Reliability and Validity of a Scale to Measure Public Health Nurses' Advocacy Practices in Italy. A validation study

Previous nursing studies have explored advocacy from several perspectives, including examining its definition, analyzing the concept, developing theory based on concept analysis, and developing scales to assess advocacy in practice. This study aims to determine the reliability and validity of a scale to assess the advocacy practices of public health nurses (PHNAP) working in extra-hospital and community settings in Italy.

A validation study was conducted. After the translation phase, the questionnaire was administered to a convenience sample of nurses in various municipalities in Italy. Reliability was assessed by calculating the alpha coefficient. To assess construct validity, exploratory and confirmatory factor analyses were conducted. Data was collected between November and December 2024.

A total of 457 questionnaires were analyzed. The overall Cronbach's alpha coefficient was 0.926, and factors 1 through 5 were 0.911, 0.812, 0.836, 0.869, and 0.895, respectively. Regarding the criterion-related validity results, the correlation coefficient between the total score and the score on the scale for the practical competence of PHNs in Italy exhibited a moderate correlation (r = 0.428; lt; 0.01). The scale comprised 27 items divided into five factors: "Raising awareness of the challenging situation faced by disadvantaged individuals," "Empowering disadvantaged individuals to improve their situation autonomously," "Establishing a foundation in local governments and community groups of disadvantaged individuals for advocacy initiatives," "Working toward policy changes," and "Collaborating with stakeholders and organizations to enhance the effectiveness of activities." In the confirmatory factor analysis; that the chi-square degree of freedom ratio (χ2 /df), the goodness-of-fit index (GFI), the root mean square of approximate error (RMSEA), the value-added fitting index (IFI) and the comparative fitting index (CFI) were determined to be 2.765, 0.849, 0.065, 0.819 and 0.824, respectively.

The scale designed in this study is valid and reliable for use in the Italian context and it is applicable in various contexts where PHNs also support disadvantaged populations.