Pressure ulcer prevention algorithm content validation: A mixed-methods, quantitative study

Lia Van Rijswijk, Janice M. Beitz

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Translating pressure ulcer prevention (PUP) evidence-based recommendations into practice remains challenging for a variety of reasons, including the perceived quality, validity, and usability of the research or the guideline itself. Following the development and face validation testing of an evidence-based PUP algorithm, additional stakeholder input and testing were needed. Using convenience sampling methods, wound care experts attending a national wound care conference and a regional wound ostomy continence nursing (WOCN) conference and/or graduates of a WOCN program were invited to participate in an Internal Review Board-approved, mixed-methods quantitative survey with qualitative components to examine algorithm content validity. After participants provided written informed consent, demographic variables were collected and participants were asked to comment on and rate the relevance and appropriateness of each of the 26 algorithm decision points/steps using standard content validation study procedures. All responses were anonymous. Descriptive summary statistics, mean relevance/appropriateness scores, and the content validity index (CVI) were calculated. Qualitative comments were transcribed and thematically analyzed. Of the 553 wound care experts invited, 79 (average age 52.9 years, SD 10.1; range 23-73) consented to participate and completed the study (a response rate of 14%). Most (67, 85%) were female, registered (49, 62%) or advanced practice (12, 15%) nurses, and had > 10 years of health care experience (88, 92%). Other health disciplines included medical doctors, physical therapists, nurse practitioners, and certified nurse specialists. Almost all had received formal wound care education (75, 95%). On a Likert-type scale of 1 (not relevant/appropriate) to 4 (very relevant and appropriate), the average score for the entire algorithm/all decision points (N ≤ 1,912) was 3.72 with an overall CVI of 0.94 (out of 1). The only decision point/step recommendation with a CVI of g‰Currency sign0.70 was the recommendation to provide medical-grade sheepskin for patients at high risk for friction/shear. Many positive and substantive suggestions for minor modifications including color, flow, and algorithm orientation were received. The high overall and individual item rating scores and CVI further support the validity and appropriateness of the PUP algorithm with the addition of the minor modifications. The generic recommendations facilitate individualization, and future research should focus on construct validation testing.

Original languageEnglish (US)
Pages (from-to)48-57
Number of pages10
JournalOstomy Wound Management
Issue number4
StatePublished - Apr 1 2015

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • General Nursing
  • Gastroenterology


  • algorithms
  • pressure ulcer
  • prevention, adult
  • validation studies


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