Methods: A two-stage process for estimating content validity was undertaken. The first stage, the development stage necessitated A review of the extant literature on marginalization of minority students in nursing education was undertaken. For the purpose of this study, the term “minority nursing student” was defined as an undergraduate nursing student who met any of the following criteria: 1) is a racial/ethnic minority; 2) is male; 3) is a sexual minority; 4) is 25 years of age or older. Hall and colleagues (1994) introduced a conceptual framework for the study of marginality within the field of nursing. Hall and colleagues (1994) ascribed seven key properties or subconcepts to marginality: 1) intermediacy; 2) differentiation; 3) power; 4) secrecy; 5) voice; 6) reflectiveness; and 7) liminality. This conceptual framework was used to develop the marginality index. This concept analysis provided the framework for the marginality index. Items for the marginality index were developed in under the guidance of the author of the concept analysis used as the foundation for the tool development. A 4-point Likert scale (0= strongly disagree to 4= strongly agree) was created. Evidence of content validity was established based on the feedback from five experts.
Results: Results of the content analysis indicated that 7 of the 35 items had a CVI of .63, which is below the threshold level of .80. After reviewing each item, all 7 seven were eliminated from the instrument. Qualitative remarks from one of the content experts suggested minor revisions on two items; both were revised accordingly. The CVI for the total instrument after revisions was .94. The marginality index consisted of 50 items, which was used for the pilot testing phase.
A study was then conducted to evaluate the psychometric properties of the marginality index. A demographic survey and the marginality index was given to all undergraduate students enrolled in a nursing program in the Midwest. A convenience sample of 323 participants was used. Prior to factor analysis, the PI examined the inter-item correlations among variables. According to Kim & Mueller (1978), any variable that yields an inter-item correlation of less than .4 may be excluded from further analysis. After analysis of inter-item correlations, the marginality tool was reduced from 28 to 19 items. Cronbach’s alpha for the revised index was α = .925.
Exploratory factor analysis of the marginality index was conducted using SPSS version 24. The first step of the process was to determine the appropriateness of factor analysis. The Kaiser-Meyer-Olkin measure for the index was .960 and the Bartlett Test of Sphericity was statistically significant, χ2 (171, n = 323) = 5759.8, p <. 001. The marginality index with a varimax rotation procedure yielded the extraction of two factors, which accounted for 70% of the variance. Analysis of these factors revealed that all seven of the expected dimensions of marginality were present. Results of the larger study suggest that minority nursing students experience significantly higher marginalization when compared to non-minority students.
Conclusion: Results of the study suggest that marginalization remains a significant issue within the realm of nursing education. Further studies need to be conducted using the marginality index. Correlational studies that evaluate the relationship between marginalization and a number of variables including self-efficacy and social integration can also be undertaken.