Reliability and validity of the Chinese version of the Oxford Positive Self Scale in Chinese Nursing Undergraduates

doi:10.21203/rs.3.rs-4923233/v1

Background

According to the recent report of the China National Mental Health Survey, young Chinese people are a high-risk group for depression among the entire adult population, and the detection rate of depression risk in Chinese individuals aged 18–24 years is as high as 24.1%, which is significantly higher than that of other age groups. Hence, it is essential to study the mental health of the Chinese youth population. People with a positive self-mindset tend to have a higher sense of self-efficacy, and when these people encounter adversities and face challenges in their lives, they are more active in finding approaches and mobilizing resources to combat them. Currently, most research studies on the positive self-concept in Chinese people have focused on the users of social media networks, and there is a lack of research on the positive self-concept level in the general population. Although individual self-concept scales, mainly the Adversity Beliefs Scale and the Self-Concept Scale, have been used in previous research, these scales do not directly measure an individual’s beliefs about the positive self-concept. Therefore, in the present study, the Oxford Positive Self Scale (OxPos) was translated into Chinese, and the psychometric properties of the Chinese version were assessed in nursing undergraduates as the research subjects.

Method

This study was conducted from April 2024 to August 2024 by recruiting undergraduate nursing students from freshman year to junior year of an undergraduate college. A total of 514 valid questionnaires were collected. The Chinese translation process of the OxPos, including both forward and backward translations, strictly adhered to the Brislin’s model and was followed by necessary modifications. Item analyses were performed using critical ratios and item-total correlation coefficients. Validity assessments included content validity, structural validity, and validity scale correlation validity. Scale reliability was determined by Cronbach’s alpha coefficient, retest reliability, and split-half reliability coefficient.

Results

The Chinese OxPos version included 24 entries in 4 dimensions with a cumulative variance contribution rate of 87.27%. The content validity index of the scale for this survey was 0.875. Exploratory factor analysis showed that the Chinese OxPos version was consistent with the dimensional division of the original scale. The validation factor analysis showed a satisfactory fit index. The Cronbach’s alpha coefficient, re-test reliability, and split-half reliability coefficient of the Chinese OxPos version were 0.935, 0.978, and 0.845, respectively.

Conclusion

After a rigorous process of adaptation to the Chinese context, the Chinese version of OxPos showed good psychometric properties. The scale proved helpful as a research tool for assessing the positive self-concept level in the Chinese cultural context.

Undergraduate nursing students

positive self-concept

reliability

validity

psychometric properties

According to the World Health Organization[¹], nearly 1 billion people worldwide (including 14% of the world’s youth population) suffer from mental disorders. Suicide accounts for more than 1 in 100 deaths, and 58% of suicides are reported in individuals aged below 50 years. Mental disorders are the leading cause of disability, leading to one in six years of healthy life lost due to disability. People with severe mental health issues die on average 10–20 years earlier than the general population, largely due to preventable physical illnesses. Sexual abuse and bullying in childhood are the major causes of depression. Social and economic inequalities, public health emergencies, wars, and natural disasters due to climatic changes are the global structural threats to mental health. Moreover, depression and anxiety disorders increased by more than 25% in the first year of the COVID-19 epidemic alone.

According to the National Mental Health Survey Report 2022: Current Situation, Influencing Factors and Service Status², among the Chinese adult population, youths are at a high risk of developing depression, and the detection rate of depression risk in young Chinese people aged 18–24 years is as high as 24.1%, which is significantly higher than that of other age groups. The detection rate of depression risk in the age group 25–34 years was 12.3%, which was significantly lower than that of the age group 18–24 years but significantly higher than that of all age groups of 35 years and above. The anxiety risk detection rates in the different age groups also showed similar trends. Mental health is an important component of one’s overall health, which is associated with the well-being of the general public and affects the harmonious development of society. Hence, strengthening mental health services and optimizing the psychosocial service system are the key measures to improve public mental health, promote social stability and interpersonal harmony, and enhance the public’s perception of well-being^[³^]

Beliefs are a set of principles and values originating from the combination of emotions, cognition, and self-will and determine how individuals feel, think, and act socially. People with a positive self-belief have a higher sense of self-efficacy, which is the individual’s assessment of his or her ability to cope successfully with a given situation. When such people encounter adversities and face challenging conditions in their lives, they become more active in searching for solutions and mobilizing resources to meet their challenges; they also set realistic goals, and gradually pursue them through various efforts and self-motivation (high sense of self-efficacy). Seligman, president of the American Psychological Association, states that in the field of psychology, establishing a positive self-perception is an important factor to develop mental health ^[⁴^]. Some studies have shown that^[⁵^]. An organization that enables its employees to develop a positive view of themselves can promote its progress toward success. Focusing on the positive self-perception and positive self-efficacy of individuals from the perspective of psychology can help stimulate the intrinsic motivation of college students to learn, increase their autonomy and commitment to learning, and thus enhance the quality of their talent^[⁶^]. In older persons, a positive self-perception of ageing enhances physical resilience and facilitates the social reintegration of elderly individuals with depressive behavior^[⁷^]. Therefore, enhancing positive self-beliefs and self-perceptions can be beneficial for all persons, regardless of whether they are college students, social workers, or elderly individuals.

Currently, most of the domestic research on positive self-concept in China focuses on the display of positive self-images on social media networks; however, positive self-concept in the general Chinese population has not yet been reported, and the domestic scales on self-concept do not directly measure the positive self-beliefs of Chinese individuals. Current research^[⁸^] suggests that undergraduate nursing students experience more pressure than students of other specialties, which could easily lead to sleep disorder, anxiety, and other psychological problems and ultimately result in the development of mental health issues. Undergraduate nursing students are the main clinical workforce in the future; hence, it is not only critical to improve their professional knowledge and operational skills, but also important to ensure that their physical and mental health issues are addressed^[⁹^].

Prof. Freeman[8] developed the Oxford Positive Self Scale (OxPos) assessment tool to assess people’s level of positive self-concept. The scale has 4 dimensions and 24 entries, and it yielded acceptable results in terms of reliability and validity. This scale was developed based on the dual continuum model of mental health and mental illness, which states that mental health and mental illness are considered related but distinct concepts, and that individuals can experience high levels of positive mental health even when they are diagnosed with a mental illness^[¹⁰^]. This theory classifies the population into four main groups: psychologically healthy, psychologically unhealthy, mentally ill, and not mentally ill. It should be noted that psychologically healthy people are also at a risk of developing a mental illness; hence, this group also requires prompt screening and intervention.

In the present study, to determine the level of positive self-concept in the general Chinese population, a Chinese version of the OxPos was developed for undergraduate nursing students as the study population. The OxPos was translated into Chinese according to the Brislin’s model of translation and cross-cultural adaptation^[¹¹^], and the psychometric properties of the Chinese version were assessed through item analysis, content validity analysis, structural validity analysis, calibration correlation validity, and reliability analysis.

2.1 Study design and participants

This study was conducted from April 2024 to August 2024 to allow the selection of undergraduate nursing students in their freshman through junior years at an undergraduate institution. The inclusion criteria were as follows: (1) enrolled as current undergraduate nursing students; (2) provided informed consent and showed willingness to cooperate in a research study; and (3) had hospital internship or apprenticeship experience. This study was authorized by Prof. Freeman and approved by the Ethics Committee of Wannan Medical College (Ethics approval number: (2024) Ethics No. (164)). Before the survey, we clearly explained to the students the purpose of the questionnaire, the meaning of all questions, and the precautions to be taken while responding. According to Kendall’s sample size estimation method^[¹²^], the required sample size in this study was 5- to 10-fold of the variant, and the data of 274 students were included in the exploratory factor analysis (EFA) after considering an attrition rate of 10–20%. The sample size requirement for the confirmatory factor analysis (CFA) was > 200^[¹³^], and the data of 240 students were included in the CFA after considering an attrition rate of 10–20%.

2.2 Instruments

2.2.1 General information questionnaire

The general information questionnaire was self-designed by the researcher based on organized reading of literature related to mental health of undergraduate nursing students. It included entries such as the major course subject, gender, grade level, whether the undergraduate was a student leader, plans for career, whether the undergraduate had any relatives in the nursing or healthcare professions, reasons for choosing nursing as the major course subject, and the highest level of education of parents.

2.2.2 The OxPos

The OxPos was developed by Freeman^[¹⁴^], a British psychologist, as a tool for assessing the degree of positive self-beliefs. For the present study, Prof. Freeman provided authorization to develop the Chinese version of the scale. The scale comprises 24 entries in 4 dimensions, namely Mastery, Strength, Enjoyment, and Character. It is scored on a 5-point scale, with a score of 0–4 assigned in the descending order from “Do not believe it,” “Believe it slightly,” “Believe it moderately,” “Believe it highly,” and “Believe it completely.” The higher the score the stronger is the positive self-belief. The overall Kaiser-Meyer-Olkin (KMO) value of the scale was 0.99, and the KMO value for the 24 entries was > 0.98; McDonald’s ω coefficients for the four sub-dimensions were 0.93, 0.94, 0.92, and 0.88, respectively, and the overall McDonald’s ω coefficient of the scale was 0.92.

2.2.3 Core Self-evaluations Scale (CSES)

The CSES was developed by Judge^[¹⁵^] in 2003 to measure the core self-evaluation level of individuals. It was adapted to the Chinese context and revised by the Chinese scholar Du Jianzheng in 2012[¹⁶], and since then, it has been widely used by university students and staff. The scale is a unidimensional self-report scale comprising 10 items on a 5-point scale, with scores 1 to 5 indicating “completely disagree,” “disagree,” “not sure,” “agree,” and “completely agree,” respectively. Entries 2, 3, 5, 7, 8, and 10 are reverse scoring questions. The total score ranges from 10 to 50, with higher scores indicating a higher level of core self-evaluation by the respondent. The Cronbach’s alpha coefficient, split-half reliability, and retest reliability at a 3-week interval for the scale were 0.83, 0.84, and 0.82, respectively.

2.3 Translation and revision of the OxPos

We obtained the authorization of the original authors of the scales by email and followed the Brislin’s model of translation and cross-cultural adaptation[11] to adapt the OxPos to the Chinese context through forward and backward translations.

(1) Positive translation: the scale was independently translated into two Chinese versions of the scale by a foreign doctor of nursing in training and a master’s student of nursing who had passed the sixth grade of English. The researcher discussed and compared the two scales with a senior doctor of nursing and compared the two versions to obtain the first draft of the Chinese version A according to the Chinese linguistic habits and cultural background.

(2) Back-translation: A master’s degree holder in English with three years of experience in studying abroad and a university English teacher were invited to back-translate the first draft of the Chinese version A; both of them had not been previously exposed to the original scale. After two independent back-translations were obtained, the group discussed the formation of the final back-translation of the Chinese version B. After comparing it with the original scale, the first draft of the Chinese version B was formed.

(3) Cultural debugging: Four nursing education experts, one psychiatric mental health expert, and one clinical nursing expert (each with more than 10 years of experience) were invited to evaluate the clarity and accuracy of the entries in the Chinese version B of the first draft of OxPos, the cultural context of each entry of the scale, and the relevance of the dimensions to which they belong.

According to the experts’ opinions, the content of the scale was revised as follows: (1) Entry 12, “I rise to the challenge” was changed to “I dare to meet the challenge” in accordance with the Chinese context and (2) Entry 21, “I am reliable” did not agree with the Chinese grammatical syntax and was changed to “I am very reliable.” The remaining scale items and dimensions were consistent with the original scale.

Six additional experts were invited for the cultural debugging of the scale, including two experts in nursing education, two experts in clinical nursing, and two experts in psychiatric and mental health. The selection criteria for the experts were as follows: (1) at least 10 years of relevant research in the field of psychiatry, psychiatric nursing, and education and (2) a doctoral degree or an associate or higher job designation. The expert panel comprised six women, four of whom had a doctoral degree, one had a master’s degree, and one had a bachelor’s degree, with an average of 19.83 ± 3.19 years of professional experience. After cross-cultural adjustment, the paper version of the questionnaire was distributed to a group of 30 students in a small class with the consent of the grade counselor, and the questionnaire data were collected after informed consent was received from the nursing students. Based on the feedback from the pre-experimental responses of the subjects, the rationality and readability of the entries were considered, and the Chinese OxPos version was finalized.

2.4 Data collection

Formal survey: In this survey, the link to Questionnaire Star was forwarded to the students after the consent of the counselor, and the completed questionnaires were collected online. Questionnaire Star set the same IP restriction to fill the questionnaire once and to exclude questions with the same option as answers or with apparent logical errors. A total of 544 questionnaires were collected in this study, of which 514 questionnaires remained after invalid questionnaires were excluded, with a sample recovery validity rate of 94.5%. Two weeks after the first assessment, 30 nursing students were selected from the sample of the initial survey for retesting to evaluate the retest reliability of the Chinese version of the OxPos.

2.5 Statistical analysis

All data were analyzed using AMOS 25.0 and SPSS 26.0. Quantitative data were expressed as mean ± standard deviation (‾x ± s), and qualitative data were expressed as frequency and percentage (%). Statistical significance was defined as P < 0.05.

2.5.1 Item analysis

Item analysis was performed using the critical ratio and correlation coefficient methods. Critical ratios were used to determine the degree of differentiation of items, with ratio ≥ 3 indicating adequate differentiation^[¹⁷^]. Homogeneity was assessed by calculating item factor correlation coefficient, with coefficient ≥ 0.40 indicating satisfactory homogeneity[17].

2.5.2 Content validity analysis

Six experts in related fields were invited to evaluate the content validity of the scale items and correlations. The item-content validity index (I-CVI) for each item was calculated by dividing the number of experts who assigned the score of 3 or 4 to an item by the total number of participating experts. The scale-content validity index (S-CVI) was determined by averaging the I-CVI values of all items. According to the criteria reported by Lynn^[¹⁸^] and Davis^[¹⁹^], when the number of experts is 6 or more, I-CVI ≥ 0.78 and S-CVI (S-CVI/UA) > 0.8 indicate good scale content validity.

2.5.3 Structural validity analysis

EFA and CFA were used to assess the construct validity of the Chinese OxPos version. The collected samples were randomly divided into two groups of subsamples. Sub-sample 1 (n = 274) was used for the EFA and sub-sample 2 (n = 240) was used for the CFA.

The EFA was used to determine the basic structure of the scale factors^[²⁰^]. If the KMO value is greater than 0.60 and the Bartlett’s test of sphericity shows a significant value, it indicates that EFA can be performed^[²¹^]. According to the principal axis factorization method, the principle of eigenvalues greater than 1 and the Promax rotation method to extract the factors, four conditions must be satisfied: (1) all factor loadings are greater than 0.40; (2) the absolute value of the difference between the two factor loadings is at least greater than 0.20; (3) at least three extracted items are attributed to a factor; and (4) the cumulative variance contribution is greater than 0.4[²²].

CFA was conducted to further validate the rationality of the model factor structure. The maximum likelihood ratio method was used to construct the structural equation model, and CFA was performed with items and factors as observed and latent variables, respectively. The fitting of the structural equation model depended on the following conditions: (1) chi-square degree of freedom (χ²/ν) < 3, (2) Tucker-Lewis index (TLI), comparative fit index (CFI), goodness-of-fit index (GFI), and incremental fit index (IFI) > 0.90, and (3) root mean square error of approximation (RMSEA) < 0.08.

In general, the RMSEA values of > 0.08, 0.05–0.08, and < 0.05 indicate poor model fit, acceptable model fit, and good model fit, respectively^[²³^].

2.5.4 Criterion-related validity

Criterion-related validity is the degree of correlation between a test measurement scale and a criterion scale determined using a recognized valid scale as the criterion. In this study, the CSES scale was used as a calibration standard for assessment, and Pearson’s correlation analysis was performed to examine the correlation between the Chinese OxPos version and the CSES scale. The correlation coefficient values of r > 0.7, 0.4 < r < 0.7, and < 0.4 indicate high, moderate, and low validity of the test, respectively^[²⁴^].

2.5.5 Reliability analysis

Internal consistency was assessed by determining split-half reliability coefficient and Cronbach’s alpha coefficient. Subsequently, 30 undergraduate nursing students were reassessed 2 weeks later using the same scale to determine retest reliability. It is known that all these indicators must exceed the value of 0.70 for a scale to demonstrate good reliability^[²⁵^].

3.1 Participant characteristics

A total of 544 questionnaires were collected, and 514 questionnaires remained after excluding the invalid ones, with the recovery rate of 94.49%. The respondents were freshman to junior undergraduate college students majoring in nursing and aged between 18 and 24 years. The survey results showed that 162 (31.5%) were freshman nursing students, 171 (33.3%) were sophomore nursing students, and 181 (35.2%) were junior nursing students. The majority of the respondents were females (398/514), mainly because of the predominance of females in the nursing profession. A total of 13.4% (69/514) of the students enrolled in the nursing program based on their own preference, 20.8% (107/514) of the students received advice from their parents and family members, 24.3% (125/514) of the students received transfers, and 28.8% of the students (148/514) chose the nursing program for employment purpose. The participant details are provided in Table 1.

Table 1

Details of participant characteristics (n = 514)
Item	Group	Number(n)	Percent (%)
Major	Midwifery	56	10.9
Major	Nursing	458	89.1
Gender	Male	116	22.6
Gender	Female	398	77.4
Humanities nursing students or Science nursing students	Humanities nursing students	281	54.7
Humanities nursing students or Science nursing students	Science nursing students	233	45.3
Grade	Freshman	162	31.5
	Sophomore	171	33.3
	Junior student	181	35.2
Are you an only child?	Yes	249	48.4
Are you an only child?	No	265	51.6
Admission with or without transfer of major	Yes	289	56.2
Admission with or without transfer of major	No	225	43.8
Do you serve as a student officer?	Yes	200	38.9
Do you serve as a student officer?	No	314	61.1
Have you ever received a scholarship?	Yes	184	35.8
Have you ever received a scholarship?	No	330	64.2
Are you planning your career?	Yes	270	52.5
Are you planning your career?	No	244	47.5
Do you have relatives in the caring or medical profession?	Yes	194	37.7
Do you have relatives in the caring or medical profession?	No	320	62.3
Reasons why you chose the nursing profession	Own preference	69	13.4
	Parental and family recommendations	107	20.8
	Transfer	125	24.3
	Affected by employment situation	148	28.8
	Other reasons	65	12.6
What do you think about the future of nursing?	Popular profession	124	24.1
	General profession	306	59.5
	Lesser known profession	84	16.3

3.2 Item analysis

According to item analysis, the decision value (CR) was 14.784–25.209 (CR > 3.000), and the difference was statistically significant (p < 0.01); moreover, the differentiation of the entries was good, and the entries were retained. The Pearson’s correlation coefficient analysis showed that the correlation coefficients between the scores of each item and the total scores of the scale were 0.569–0.696 (p < 0.01), thus suggesting that the items were well represented and that no items were deleted. Additionally, the Cronbach’s alpha coefficient of the corresponding factors decreased after deleting any of the items; thus, all 24 items were retained. The details of the analyses are provided in Table 2.

Table 2. Item analysis for the Chinese OxPos version (n = 514)
Factor	Item	Item score	Critical ratio	The correlation coefficient between the Item and the total score	Cronbach’s α of factor	Cronbach’s alpha, if an item deleted
Factor 1	a01	3.36±1.265	17.184	0.636^**	0.914	0.933
	a02	3.40±1.218	20.415	0.652^**		0.933
	a03	3.32±1.242	18.668	0.612^**		0.933
	a04	3.33±1.296	18.301	0.625^**		0.933
	a05	3.19±1.292	16.990	0.612^**		0.933
	a06	3.40±1.265	22.519	0.695^**		0.932
	a07	3.31±1.262	16.881	0.611^**		0.933
Factor 2	a08	3.17±1.299	18.555	0.626^**	0.926	0.933
	a09	3.29±1.270	25.209	0.687^**		0.932
	a10	3.28±1.272	23.323	0.677^**		0.932
	a11	3.22±1.264	17.550	0.617^**		0.933
	a12	3.23±1.231	18.714	0.652^**		0.933
	a13	3.28±1.262	22.484	0.696^**		0.932
	a14	3.24±1.313	20.545	0.644^**		0.933
	a15	3.35±1.259	19.295	0.662^**		0.932
Factor 3	a16	3.41±1.244	18.720	0.663^**	0.898	0.932
	a17	3.35±1.230	19.973	0.638^**		0.933
	a18	3.40±1.287	17.941	0.594^**		0.934
	a19	3.34±1.232	18.723	0.640^**		0.933
	a20	3.32±1.213	18.982	0.618^**		0.933
Factor 4	a21	3.32±1.248	15.903	0.619^**	0.875	0.933
	a22	3.34±1.238	15.117	0.569^**		0.934
	a23	3.37±1.238	14.784	0.597^**		0.933
	a24	3.36±1.237	15.764	0.590^**		0.934

“**”represents p < 0.01, which indicates a significant correlation.

3.3 Content validity

Six experts in related fields were invited to evaluate the content validity of the scale entries and correlations. The Chinese OxPos version had an I-CVI of 0.833–1.000 for each entry and an S-CVI of 0.875. The content validity of this study was within the acceptable range, and the scale had good content validity.

3.4 Structural validity

The EFA results showed a KMO value of 0.95 and a significant Bartlett’s sphericity test (χ² = 8991.805, df = 276, p < 0.001). Four common factors with eigenroots greater than 1 were extracted, with a cumulative variance contribution of 87.274%. The factor loadings of the entries on the dimensions to which they belonged in the component matrix after maximal variance orthogonal rotation were > 0.4, and the factor loadings of the entries of the scale ranged from 0.816 to 0.902, as shown in Table 3.

Table 3

Factor loading of each item in the Chinese OxPos version (n = 274)
Item	Factor 1	Factor 2	Factor 3	Factor 4
15. I can do things as well as anyone else	0.893
09. I can keep going	0.886
13. I don’t give up	0.885
12. I dare to meet the challenge	0.885
10. I can succeed in challenging situations	0.875
14. I will be okay	0.875
11. I can cope with anything	0.867
08. I am strong	0.862
05. I can do things well		0.891
02. I am useful		0.885
04. I can achieve things		0.878
03. I have a purpose		0.877
07. I am worthwhile		0.871
06. I can succeed		0.862
01. I can make a difference		0.857
18. I can switch off			0.902
17. I can relax			0.878
19. I can have fun			0.868
20. I can do fun things			0.843
16. I can enjoy things			0.816
22. I am thoughtful				0.886
23. I am a good person				0.856
24. I am helpful				0.836
21. I am very reliable				0.826

The CFA showed the following results for the model fit indices: χ²/ν = 1.578, GFI = 0.889, IFI = 0.925, CFI = 0.924, TLI = 0.914, and RMSEA = 0.049. The standardized regression coefficients of the 24 entries were 0.470–0.644 (p < 0.001). Two model corrections were performed based on the larger two correction indices, and two residual paths were added (e5 and e8, and e11 and e14). The results of the two corrections achieved the ideal fitting effect, and the Chinese data fitted well with the original four-factor structural model. The OxPos-corrected structural model (n = 240) is shown in Fig. 1.

3.5 Criterion-related validity

The Chinese version of the CSES was used as a calibration scale to analyze its correlation with the total score and dimensions of OxPos. The results showed that the total scores of the two scales were positively correlated (r = 0.581, p < 0.01). The correlation coefficients of the OxPos dimensions with the CSES were 0.391, 0.566, 0.383, and 0.389, respectively (p < 0.01).

3.6 Reliability analysis

The Cronbach’s alpha coefficients for each dimension of the Chinese OxPos version were 0.875–0.926, and the split-half reliability coefficients for each dimension were 0.879–0.926. Thirty nursing students in the same class were retested 2 weeks after the initial survey, and the retest reliability values for each dimension of the scale were 0.874–0.931 (Table 4).

Table 4

Reliability of the Chinese OxPos version (n = 514)
Name	Item number	Cronbach’α coefficient	Retest reliability	Split-half reliability coefficient
Overall scale	24	0.935	0.978	0.845
Mastery dimension	7	0.914	0.931	0.909
Strength dimension	8	0.926	0.930	0.926
Enjoyment dimension	5	0.898	0.885	0.889
Character dimension	4	0.875	0.874	0.879

4.1 The meaning and application value of the Chinese OxPos version

Knowledge of positive self-perception is important. Nursing students with higher levels of positive self-perceptions have good self-efficacy, high self-esteem, and stable emotions and internal control; moreover, they tend to be more positive under academic pressures and difficulties during their school years and have lower levels of academic burnout. Prof. Bian Yufang believes that the youth group is divided into three categories: mentally healthy, having a tendency to develop psychological issues, and already have psychological issues. For the 80% of young people who are psychologically healthy, schools, families, and society should cultivate their positive self-quality, which will benefit them for life^[²⁶^]. Zhou et al.^[²⁷^] concluded that positive upbringing is associated with a lower risk of depression, anxiety, self-injurious behaviors, and suicidal ideation in adolescents and called for more support and assistance from family, school, and peers. Assessing the level of positive self-concept can also help promote disease recovery in the elderly population. Wu et al. ^[²⁸^] surveyed 1198 Chinese older adults over the age of 60 years in China and found that the likelihood of disease recovery was reduced by 50.3% in older adults with a low level of positive mental health (debilitating) and by 29.8% in older adults with a moderate level of positive mental health; this implies that older adults with a high level of positive mental health showed better disease recovery, had lower treatment cost and reduced treatment time, had better treatment experience, and had lower number of comorbidities.

Thus far, there have been no studies on the application of this scale to evaluate the positive self level of the general population in China. The Chinese OxPos version can more effectively evaluate the positive self level of the general population in China, and the introduction of this scale can provide a helpful tool to Chinese researchers to conduct relevant studies in psychology.

4.2 The psychometric properties of the Chinese OxPos version

A preliminary survey of 30 students revealed that the semantic expression of the Chinese OxPos version was clear and easy to understand, and the scale structure was reasonable. The Chinese OxPos version was analyzed by item analysis, and the results showed that the CR of the decision value was 14.784–25.209, which indicated that the differentiation of the scale entries was good. The correlation coefficients between the scores of each entry of the scale and the total score were 0.569–0.696, which were greater than 0.4, thus indicating that the homogeneity of the scale was good. After deleting each item, none of the Cronbach’s alpha values exceeded the original values of the translation scale.

The validity of a scale refers to the validity of the findings of a measurement instrument and is typically measured using content and structural validity^[²⁹^]. Here, we invited six clinical experts to assess the semantic form, linguistic conventions, professional nature, and content validity of the Chinese OxPos version. The experts reviewed the content validity of the scale items and agreed that the original form of the scale showed good content validity.

The content validity indices I-CVI and S-CVI showed values of 0.833–1.000 and 0.875, which were within the reasonable standards. The EFA results showed that the four main factors of the Chinese OxPos version explained 87.274% of the total variance, and these four factors were consistent with the dimensional division of the original scale. The model obtained from the CFA was a good fit after two corrections, which suggested good structural validity of the scale. We also used the CSES as a calibration scale, and Pearson’s correlation analysis showed that the correlation coefficients between the two scales (r = 0.581, p < 0.01) were moderately significant and positive. Overall, the Chinese OxPos version showed appropriate validity among the undergraduate nursing students.

Reliability represents the consistency and stability of the measurement instrument^[³⁰^]. The Cronbach’s alpha coefficient for the Chinese OxPos version was 0.935, and the Cronbach’s alpha coefficients for the dimensions were 0.875–0.926. The split-half reliability coefficient was 0.845, and the split-half reliability coefficients for the dimensions were 0.879–0.926. The McDonald’s ω coefficient of the original scale was 0.92, and the McDonald’s ω coefficients of the four subdimensions were 0.88–0.94. The reliability of the dimensions after adaptation to the Chinese context was lower than that of the original scale; however, in general, the reliability values after adaptation to the Chinese context were at a better level, and the re-test reliability of the scale with a 2-week interval was 0.978, which indicated that the scale had good stability across time.

4.3 Limitation and perspectives

The present study has some limitations. First, only undergraduate nursing students were selected as the subjects for reliability testing; hence, future research is required to further expand the validation population for the Chinese OxPos version. Second, this scale is a self-assessment scale; consequently, subjects often subconsciously chose the correct answer instead of their true thoughts. Thus, bias was inevitable in this study. Third, because of the unbalanced ratio of male and female nursing students in this study and the influence of the social environment as reported previously, male nursing students have misconceptions about the nursing profession when attending the program; moreover, this traditional perception may affect the level of positive ego of male nursing students. Future research should test the Chinese OxPos version based on balancing traditional perceptions and gender.

The English OxPos version was successfully translated and adapted to Chinese culture, and the psychometric properties of the Chinese version were validated among undergraduate nursing students. Factor analysis showed that the Chinese OxPos version was dimensionally consistent with the original scale, with adequate reliability and validity. The present study showed that the Chinese OxPos version is a useful research tool to assess the level of positive self-concept in the Chinese cultural context.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Funding

This study was funded by the Doctoral Scientific Research Foundation of Wannan Medical College (Grant number: WYRCQD2023043) and the Anhui Province Higher Education Quality Project Foundation (Grant number: 2023jyxm0660).

Author Contribution

LT: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Software, Supervision, Validation, Writing – original draft, Writing – review & editing. WW and GZ: Formal analysis, Investigation, Methodology, Software, Validation, Writing – review & editing. ZW and ZD: Investigation, Methodology, Supervision, Validation, Writing – review & editing. QZ and LS: Investigation, Methodology, Project administration, Supervision, Validation, Writing – review & editing. RM: Conceptualization, Formal analysis, Investigation, Methodology, Validation, Writing – review & editing. YL and HC: Formal analysis, Funding acquisition, Methodology, Resources, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing.All authors reviewed the manuscript.

Acknowledgement

The authors are grateful to the school grade counselors, current nursing students, and other staff members who cooperated with this survey. We thank Professor Freeman for his authorization of the Chinese OxPos version.

Data availability statement

The data collected in this survey are available by contacting the corresponding author with a reasonable request. Requests for access to these datasets should be directed to HC ([email protected]).

Ethics statement

The present research involving humans was approved by the Ethics Committee of Wannan Medical College (Ethics approval number: (2024) Ethics No. (164)). The study was conducted in accordance with the local legal and institutional requirements. Informed consent was obtained from the study participants.

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No competing interests reported.