Development and content validation of a nurse-led continuity of care model for older adults with type 2 diabetes in Indonesian primary care

Abstract Background Older adults with type 2 diabetes require coordinated, longitudinal and age-sensitive primary care because diabetes in later life is frequently complicated by multimorbidity, functional limitations, polypharmacy and family-supported self-management. In Indonesian primary care, education, follow-up, home visits, referral, family engagement and interprofessional communication may remain fragmented. This study developed and content-validated a nurse-led continuity of care model for older adults with type 2 diabetes in Indonesian primary care. Methods A sequential model-development design was used, comprising conceptual synthesis, model and module development, multidisciplinary expert content validation, refinement and readability/practicality testing. The model integrated the Functional Consequences framework, King’s Goal Attainment Theory, Meiqari et al.‘s continuity-of-care framework, unpublished formative project findings and focus group discussions with community nurses, and systematic review evidence on continuity-of-care strategies for older adults with diabetes in Asia. Twelve purposively selected multidisciplinary experts (community/primary care nursing, programme leadership, academia, medicine, pharmacy and geriatric diabetes care), each meeting predefined eligibility criteria, rated the model book and two modules on a four-point scale. Content validity was quantified using the item-level content validity index (I-CVI; proportion of experts rating an item 3 or 4) and the scale-level content validity index average (S-CVI/Ave), with an a priori acceptability threshold of ≥ 0.90. Readability/practicality appraisal involved 22 intended users (12 health workers, 10 older adults with diabetes) using structured appraisal items scored as a percentage of the maximum; scores above 81.25% were classified by the appraisal instrument as “very practical”. Results The process produced a nurse-led continuity of care package in which the community nurse coordinates physician-led structured diabetes education, shared goal setting, interprofessional home visits by community nurses, nutritionists and pharmacists, telephone follow-up with patients, multidisciplinary case conferences, family follow-up, and patient-and-family education sessions. Mean item scores were 3.86 (model book), 3.82 (older-adult and family module) and 3.90 (health-worker module) on a four-point scale; because no item was rated below 3 by any expert, all I-CVI values were 1.00 and the S-CVI/Ave was 1.00 for all three instruments, meeting the ≥ 0.90 threshold. Readability/practicality appraisal scores were 90.52% for the health-worker module and 97.13% for the older-adult and family module; both fell within the instrument-defined “very practical” category. These scores represent preliminary user appraisal and do not establish routine-care practicality or implementation feasibility. Expert feedback informed refinements to primary care scope, implementation flow, interprofessional roles, family involvement, telehealth monitoring, emergency action guidance, nutrition, medication, foot care and stress-management content. Conclusions The model showed high expert agreement on content and preliminary usability among the sampled intended users. These findings support progression to pilot and feasibility testing but do not establish implementation feasibility or clinical effectiveness. Future studies should assess caregiver usability, feasibility, fidelity, acceptability, workforce and resource requirements, and effects on self-management, glycaemic outcomes and functional well-being. Clinical trial number Not applicable.