{
  "abstract": "Background: Nursing studies have separately linked self-perceived digital literacy with self-reported innovative behavior and the clinical practice environment with creative self-efficacy and innovative behavior. A related association pattern has been reported among Chinese medical students, but joint evidence from multi-institutional nursing samples remains limited.\n\nObjective: To evaluate the measurement structure and examine the three-variable association pattern among self-perceived general digital literacy, creative self-efficacy, and self-reported innovative behavior in nursing students recruited from three institutions.\n\nMethods: A multi-institutional cross-sectional online survey conducted from September to December 2025 included 502 undergraduate nursing students from three medical higher-education institutions in Anhui Province, China. Item-level confirmatory factor analyses compared five theoretically plausible measurement models, and convergent and discriminant validity were evaluated before PROCESS Model 4 was applied to observed total scores. The primary analysis used 5,000 bootstrap resamples and eight theory-informed covariates.\n\nResults: Self-perceived general digital literacy was correlated with creative self-efficacy ( r = 0.574) and self-reported innovative behavior ( r = 0.584), while creative self-efficacy was strongly correlated with self-reported innovative behavior ( r = 0.834; all p < 0.001). The theory-consistent higher-order three-construct model showed acceptable fit ( χ ² = 1314.15, df = 426, CFI = 0.935, TLI = 0.929, RMSEA = 0.065, SRMR = 0.068), fitted substantially better than the one-factor model, and significantly outperformed the corresponding model combining creative self-efficacy and innovative behavior (Δ χ ² = 151.76, Δdf = 2, p < 0.001). Their latent correlation was 0.907, HTMT was 0.902 (95% CI, 0.858–0.941), and the Fornell-Larcker criterion was not met. In the adjusted observed-score model, the total coefficient, direct coefficient, and bootstrap product term involving creative self-efficacy were 0.145 (95% CI, 0.127–0.163), 0.040 (95% CI, 0.025–0.055), and 0.105 (95% CI, 0.087–0.124), respectively. The product-term confidence interval excluded zero, and its estimate was materially similar without covariate adjustment. A supplementary post hoc reparameterization based on the observed-score correlations indicated that the data did not uniquely determine the directional ordering.\n\nConclusion: In this pooled three-institution nursing-student sample, the three self-report constructs showed a coherent cross-sectional association pattern across measurement-model comparisons and adjusted and unadjusted specifications. This finding connects two previously separate lines of nursing evidence and extends the complete pattern beyond a single-campus nursing sample. Creative self-efficacy was a theoretically relevant correlate within the contemporaneous statistical decomposition, not an established temporal or causal mechanism. Longitudinal studies with objective or observer-rated measures are needed to test temporal ordering and educational or practice-relevant implications.",
  "abstract_shown": true,
  "affiliations": [
    "School of Nursing, Wannan Medical University , ,",
    "Department of Emergency, Yijishan Hospital of Wannan Medical University , ,"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Tong Wu"
    },
    {
      "affs": [
        0
      ],
      "name": "Xudong Fan"
    },
    {
      "affs": [
        0
      ],
      "name": "Xinle Zhou"
    },
    {
      "affs": [
        1
      ],
      "name": "Yingying Wang"
    },
    {
      "affs": [
        0
      ],
      "name": "Miao Wang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/c5fa816wjz2zh.bib",
  "cited_by": 0,
  "doi": "10.3389/fpubh.2026.1938122",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661974/?tool=EBI",
  "id": "c5fa816wjz2zh",
  "issns": [
    "2296-2565"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13661974",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2911|Healthcare Education and Workforce Issues"
    ]
  ],
  "openalex": "W7214892545",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661974/pdf/?tool=EBI",
  "pmcid": "PMC13661974",
  "pmid": null,
  "published": "2026-09-30",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/c5fa816wjz2zh.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:20Z",
      "native_id": "PMC:PMC13661974",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13661974"
    },
    {
      "first_seen": "2026-10-30T12:20:22Z",
      "native_id": "10.3389/fpubh.2026.1938122",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1938122/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:2296-2565",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Self-perceived digital literacy, creative self-efficacy, and self-reported innovative behavior among undergraduate nursing students in Anhui, China: a multi-institutional cross-sectional study",
  "title_text": "Self-perceived digital literacy, creative self-efficacy, and self-reported innovative behavior among undergraduate nursing students in Anhui, China: a multi-institutional cross-sectional study",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:22Z",
  "url": "https://research.draconitic.com/paper/c5fa816wjz2zh",
  "venue": "Frontiers in public health",
  "versions": []
}