Table 3: Questionnaire development steps.

Step	Purpose	Methods
1. Determine what is to be measured	Select and study a well-grounded theory to develop hypotheses, constructs and concepts related to the phenomenon being measured	Review of Rogers’ Diffusion of Innovations theory which explains characteristics that influence a NP to have awareness-knowledge of GINA. Theoretical components to be synthesized into constructs/concepts in order to generate questionnaire items.
2. Generate an item pool from review of literature	To propose self-report/response data collection items that facilitate responses representing variables that influence awareness of GINA.	Draft items for scale responses according to constructs/concepts of the theory. asking level of importance by dissertation committee members in assessing awareness-knowledge of GINA in NPs
3. Determine the format for measurement	To determine what scales are most compatible with the theory: constructs and concepts	Occurs simultaneously with generation of questionnaire items so that the two steps are compatible
4. Initial questionnaire item pool reviewed by experts	To establish content validity	Nine nurse practitioners with genetic expertise scored the questionnaire items for content validity index to prepare questionnaire for transfer to Qualtrics® survey software for field testing
5. Consider inclusion of validation items/field test revised questionnaire	Test reliability in a small sample Interact with subjects regarding readability, item burden and testing problems	Refined questionnaire items on Qualtrics® survey software. Utilize ten Clemson University NPs, not possessing genetic expertise and not included in the sample population, to identify questionnaire administration problems.
6. Administer final revised online questionnaire to pilot sample	To evaluate for construct validity and reliability	Utilize pilot sample to include members of two SC NP associations
	Use findings to evaluate future development steps	Cronbach’s alpha for reliability Descriptive statistics for construct validity