, the study presents an original and innovative contribution in terms of both clinical practices and disaster management planning.\u003c/p\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eDiscussion of the Validity and Reliability data of the Scale\u003c/h2\u003e \u003cp\u003eThe validity and reliability analyses of the \u003cem\u003eNeonatal Safety Assessment Scale in Disasters\u003c/em\u003e, developed in this study, were comprehensively evaluated.\u003c/p\u003e \u003cp\u003eAccordingly, face validity was evaluated in the first phase. Face validity provides a subjective assessment regarding the extent to which a measurement instrument represents the targeted construct; it plays a significant role, particularly in the initial steps of scale development studies. Face validity offers a crucial indicator regarding whether the measurement instrument represents the target construct in terms of its appearance during the early stages of the scale development process. Therefore, the examination of face validity through expert evaluation is a standard practice recommended in the literat\u0026uuml;re [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFollowing the face validity assessment, content validity was evaluated using the Content Validity Index (CVI) method recommended by Polit and Beck [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Within this scope, each item was rated by four subject matter experts using a 4-point scale, and the suitability of each item in terms of content was scored. The obtained CVI value was determined to be 1.00; this value is substantially above the minimum acceptable threshold of 0.80 recommended by Polit and Beck [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. A CVI of 0.90 or higher indicates a high level of consensus regarding content and demonstrates that the scale items possess conceptual integrity [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDuring the pilot testing process, language that is current, applicable, and easily understood by nurses was prioritized. Reverse-coded items were intentionally included in the scale to control for respondent bias [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] These results indicate that the content validity of the developed 'Neonatal Safety Assessment Scale in Disasters' is robust. Furthermore, the high CVI value obtained during this process provides strong evidence regarding both the capacity of the scale items to represent neonatal safety in disaster settings and their adequacy in covering the target construct. Similarly, high CVI values have been reported as indicators of strong content validity, particularly in scales measuring patient safety, clinical skill assessment, and emergency processes [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the context of reliability analyses, reliability is generally categorized into four groups: internal consistency reliability, test-retest reliability, parallel forms reliability, and inter-rater reliability [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. In the reliability analyses of the Neonatal Safety Assessment Scale in Disasters developed in this study, internal consistency reliability (Kuder-Richardson 20 coefficient and item-total correlation) and independent inter-rater agreement techniques were utilized.\u003c/p\u003e \u003cp\u003eThe Kuder-Richardson 20 (KR-20) coefficient was utilized to evaluate internal consistency due to the dichotomous nature of the items. KR-20 is the recommended reliability coefficient for measuring inter-item consistency in scales with a unidimensional structure and a binary (two-option) response format. In particular, it is acknowledged that Cronbach's Alpha may be limited when applied to dichotomous items due to its assumption of continuous variables.\u003c/p\u003e \u003cp\u003eThe KR-20 value of 0.81 obtained in this study is consistent with the literature, where values of \u0026ge;\u0026thinsp;0.80 are accepted as indicating a 'good level of reliability' [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e].This finding indicates that the scale items are internally consistent and present a reliable structure for assessing neonatal safety under disaster conditions.\u003c/p\u003e \u003cp\u003eCohen\u0026rsquo;s Kappa coefficient was calculated regarding the inter-observer agreement of the scale. This coefficient measures the true level of agreement between two raters beyond chance agreement, and values between 0.81 and 1.00 represent a level of 'perfect agreement' [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. In this study, the Cohen's Kappa value was determined to be 0.85, demonstrating that a high level of observer consistency was achieved in the interpretation of the scale items.\u003c/p\u003e \u003cp\u003eIt is known that in scales with a dichotomous structure, traditional factor analyses offer limited accuracy due to the distribution of data into binary categories. Since the assumptions of factor analysis are based on continuous and normally distributed data, its application to dichotomous data may lead to misleading results. Therefore, in this study, construct validity was supported indirectly through item analyses and expert opinions [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs a result of the item-total score correlation analyses, items with negative correlations and values below 0.20 were excluded from the scale, thereby enhancing the discriminatory power of the scale. The scale was reduced from its initial 31-item form to 19 items, resulting in a structure consisting of four sub-dimensions. This approach is consistent with item reduction strategies commonly applied in scale development processes and contributes to the construct validity of the scale [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. It was observed that while the scale initially consisted of 31 items, 1 item was removed following content validity analysis and 11 items were removed following item-total correlation analysis, establishing a four-dimensional structure with the remaining 19 items. These dimensions are:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIdentity Safety,\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTransport Safety,\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePhysical Safety,\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTreatment/Nutritional Safety.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThe results of the present study indicate that the instrument developed for evaluating neonatal safety in disaster settings is a valid and reliable tool.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this study, it was concluded that the 'Neonatal Safety Assessment Scale in Disasters', developed to evaluate the safety of newborns in disasters, is a valid and reliable instrument that can be effectively utilized by pediatric nurses providing neonatal care. Regarding the safety score obtained by summing the points from the scale items, higher scores indicate safety, whereas lower scores indicate risk. The scale is composed of four sub-dimensions covering neonatal risks: Identity Safety, Transport Safety, Physical Safety, and Treatment/Nutritional Safety.\u003c/p\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eLimitation and Strenghs\u003c/h2\u003e \u003cp\u003eA limitation of this study is that it was conducted with nurses following the 2023 earthquake in Turkey; therefore, there may be limitations in generalizing the findings to other types of disasters. Although the dichotomous response format of the scale contributes to ease of use and rapid decision-making, it presents certain constraints from an analytical perspective. The dichotomous data structure may lead to consequences such as failure to meet assumptions in parametric analyses, limited applicability of factor analyses, and reduced statistical power due to low item variance. Since Likert-type scales in the literature allow for broader comparisons, the limited number of studies available for comparison with similar measurement instruments represents one of the challenges of this study.\u003c/p\u003e \u003cp\u003eThe data obtained in the qualitative phase of the research, conducted using a sequential mixed methods design, align with the risks defined in the literature while also reflecting current field experiences. The scale items were generated based on a literature review, expert opinions, and field observations following the major earthquake that occurred in Turkey on February 6, 2023. In this respect, the study presents an original instrument shaped not only by theoretical frameworks but also by evidence based on real disaster experiences. Its dichotomous structure provides ease of use for practitioners. By covering four fundamental safety domains (identity, physical, transport, and treatment/nutritional safety), the scale allows for the systematic, multidimensional assessment of newborns in disaster situations. The scale makes a significant contribution regarding prioritization, standardization of care, and early risk identification in post-disaster healthcare services.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCompeting Interests\u003c/h2\u003e \u003cp\u003eThe author declares that there are no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study was financially supported by the Mustela Foundation.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eThis research was conducted as a thesis within the scope of the Pediatric Nursing master's program at Hatay Mustafa Kemal University. All stages of the research were reviewed and conducted jointly by the advisor author.Assoc. Prof. Emel Demir designed the study, constructed the dataset, and drafted parts of the initial manuscript.Res. Assist. Rana Rehap Sert collected the data and performed the statistical analyses.All authors reviewed and approved the final version of the manuscript and take full responsibility for its content.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to thank all nurses who participated in the present study.Funding:This study was financially supported by the Mustela Foundation\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to ethical considerations and participant confidentiality but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eConk Z, Basbakkal Z, Bal Yilmaz H, Bolisik B, editors. Pediatric nursing. 3rd ed. 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Qual Quant. 2010;44(1):153\u0026ndash;66. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11135-008-9180-0\u003c/span\u003e\u003cspan address=\"10.1007/s11135-008-9180-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Neonatal safety, disaster, scale development","lastPublishedDoi":"10.21203/rs.3.rs-8451011/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8451011/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eNewborns are highly vulnerable to multidimensional safety risks during disasters. This study aimed to develop a valid and reliable instrument to assess neonatal safety in disaster settings.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe study population consisted of neonatal nurses providing care to newborns affected by the earthquakes in T\u0026uuml;rkiye on February 6, 2023. The sample was determined using the rule of ten participants per item, resulting in 302 nurses. Content validity was assessed with the Polit-Beck Content Validity Index (CVI). Reliability was evaluated using the Kuder-Richardson 20 (KR-20) coefficient. Items with negative item-total correlations or correlations below 0.20 were considered for removal.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe Polit-Beck CVI was 1.00, and the KR-20 coefficient was 0.81, indicating high reliability. Ten items were removed due to low item-total correlations, resulting in the final version of the scale. The \u0026ldquo;Neonatal Safety Assessment Scale in Disasters\u0026rdquo; demonstrated strong validity and reliability, making it suitable for evaluating neonatal safety in disaster contexts.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe developed instrument is a robust and reliable tool for assessing neonatal safety during disasters, supporting clinical decision-making and preparedness in neonatal care.\u003c/p\u003e","manuscriptTitle":"A Study on the Development of the Neonatal Safety Assessment Scale in Disasters","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-12 12:36:42","doi":"10.21203/rs.3.rs-8451011/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-05T06:32:55+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-16T21:06:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-16T14:34:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-15T08:43:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-12T18:50:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"92717275409227533756956502362582702378","date":"2026-01-12T09:31:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"159002114117691885462263492071781407105","date":"2026-01-11T11:01:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"290350876872900893066721019416482005573","date":"2026-01-10T09:01:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"83479120888554688598482110780033771296","date":"2026-01-08T08:14:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"39876589723978665144915147501209639941","date":"2026-01-08T07:44:42+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-08T06:58:03+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-30T09:58:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-29T11:49:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-29T11:48:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-12-25T21:24:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5f7d53f0-d01b-4817-8c5f-fa2e5aae8626","owner":[],"postedDate":"January 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-04T08:53:05+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-12 12:36:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8451011","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8451011","identity":"rs-8451011","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}