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Development and psychometric validation of a health literacy competency scale for nurses, and its application in a
Xuemei Bao1,2, Shuhan Liu1, Xiaoxiao Hu2
1Chongqing Red Cross Hospital, Chongqing, China.
Objectives:
This study aimed to develop the Health Literacy Competencies Scale for Nurses (HLC-N) and examine the current status and influencing factors of health literacy competencies (HLC) among nurses in China.
Design:
A multi-phase methodological study consisting of three stages: (1) item generation (literature review, semi-structured interviews with 12 nurses, a two-round Delphi process with 16 experts, and pilot testing with 30 nurses); (2) psychometric validation (item analysis, exploratory factor analysis [EFA], confirmatory factor analysis [CFA], and reliability testing); and (3) a cross-sectional survey to examine current status and influencing factors.
Setting:
Psychometric validation was conducted across general hospitals in Chongqing, Sichuan, and Zhejiang provinces (July-August 2025). The cross-sectional survey was carried out in general hospitals across three districts of Chongqing, China (August-September 2025).
Participants:
Psychometric validation included 860 in-service nurses (467 for EFA; 393 for CFA and reliability; 81 for test-retest). Inclusion criteria: registered nurses with ≥1 year of clinical experience. Exclusion criteria: intern nurses, refresher nurses, or those who had previously participated in scale development. The cross-sectional survey included 647 nurses from primary, secondary, and tertiary hospitals in Chongqing.
Results:
The final HLC-N comprised 39 items across five dimensions, explaining 72.6% of the variance, with good model fit: χ2/df = 2.223, RMSEA = 0.056 (90% CI 0.052 to 0.060), CFI = 0.942. Cronbach's α for the total scale was 0.958 (95% CI 0.949 to 0.966). Among 647 nurses, the mean HLC score was 154.41 (SD 20.60). In multivariate regression, health status (β = 0.087, 95% CI 0.494 to 7.089, p = 0.024), health literacy training (β = 0.164, 95% CI 2.899 to 10.735, p = 0.001), and competency training (β = 0.122, 95% CI 1.101 to 8.940, p = 0.012) were independent predictors, explaining 7.8% of the variance (adjusted R2 = 0.078).
Conclusion:
The HLC-N demonstrated robust psychometric properties and may serve as a reliable tool for assessing HLC among nurses in China. Targeted training and health promotion for nurses could enhance their HLC. Future research should explore additional predictors and validate the scale across diverse nursing populations.
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