title: A new method for assessing content validity in model-based creation and iteration of eHealth interventions.
abstract: BACKGROUND
  The advent of eHealth interventions to address psychological concerns and health behaviors has created new opportunities, including the ability to optimize the effectiveness of intervention activities and then deliver these activities consistently to a large number of individuals in need. Given that eHealth interventions grounded in a well-delineated theoretical model for change are more likely to be effective and that eHealth interventions can be costly to develop, assuring the match of final intervention content and activities to the underlying model is a key step. We propose to apply the concept of "content validity" as a crucial checkpoint to evaluate the extent to which proposed intervention activities in an eHealth intervention program are valid (eg, relevant and likely to be effective) for the specific mechanism of change that each is intended to target and the intended target population for the intervention.
  
  
  OBJECTIVE
  The aims of this paper are to define content validity as it applies to model-based eHealth intervention development, to present a feasible method for assessing content validity in this context, and to describe the implementation of this new method during the development of a Web-based intervention for children.
  
  
  METHODS
  We designed a practical 5-step method for assessing content validity in eHealth interventions that includes defining key intervention targets, delineating intervention activity-target pairings, identifying experts and using a survey tool to gather expert ratings of the relevance of each activity to its intended target, its likely effectiveness in achieving the intended target, and its appropriateness with a specific intended audience, and then using quantitative and qualitative results to identify intervention activities that may need modification. We applied this method during our development of the Coping Coach Web-based intervention for school-age children.
  
  
  RESULTS
  In the evaluation of Coping Coach content validity, 15 experts from five countries rated each of 15 intervention activity-target pairings. Based on quantitative indices, content validity was excellent for relevance and good for likely effectiveness and age-appropriateness. Two intervention activities had item-level indicators that suggested the need for further review and potential revision by the development team.
  
  
  CONCLUSIONS
  This project demonstrated that assessment of content validity can be straightforward and feasible to implement and that results of this assessment provide useful information for ongoing development and iterations of new eHealth interventions, complementing other sources of information (eg, user feedback, effectiveness evaluations). This approach can be utilized at one or more points during the development process to guide ongoing optimization of eHealth interventions.
authors.affiliation: Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, United States. nlkaphd@mail.med.upenn.edu.
authors.forename: Nancy
authors.identifier: http://orcid.org/0000-0001-7412-1428
authors.initials: N
authors.lastname: Kassam-Adams
authors.forename: Meghan L
authors.identifier: http://orcid.org/0000-0001-6718-1721
authors.initials: ML
authors.lastname: Marsac
authors.forename: Kristen L
authors.identifier: http://orcid.org/0000-0003-2894-3564
authors.initials: KL
authors.lastname: Kohser
authors.forename: Justin A
authors.identifier: http://orcid.org/0000-0001-9475-8450
authors.initials: JA
authors.lastname: Kenardy
authors.forename: Sonja
authors.identifier: http://orcid.org/0000-0001-8425-7126
authors.initials: S
authors.lastname: March
authors.forename: Flaura K
authors.identifier: http://orcid.org/0000-0001-6632-1403
authors.initials: FK
authors.lastname: Winston
mesh_terms: D000223:Adaptation, Psychological; D002648:Child; D005260:Female; D015438:Health Behavior; D006801:Humans; D008490:Medical Informatics / Q000592:standards; D016730:Program Development; D011788:Quality of Life; D015203:Reproducibility of Results; D012107:Research Design; D013313:Stress Disorders, Post-Traumatic / Q000517:prevention & control*; D017216:Telemedicine / Q000458:organization & administration* / Q000592:standards
keywords: child; methods; secondary prevention; stress disorders, post-traumatic; telemedicine