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
- 1School of Nursing, Wannan Medical University , ,
- 2Department of Emergency, Yijishan Hospital of Wannan Medical University , ,
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.
Objective: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
Related
- Knowledge, attitudes, practices, and perceived barriers regarding artificial intelligence among undergraduate nursing students in Somalia: A cross-sectional study
- Resilience as an indirect pathway linking perceived skill development and institutional support with job satisfaction and burnout among nurses in Saudi Arabia: A cross-sectional study
- Dietary self-regulation levels among adults in Shanghai: cross-sectional associations with e-health literacy, perceived stress, and rest intolerance
- Association Between Health Literacy and Medication-Related Burden in Older Adults with Cardiometabolic Diseases: The Mediating Role of Perceived Social Support in a Cross-Sectional Study.
- Assessment of mental health literacy among non-medical undergraduate students of Makerere University, Uganda.
BibTeX
@article{wu2026selfperceived,
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}},
author = {Tong Wu and Xudong Fan and Xinle Zhou and Yingying Wang and Miao Wang},
journal = {Frontiers in public health},
year = {2026},
month = sep,
doi = {10.3389/fpubh.2026.1938122},
url = {https://europepmc.org/article/PMC/PMC13661974},
note = {CC BY},
}
RIS
TY - JOUR
TI - 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
AU - Tong Wu
AU - Xudong Fan
AU - Xinle Zhou
AU - Yingying Wang
AU - Miao Wang
PY - 2026
DA - 2026/09/30
JO - Frontiers in public health
DO - 10.3389/fpubh.2026.1938122
UR - https://europepmc.org/article/PMC/PMC13661974
AB - 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. Objective: 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. Methods: 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. Results: 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. Conclusion: 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.
SN - 2296-2565
ER -