ORIGINAL RESEARCH article
Front. Public Health
Sec. Public Health Education and Promotion
Transcultural adaptation and psychometric evaluation of the Chinese version Attitude and Confidence with Oral Healthcare among Nursing Students Scale: a cross-sectional survey in China
Provisionally accepted
Yaqin Li1,2*
Chengyang Xie1Yan Yue1
Weihao Kong1Yuexuan Ma1Kefan Chen1Biyao Liu1
Xiaoli Liao3Lingli Li1,4*- 1West China Hospital of Sichuan University, Chengdu, China
- 2The Hong Kong Polytechnic University, Hong Kong, Hong Kong, SAR China
- 3Sun Yat-Sen University, Guangzhou, China
- 4Nursing Key Laboratory of Sichuan Province, Chengdu, China
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Objective: Positive attitude and strong confidence toward oral healthcare among nursing students are essential prerequisites for providing quality oral healthcare, which directly impacts the likelihood and effectiveness of their post-training care practices. However, no validated scale currently available in China for measuring nursing students' oral healthcare-related attitude and confidence. This study aims to adapt the original English version Attitude and Confidence with Oral Healthcare among Nursing Students (ACORN) Scale into Chinese culture and assess its psychometric properties. Methods: This study followed the Brislin Translation Model, including forward translation, back translation, and expert consultation (consultation of the differences between the original English version and the synthesized back-translated version ACORN scale with the original author, pilot testing, expert consultation, and bilingual testing). The formal experiment was conducted across eight universities offering bachelor' s nursing programs in China (Chengdu and Shenyang City), involving 536 nursing students who had completed oral healthcare courses. Item analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and reliability testing (internal consistency and test-retest reliability) were conducted. The data was divided into two equal sets using the random number table function in SPSS—one for EFA and the other for CFA. Results: The EFA extracted three dimensions, including 2 / 21 attitudes toward oral care (8 items), confidence in oral care practices (4 items), and confidence in diagnosing oral diseases (10 items), with a cumulative variance contribution rate of 66.33%. The CFA confirmed the three-factor structure with excellent model-fit indicators. The overall Cronbach's alpha for the Chinese version ACORN scale was 0.95, with the three dimensions having values of Cronbach's alphas of 0.92, 0.85, and 0.94, respectively. Twenty nursing students participated in test-retest survey after a two-week interval, resulting in a test-retest value of 0.76. Conclusion: The Chinese version ACORN scale exhibits strong reliability and validity performances, can be used to assess the oral care-related attitudes and confidence of nursing students in China.
Keywords: Transcultural adaptation, psychometric evaluation, Attitude, confidence, oralhealthcare, nursing students
Received: 20 Aug 2025; Accepted: 03 Nov 2025.
Copyright: © 2025 Li, Xie, Yue, Kong, Ma, Chen, Liu, Liao and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Yaqin Li, yaqinli0809@gmail.com
Lingli Li, lilingli2000@126.com
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