Cultural Adaptation and Psychometric Validation of the Persian Student Nurse Stress Index in Iran

Background and Purpose: This article aimed to develop and psychometrically validate the Persian Student Nurse Stress Index (SNSI). The SNSI is a culturally tailored tool that assesses stress among Iranian nursing students. It captures unique sociocultural stressors that are rooted in Iran's collectivist and Islamic context. The SNSI is applicable in other global collectivist settings, such as India, Pakistan, and Indonesia, to inform evidence-based interventions for nursing education. Methods: The SNSI was translated into Persian using a forward-backward translation process. A cross-sectional study was conducted with 408 undergraduate and graduate nursing students from four Iranian universities who were randomly sampled from March 2020 to June 2022. The sample was divided (n = 208 for exploratory factor analysis [EFA], n = 200 for confirmatory factor analysis [CFA]) to ensure robust psychometric validation through separate exploratory and confirmatory analyses. Data were collected using both paper-based and online questionnaires to accommodate student preferences and ensure accessibility. The psychometric evaluation included content validity (scale-level content validity index [S-CVI]), EFA (n = 208), CFA (n = 200), Cronbach's alpha, and test-retest reliability (intraclass correlation coefficient [ICC]). Results: The Persian SNSI comprises 19 items across three factors: expectations, communication, and health (11 items, explaining 38.2% of the variance); academic topics (6 items, explaining 18.6% of the variance); and restrictions on free time (2 items, explaining 8.6% of the variance). These factors explain 65.4% of the total variance. The S-CVI was .88. EFA showed a Kaiser-Meyer-Olkin value of .90 (p < .001). CFA confirmed an acceptable fit (root-mean-square error of approximation = .11, comparative fit index = .93, and incremental fit index = .93). Cronbach's alpha was .86, and the ICC was .88. The mean stress score was 54.86 (SD = 16.78), with interpersonal stressors being the most prominent. Conclusions: The Persian SNSI is a valid and reliable tool for assessing stress in Iranian nursing students. It could inform evidence-based interventions, such as counseling and curriculum reforms, to enhance student mental health and academic success. The tool's scalability makes it a transformative model for nursing education in collectivist societies.