Cross-cultural adaptation and psychometric validation of the Chinese version of the Attitudes of Nursing Staff towards Oral Healthcare for Care-Dependent Older Adults (ANOCO) scale
- 1School of Nursing, Wenzhou Medical University, Wenzhou, 325035 People’s Republic of China
- 2School of Nursing, Soochow University, Suzhou, 215006 People’s Republic of China
- 3School of Nursing, Hangzhou Normal University, Hangzhou, 321121 People’s Republic of China
Abstract
Objectives: To translate, culturally adapt, and psychometrically evaluate the Chinese version of the Attitudes of Nursing Staff towards Oral Healthcare for Care-Dependent Older Adults (ANOCO) questionnaire.
Methods: A cross-sectional descriptive design was used for this study. Guided by the Brislin translation model, we produced the Chinese ANOCO and enriched its content through qualitative interviews. Cross-cultural adaptation and item refinement were completed via expert consultation (n = 14) and cognitive testing with 30 nursing staff. A cross-sectional survey was administered to 240 registered nurses from 12 tertiary hospitals across six regions and 318 undergraduate nursing interns from three universities. Psychometric testing included exploratory and confirmatory factor analyses, Cronbach’s alpha, Spearman–Brown split-half reliability, and intraclass correlation coefficients.
Results: The finalized questionnaire contains 22 items organized into four dimensions. Item-level content validity indices ranged from 0.938 to 1.000, while the scale-level index reached 0.922. EFA extracted four factors explaining 73.261% of the total variance, and CFA demonstrated strong structural validity with good model fit. Reliability analyses yielded a Cronbach’s alpha of 0.947, split-half reliability.
Conclusions: The Chinese ANOCO is a reliable, valid, and clinically applicable tool for assessing nursing attitudes toward oral care for older adults, offering guidance for managerial decision-making, intervention planning, and educational evaluation.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12903-026-09501-1.
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BibTeX
@article{cheng2026crosscultural,
title = {{Cross-cultural adaptation and psychometric validation of the Chinese version of the Attitudes of Nursing Staff towards Oral Healthcare for Care-Dependent Older Adults (ANOCO) scale}},
author = {Linan Cheng and Xuancheng Chen},
journal = {BMC Oral Health},
year = {2026},
month = aug,
doi = {10.1186/s12903-026-09501-1},
url = {https://doi.org/10.1186/s12903-026-09501-1},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Cross-cultural adaptation and psychometric validation of the Chinese version of the Attitudes of Nursing Staff towards Oral Healthcare for Care-Dependent Older Adults (ANOCO) scale
AU - Linan Cheng
AU - Xuancheng Chen
PY - 2026
DA - 2026/08/01
JO - BMC Oral Health
DO - 10.1186/s12903-026-09501-1
UR - https://doi.org/10.1186/s12903-026-09501-1
AB - Objectives: To translate, culturally adapt, and psychometrically evaluate the Chinese version of the Attitudes of Nursing Staff towards Oral Healthcare for Care-Dependent Older Adults (ANOCO) questionnaire. Methods: A cross-sectional descriptive design was used for this study. Guided by the Brislin translation model, we produced the Chinese ANOCO and enriched its content through qualitative interviews. Cross-cultural adaptation and item refinement were completed via expert consultation (n = 14) and cognitive testing with 30 nursing staff. A cross-sectional survey was administered to 240 registered nurses from 12 tertiary hospitals across six regions and 318 undergraduate nursing interns from three universities. Psychometric testing included exploratory and confirmatory factor analyses, Cronbach’s alpha, Spearman–Brown split-half reliability, and intraclass correlation coefficients. Results: The finalized questionnaire contains 22 items organized into four dimensions. Item-level content validity indices ranged from 0.938 to 1.000, while the scale-level index reached 0.922. EFA extracted four factors explaining 73.261% of the total variance, and CFA demonstrated strong structural validity with good model fit. Reliability analyses yielded a Cronbach’s alpha of 0.947, split-half reliability. Conclusions: The Chinese ANOCO is a reliable, valid, and clinically applicable tool for assessing nursing attitudes toward oral care for older adults, offering guidance for managerial decision-making, intervention planning, and educational evaluation. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12903-026-09501-1.
SN - 1472-6831
ER -