Development and validation of an evaluation index system of health education competence for dental nurses in China: a mixed methods study.

BACKGROUND

The global prevalence of oral diseases has imposed substantial health and economic burden. In China, oral health knowledge, behaviors, and literacy among residents remain insufficient, highlighting the need for improvement. Thus, strengthening the health education competence of dental nurses is important to address this issue, enhance oral health education, and support the development of an effective evaluation system. Therefore, this study aimed to develop a set of evaluation tools to facilitate the scientific and objective assessment of dental nurses' health education competence.

METHODS

A mixed-methods approach integrating qualitative and quantitative research methods was employed. Initially, we constructed a pool of index system items through a thorough literature review and semi-structured interviews. The initial draft was then refined using the Delphi method, which involved expert consensus to enhance accuracy and relevance. We determined the weights of the items using the Analytic Hierarchy Process, and to assess the reliability and validity of the constructed system, a questionnaire survey was conducted, followed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).

RESULTS

A total of 15 experts, including dental nursing and dentistry professionals, participated in the Delphi process, resulting in 3 primary, 11 secondary, and 46 tertiary indicators. The experts' enthusiasm in the two rounds was 93.75% and 100%, with authority coefficients of 0.88 and 0.92, and coordination coefficients ranging from 0.10 to 0.41 and 0.10-0.22, respectively. A total of 425 questionnaires were collected, with a Cronbach's α value of 0.978. EFA identified four common factors and led to the exclusion of 15 items, leaving 31 items that explained 70.43% of the total variance. The final evaluation system included 4 primary, 9 secondary, and 31 tertiary indicators. CFA showed good model fit (χ/df = 1.538, GFI = 0.966, AGFI = 0.927, RMSEA = 0.050). The combination reliability (CR) values of the four primary indicators were all above 0.70 (0.82, 0.94, 0.86, 0.88), and the average variance extracted (AVE) values were all above 0.5 (0.70, 0.84, 0.76, 0.79), indicating good reliability and validity.

CONCLUSION

The evaluation tool constructed in this study demonstrates adequate psychometric properties (e.g., reliability and validity) and can serve as a valuable resource for evaluating the health education competence of dental nurses in China, ultimately informing the development of targeted strategies to enhance their skills and improve public oral health outcomes.