Development and Content Validation of the YANR Digital Family Support Nursing Framework for Mental Health Care: A Modified Delphi Study

Background Family caregivers play a vital role in supporting individuals with mental health conditions. Effective support requires competencies in mental health literacy, emotional support, caregiving, problem-solving, relapse prevention, and access to professional and community resources. Therefore, an integrated framework is needed to guide family support nursing practices. Methods A methodological framework-development study was conducted involving eight experts from mental health nursing, family nursing, and nursing research methodology. The framework was evaluated using a structured instrument comprising 48-items across eight assessment groups, including six framework domains and implementation-related components. Experts rated item relevance using a four-point scale and provided qualitative feedback. Ratings of 3 or 4 were classified as positive for content validity assessment. Descriptive statistics were used to summarize expert ratings, while qualitative comments were reviewed to inform revisions between rounds. Content validity was assessed using the item-level content validity index (I-CVI) and scale-level content validity index based on the average method (S-CVI/Ave). Results The overall mean rating increased from 3.779 in Round 1 to 3.883 in Round 2. The proportion of ratings assigned the highest score of 4 increased from 77.9% to 88.3% after the intervention. The mean ratings increased across all eight assessment groups after framework refinement. In both rounds, all 48 items achieved an I-CVI of 1.00 and an S-CVI/Ave of 1.00. These findings indicate complete expert agreement on item relevance under predefined dichotomization rules. Conclusion The two-round modified Delphi process supported the content relevance of the YANR Digital Family Support Nursing Framework for Mental Health Care and informed its refinement through expert feedback. The findings provide an initial basis for further framework development. Subsequent research should examine its comprehensibility, feasibility, and practical utility, followed by evaluation of its effectiveness in nursing practice. The findings should not be interpreted as evidence of clinical effectiveness.