{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:55Z","timestamp":1783641655902,"version":"3.55.0"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T00:00:00Z","timestamp":1764806400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005762","name":"National Taiwan University Hospital","doi-asserted-by":"publisher","award":["112-M0030"],"award-info":[{"award-number":["112-M0030"]}],"id":[{"id":"10.13039\/501100005762","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Effective communication between healthcare providers and families is critical in ICUs, yet existing assessment scales predominantly focus on unidirectional, face-to-face interactions. The COVID-19 pandemic accelerated adoption of digital communication modalities that have persisted in contemporary practice. This study developed and validated the Healthcare Provider and Family Bidirectional Digital Communication Scale (HF-BDCS) to address these gaps.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>The HF-BDCS was developed through literature review and qualitative interviews with 15 stakeholders (healthcare providers and family members). Content validity was assessed by 5 experts. Psychometric evaluation with 300 participants (100 physicians, 100 nurses, 100 family members) included exploratory factor analysis and internal consistency assessment using Cronbach\u2019s alpha.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Expert review yielded 14 items with excellent content validity (S-CVI\/Ave: relevance=1.00, importance=1.00, clarity=0.98). Exploratory factor analysis produced a 13-item scale with three factors explaining 64.53% of variance: Digital Communication Efficiency and Quality (6 items, 25.87%), Digital Communication Perceptions (5 items, 25.12%), and Digital Communication Regulations (2 items, 13.54%). Internal consistency was good (Cronbach\u2019s alpha=0.80-0.86) across all factors and participant subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The HF-BDCS is the first validated bidirectional instrument for assessing digital communication in ICUs, demonstrating strong psychometric properties. By capturing both healthcare provider and family perspectives, the scale enables identification of perception discrepancies and supports improvements in digital communication practices, ultimately enhancing patient- and family-centered care in contemporary ICUs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0338410","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T18:51:17Z","timestamp":1764874277000},"page":"e0338410","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Development and validation of the healthcare provider and family bidirectional digital communication 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meta-analysis","volume":"25","author":"JM van den Broek","year":"2021","journal-title":"Crit Care"},{"issue":"3","key":"pone.0338410.ref005","first-page":"236","article-title":"Internal psychometric properties of the Critical Care Family Needs Inventory","volume":"20","author":"JS Leske","year":"1991","journal-title":"Heart Lung"},{"issue":"2","key":"pone.0338410.ref006","first-page":"332","article-title":"Needs of relatives of critically ill patients: a descriptive study","volume":"8","author":"NC Molter","year":"1979","journal-title":"Heart Lung"},{"issue":"2","key":"pone.0338410.ref007","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1097\/00003246-199802000-00023","article-title":"Measuring the ability to meet family needs in an intensive care unit","volume":"26","author":"D Johnson","year":"1998","journal-title":"Crit Care 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Creswell","year":"2018","edition":"3"},{"key":"pone.0338410.ref012","doi-asserted-by":"crossref","first-page":"2134","DOI":"10.1111\/1475-6773.12117","article-title":"Achieving integration in mixed methods designs-principles and practices","volume":"48","author":"MD Fetters","year":"2013","journal-title":"Health Serv Res"},{"issue":"4","key":"pone.0338410.ref013","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1046\/j.1365-2648.2000.t01-1-01567.x","article-title":"Research guidelines for the Delphi survey technique","volume":"32","author":"F Hasson","year":"2000","journal-title":"J Adv Nurs"},{"issue":"1","key":"pone.0338410.ref014","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1097\/01.CCM.0000251122.15053.50","article-title":"Refinement, scoring, and validation of the Family Satisfaction in the Intensive Care Unit (FS-ICU) survey","volume":"35","author":"RJ Wall","year":"2007","journal-title":"Crit Care 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