Development and Psychometric Validation of the Physical Activity and Health Literacy Scale (PA-HLS) for College...

Declining physical fitness among college students has become a global public health concern. Existing physical literacy and health literacy instruments do not adequately capture the competencies required to access, interpret, and critically evaluate physical activity-related health information in contemporary digital environments.

This study aimed to develop and psychometrically validate the Physical Activity and Health Literacy Scale (PA-HLS) for college students based on Nutbeam's hierarchical model of health literacy.

An initial item pool was generated through a systematic literature review and refined via two rounds of Delphi expert consultation (n = 19) and pilot testing (n = 30). The final 15-item PA-HLS was administered to 442 Chinese college students. Psychometric evaluation included content validity assessment, item analysis, exploratory and confirmatory factor analyses, internal consistency reliability (Cronbach's α and McDonald's ω), discriminant validity testing, and Rasch model analysis.

All items demonstrated good discrimination (critical ratios = 6.74-31.90, p < 0.001) and strong factor loadings (0.59-0.93). Content validity was excellent (I-CVI = 1.00; S-CVI = 1.00). Exploratory factor analysis supported a three-factor structure explaining 77.1% of the total variance, which was confirmed by confirmatory factor analysis with acceptable model fit. Internal consistency was high for the total scale (α = 0.892; ω = 0.869) and all subscales. Rasch analysis further supported the scale's measurement quality.

The PA-HLS is a theoretically grounded and psychometrically robust instrument for assessing physical activity-related health literacy among college students and may inform targeted health promotion interventions in university settings.