Developing and Validating the Nursing Student Misinformation Attitudes, Confidence, and Knowledge Assessment Tool

Objectives: Misinformation has become an increasing concern in healthcare. But how much do students know about health misinformation, and how confident are they when trying to mitigate it? To find out, we are developing a survey instrument to understand nursing students’ attitude, confidence, and knowledge about misinformation in the patient care setting. This survey will inform the development of open educational modules that will teach students about health misinformation as well as two strategies for mitigation: pre-bunking and motivational interviewing.

Methods: Our interdisciplinary team designed the 7-item Nursing Student Misinformation Attitudes, Confidence, and Knowledge Assessment Tool. To evaluate content validity, we assembled a panel of expert judges (n=10) in nursing, misinformation, and instrument development. Experts scored each item on the tool in terms of necessity, relevancy, clarity, and importance. We calculated content validity ratio (CVR), content validity index (CVI), multi-rater kappa, and impact score. Judges also provided qualitative feedback on item wording. We revised the tool based on expert recommendation. Then, to obtain baseline information and evaluate reliability, specifically internal consistency using Cronbach’s alpha, we invited n=211 baccalaureate sophomore-level nursing students to complete the tool electronically using Qualtrics. The final tool features five quantitative items that use a 5-point Likert scale from 1 - “not at all” to 5 - “extremely” and two free response items. The tool will be used to evaluate the impact of our open educational modules on nursing student attitude, confidence, and knowledge about misinformation at an R1 research university as part of a required course on nursing research and evidence-based practice. The tool will be made available to the research community at large.

Results: Experts determined that all items were relevant (item CVI=0.9-1; kappa=0.9-1) and important (impact score=3.52-4.9). Further, experts deemed all items necessary (CVR=0.8-1), with the exception of an item asking students to provide a short definition of misinformation (CVR=0.2). Five out of the seven items required revision to improve clarity (item CVI=0.7). Thus, the tool was revised based on expert qualitative feedback. N=115 (54.5%) nursing students completed the revised tool. Students endorsed the importance of addressing health misinformation with patients and their families or caregivers (mean=4.66, SD=0.54) and other health care providers (mean=4.6, SD=0.65) but reported much lower confidence in their ability to address health misinformation (mean=2.90, SD=0.83; mean=2.57, SD=0.93, respectively). Likewise, students report that their nursing education has moderately prepared them to address health misinformation (mean=3.2, SD=0.99). The tool had adequate internal consistency (Cronbach’s alpha=0.73).

Conclusions: As health misinformation continues to proliferate, educating future health care professionals is of utmost importance. Having a tool to help understand students’ baseline comfort with (and understanding of) dispelling misinformation will be essential when building educational tools.