Climate Change Awareness: a Randomized Controlled Trial

Background and Rationale: Climate change poses significant challenges to public health and healthcare systems. Nurse managers play a crucial role in implementing environmentally sustainable healthcare practices and mitigating the negative effects of climate change on health services. Despite the increasing awareness of climate change among healthcare professionals, structured educational programs aimed at enhancing nurse managers' knowledge and attitudes regarding this issue are needed. This study aims to evaluate the effectiveness of an educational intervention in improving nurse managers' awareness of climate change.

Study Objectives: This study's primary objective is to assess an educational program's impact on nurse managers' awareness of climate change. Specific objectives include:

Measuring the baseline level of climate change awareness among nurse managers. Evaluating the effectiveness of the educational intervention in enhancing their awareness.

Identifying factors associated with higher awareness levels.

Methods:

Study Design:

A randomized controlled trial (RCT) will be conducted with a pre-test and post-test design.

Study Setting and Population:

The study will be conducted at two major hospitals: Kartal Dr. Lütfi Kırdar City Hospital and Göztepe Prof. Dr. Süleyman Yalçın City Hospital. The target population consists of nurse managers working in these hospitals.

Sample Size Calculation: The study aims to include 108 nurse managers, with 54 in the experimental and 54 in the control groups. Sample size calculation was performed using G*Power 3.1.9.7 based on the effect size reported in the study by Alvarez-Nieto et al. (2022). An effect size of 0.79 (d = 0.79), 5% significance level (α = 0.05), and 95% power (1-β = 0.95) were used to determine a required sample size of 90 participants. To account for potential dropouts, the sample size was increased by 20%, resulting in a final target of 108 participants.

Sampling Method:

A census sampling method will be used to include all eligible nurse managers in the study setting. Since the number of nurse managers is limited, this method ensures maximum representation.

Intervention: The educational intervention will include a structured training program on climate change awareness. The program will include:

The science of climate change and its health implications. The role of healthcare professionals in mitigating climate change. Strategies for implementing sustainable practices in healthcare settings. The training will be delivered via interactive workshops and online modules over a four-week period.

Data Collection Tools:

Data will be collected through:

Demographic Information Form: A 12-item questionnaire covering age, gender, education level, work experience, and prior climate change training.

Climate Change Awareness Scale: Developed by Ataklı and Kuran (2022), this 52-item, five-factor Likert scale measures climate change awareness, issue perception, knowledge of causes, concerns, and expected policies. Higher scores indicate greater awareness. The scale has a Cronbach's alpha reliability coefficient of 0.92.

Data Collection Process:

Institutional approvals will be obtained from the Provincial Health Directorate.

The study will be introduced to nurse managers via hospital education nurses, who will disseminate information and collect voluntary participation lists.

Participants will be randomized into experimental and control groups. Pre-test data will be collected before the intervention. The educational program will be delivered to the experimental group. Four weeks after the intervention, post-test data will be collected from both groups.

Data Analysis:

Descriptive statistics (frequency, percentage, mean, standard deviation) will summarize demographic and baseline characteristics.

The normality of scale scores will be assessed using the Kolmogorov-Smirnov test.

Independent samples t-test will be used for normally distributed continuous variables.

Mann-Whitney U test will be applied for non-normally distributed variables. One-way ANOVA or the Kruskal-Wallis test will be used for comparisons across multiple groups.

All statistical analyses will be conducted using SPSS 26.0 with a significance level of p < 0.05.

Ethical Considerations: The study will adhere to ethical principles, including obtaining informed consent from participants. Institutional Review Board (IRB) approval will be obtained before data collection.

Expected Outcomes: The study is expected to demonstrate that a structured educational program significantly improves nurse managers' awareness of climate change. The findings will contribute to developing sustainable healthcare policies and training programs tailored to healthcare leaders.

Conclusion: Addressing climate change awareness among nurse managers is essential for sustainable healthcare delivery. This study's results will provide evidence-based recommendations for integrating climate change education into nursing leadership programs.