Background and purpose: Researches show that limited models have been designed to measure the maturity of digital transformation in libraries, however, no valid and reliable tool has been provided to measure the maturity of digital transformation in academic libraries so far. Identifying the factors affecting the maturity of digital transformation and managing its correct use in the libraries of medical sciences universities is of particular importance in improving the efficiency and effectiveness and as a result, the success and growth of the libraries. Therefore, the purpose of the current research is to compile and validate a suitable tool to determine the factors affecting the maturity of digital transformation in the libraries of medical sciences universities. Materials and methods: The type of qualitative (exploratory) study was based on the plan of developing the tool, which was carried out in two phases: in the first phase, to collect information related to the identification of factors affecting the maturity of digital transformation, the meta-composite method was used under “ Sandelowski and Barroso's model. Then, in the second phase of the Delphi method, the factors were localized and adapted to the topic. The intended community in the met composite section was all related sources from reliable databases, with 82 sources. After extracting, screening, and considering the input and output criteria of the researchers, 41 Persian and Latin sources were selected. The statistical population in the Delphi phase included 15 professors and experts in the field of digital maturity and digital technologies in universities of medical sciences who were selected in a non-probable and purposeful way according to the criteria for entering the research (relevance of work experience and organizational position and field of study of the experts to the subject research, conflict with the discussed issue, having at least 5 years of work experience) as samples. The measurement tool was a structured questionnaire of 69 questions created by the researcher, which was compiled by reviewing the previous findings and then sent to the experts in two stages with the help of the fuzzy Delphi technique, and finally 61 final questions were obtained. Results: In this research, based on the findings of the meta-combination section, 69 primary categories for the maturity of digital transformation were identified first by reviewing the literature and backgrounds. Then, in the next step, a relationship was established between these categories, and they were categorized into 13 items. Then, the identified main categories were divided into 2 general categories (internal and external factors). Then, for quality control, the validity and internal reliability of check methods were used. The size of the Kappa coefficient (0.78) in this research indicated the good internal reliability of the obtained results. Finally, for validation, the developed tool was provided to the members of the Delphi panel, which had 15 members. After two stages of fuzzy Delphi and after making corrections and removing irrelevant items (8 items) and the agreement score of experts in the rest of the factors (61 items), it was observed that the disagreement of experts in the first and second steps did not have a significant difference and the agreement score of experts in all commons was more than 70%; therefore, the survey was stopped in the second stage, and all factors were confirmed. The results of the fuzzy Delphi analysis led to the confirmation of 61 items of the digital transformation maturity questionnaire in the libraries of medical sciences universities in 2 main components (inter-organizational factors and extra-organizational factors) and 13 subcomponents. Conclusion: The developed tool provides researchers with criteria for determining the state of maturity for digital transformation in the libraries of medical sciences universities. The discovered factors include 10 internal organizational factors (digital culture development, digital infrastructure development factor, new technology infrastructure development factor, human resources development factor, management resource development factor, digital strategy development factor, digital support factor, organizational rules and regulations factor, financial resources factor and experience development factor (digital users) and 3 components of extra-organizational factors (collaboration and support of upstream and academic institutions, the factor of development of national culture in the field of digital transformation and the factor of national laws and regulations) which can be used as a suitable tool to measure the maturity of digital transformation in libraries.