New 19-Item Scale Measures What Nurses Know About Health Literacy Practice

Researchers in Taiwan have developed and validated a new questionnaire designed to measure how much registered nurses know about putting health literacy principles into practice. The instrument, called the Health Literacy Practice Knowledge Scale for Nurses (HLPKSN), was described in a cross-sectional study published in BMC Nursing. After a structured development process involving literature review, item development, expert review, pilot testing and statistical evaluation, the final version contains 19 items and showed acceptable internal consistency, with a KR-20 coefficient of 0.705.

Health literacy is recognized in the study as a key determinant of health outcomes and a global priority under the United Nations 2030 Sustainable Development Goals. The authors note that although nurses play a pivotal role in delivering health literacy–responsive care, objective, psychometrically validated instruments for assessing nurses' health literacy practice knowledge have remained limited, particularly in Chinese-speaking contexts. The HLPKSN was created to fill that gap and to support competency-based nursing education.

The development process followed a multi-stage design. After pilot testing, the scale was administered as an online survey in November 2024 to a convenience sample of 434 registered nurses in Taiwan. The psychometric evaluation combined Classical Test Theory with Rasch analysis, examining both reliability and item statistics and how well individual items and respondents fit the measurement model.

The results indicated satisfactory performance at the item level. Mean item difficulty was 0.73 and mean item discrimination was 0.34, values the authors characterized as acceptable. Rasch model fit was good, with both Infit and Outfit statistics falling within the acceptable range of 0.7 to 1.3.

Item reliability reached 0.98 and item separation was 7.27, indicating that the 19 items were reliably ordered along the difficulty continuum. Performance at the person level was weaker. Person reliability was 0.59 and person separation was 1.20, which the researchers interpreted as meaning the scale distinguishes approximately two ability strata among respondents.

Because of this limited person separation, the authors conclude that the HLPKSN is currently best suited to group-level assessment rather than high-stakes individual discrimination. Despite that constraint, the study's conclusions position the scale as a content-valid and practice-oriented tool. The authors state that the HLPKSN provides an objective means of identifying knowledge gaps among nursing staff, evaluating educational interventions, and supporting competency-based nursing education and continuing professional development to strengthen health literacy–responsive nursing practice.

The findings carry caveats worth emphasizing. The sample was a convenience sample drawn from a single country and surveyed at one time point, so the results reflect that population and cannot be generalized automatically to nursing workforces elsewhere. The authors published the instrument as open access, allowing other research teams to examine and test it independently.

Subject of Research: Development and psychometric validation of the health literacy practice knowledge scale for nurses

Article Title: Development and psychometric validation of the health literacy practice knowledge scale for nurses

Article References: Chung, Y.-T., Cheng, S.-F., Chen, T.-L., & Kuo, C.-L. (2026). Development and psychometric validation of the health literacy practice knowledge scale for nurses. BMC Nursing. https://doi.org/10.1186/s12912-026-05584-x

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05584-x

Keywords: Development, psychometric, validation, health, literacy, practice, knowledge, scale, nurses, scientific research