Development and initial validation of a scale to measure barriers to continuing nursing education

Abstract

Objectives: To develop and obtain initial evidence of content validity, internal consistency, and construct structure of the Barriers to Continuing Education Questionnaire (BPCC), designed to assess the factors influencing the continuing education of nursing professionals. Methods: A prospective, longitudinal, exploratory, and mixed-methods study was conducted in Mexico for the development of an instrument. The candidate content was identified through a literature review and organized into sociodemographic, personal, work, and organizational domains. Twenty-five nursing experts evaluated the items using three Delphi rounds. To accept an item, at least 80% of favorable evaluations were required. The resulting 65-item questionnaire was piloted in January 2022, using a stratified random sample of 60 nursing professionals belonging to a staff of 201 workers from a second-level hospital. Descriptive statistics, Cronbach's alpha, principal component analysis, and Pearson correlations with SPSS version 20 were calculated. Results: The first Delphi round began with 61 items; 25 were retained, 31 were restructured, and 9 were added, for a total of 65 items. Internal consistency in the three Delphi rounds was 0.997, 0.927, and 0.900. In the final round, all items achieved content validity indexes per item and at the scale level of 1.00. The average response time of the pilot test was 32 minutes. The pilot sample had a mean age of 37.8 years and was predominantly composed of women and married people. Internal consistency was 0.849. 21 components were extracted; among the highest coefficients were 0.957 for the comprehension of statistical data and the number of self-financed courses; 0.915 for feeling rewarded and the assignment of functions according to academic preparation; and 0.908 for the training modality and the influence of colleagues. Conclusions: The BPCC showed excellent agreement among experts and good internal consistency in the pilot test. Its four-domain structure incorporates barriers that go beyond motivation. Larger independent samples are required to confirm factor structure, temporal stability, measurement invariance, and criterion validity. Clinical relevance: Identifying modifiable educational barriers can help clinicians plan accessible training activities and support staff competence. The scale requires additional validation before being routinely used in clinical settings or in dental teams.