Student nurses' knowledge and skills of children's environmental health: Instrument development and psychometric analysis using item response theory

Abstract

Background: Climate change has an important impact on health, particularly in children. Therefore, the inclusion of environmental issues in the undergraduate nursing curriculum is essential. Knowledge and skills in environmental sustainability can be measured through questionnaires. Objectives: The aim of this study was to develop and validate the Children's Environmental Health Knowledge Questionnaire (ChEHK-Q) and the Children's Environmental Health Skills Questionnaire (ChEHS-Q) to measure knowledge and skills, respectively, about children's environmental health in nursing students. Design: This was an observational, cross-sectional study undertaken in four phases: (1) Development of the questionnaire and item wording, (2) content validation by an expert panel, (3) pilot test and (4) psychometric evaluation. Settings: A Faculty of Health Sciences in Spain. Participants: 308 nursing students enrolled in the first, third and fourth years of study. Methods: The development and validation of the children's environmental health questionnaires was carried out based on the item response theory. Results: The 26-item ChEHK-Q shows good fit and reliability of 0.98 for items and 0.70 for people based on the Rasch Model. The 12-item ChEHS-Q also shows good fit and reliability of 0.87 for items and 0.76 for people based on Andrich's rating scale model. The temporal stability measured using the intraclass correlation coefficient was 0.86 in the ChEHK-Q and 0.73 in the ChEHS-Q. Both questionnaires present enough evidence for construct validity; they work well to distinguish between nursing students with low or high knowledge of or skills in children's environmental health. Conclusions: The Children's Environmental Health Knowledge Questionnaire and the Children's Environmental Health Skills Questionnaire are useful tools for measuring knowledge and skills, respectively, among nursing students. This validation study obtained good psychometric properties concerning validity and reliability.