Chinese Sleep Health Communication Scale Shows Preliminary Reliability but Weak Concurrent Validity

A new study published in BMC Nursing addresses part of that gap by translating a sleep-related measurement scale into Chinese and testing how well it performs psychometrically among hospital nurses in Southeast China.

The work, led by Xiang Fu, Feixin Yan, Qubo Huang and Yanjuan Lin, focused on the Sleep Health Communication scale, referred to in the study as the SHC. The researchers carried out the translation following the standard procedures of the classic Brislin translation model, a widely used approach for adapting measurement instruments across languages and cultures while preserving their intended meaning.

Data collection took the form of a cross-sectional survey conducted between May 1 and June 1, 2025, in a large general hospital located in Southeast China. Participants completed a battery that included demographic information, the Sleep Health Literacy scale (SHL), and the Anxiety and Preoccupation about Sleep Questionnaire (APSQ). The sample was divided for analysis: random subsample 1, comprising 317 participants, was used for item analysis and exploratory factor analysis, while random subsample 2, comprising 318 participants, was used to test internal consistency, perform confirmatory factor analysis, and calculate convergent and discriminant validity.

Reliability over time was assessed in a smaller group. Forty randomly selected participants were retested one month later to evaluate test-retest reliability. In addition, six experts in relevant disciplines were recruited to judge the content validity of the adapted scale, and concurrent validity was examined through Pearson correlation analysis between the total score of the SHC and the overall score of the APSQ.

The resulting Chinese version of the SHC scale comprised two dimensions with a total of nine items. Confirmatory factor analysis supported this two-factor structure with acceptable model fit indices, reporting a chi-square to degrees-of-freedom ratio of 2.946 and a root mean square error of approximation of 0.078, values generally considered indicative of a reasonable fit between the model and the observed data.

The reliability figures were reported as follows. The overall Cronbach’s alpha coefficient of the scale was 0.889, and the McDonald’s omega coefficient was 0.894, both suggesting good internal consistency. The test-retest reliability yielded a correlation coefficient of 0.881, and the two-way mixed-effects model intraclass correlation coefficient was 0.866, indicating that scores remained reasonably stable over the one-month interval.

Content validity results were also favourable. The item-level content validity index ranged from 0.833 to 1.000, and the scale-level average content validity index was 0.944, reflecting expert agreement that the translated items adequately represent the construct. However, the concurrent validity results were more cautious: the correlation between total SHC scores and total APSQ scores was r = −0.187, a statistically significant but weak association.

The authors were explicit about the limitations of these findings. In their conclusion, they state that the Chinese version of the scale, the SHC-C, exhibited preliminary reliability and validity, and they note that the overall concurrent validity with the APSQ was weak. They further report that the two-item Critical Application factor showed an even weaker, non-significant correlation and limited internal consistency, suggesting that this subscale may require particular scrutiny in future work.

The study team recommends that the psychometric properties of the SHC-C should be further validated using larger and more diverse samples. As a cross-sectional survey conducted in a single large general hospital over one month, with a modest retest subgroup of forty participants, the evidence base remains preliminary. The findings establish an initial Chinese-language instrument for measuring sleep health communication among nurses, while leaving open the question of how broadly and reliably it will perform beyond the population in which it was first tested.

Subject of Research: Translation and psychometric validation of a sleep health communication scale for Chinese nurses

Article Title: Translation and cultural adaptation of the sleep health literacy scale and psychometric validation of the sleep health communication scale

Article References: Fu, X., Yan, F., Huang, Q., & Lin, Y. (2026). Translation and cultural adaptation of the sleep health literacy scale and psychometric validation of the sleep health communication scale. BMC Nursing. https://doi.org/10.1186/s12912-026-05556-1

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05556-1

Keywords: sleep health, nurses, psychometrics, scale validation, cross-sectional survey, reliability, concurrent validity, BMC Nursing, China, translation, cultural, adaptation