Health literacy continues to be a pervasive issue faced by adults today within the healthcare environment. One in four adults cannot make informed decisions regarding their own care and do not understand basic healthcare information. Nursing provides the majority of healthcare teaching, yet little is known about the current knowledge level of such providers about health literacy knowledge and strategies. The purpose of this study was to determine the reliability and validity of the Health Literacy Knowledge, Application, and Confidence scale (HLKACS) with nursing students enrolled in baccalaureate and associate degree nursing programs in the state of Michigan. The study sample completed 344 surveys that consisted of demographic variables and the HLKACS, which was created to measure knowledge, application, and confidence in health literacy. The 29-item HLKACS instrument includes nine items measuring knowledge, 13 items measuring the application, and seven items measuring confidence. The results demonstrated satisfactory (or good) reliability for application and confidence subscale with internal consistencies of Cronbach’s alpha’s ranging from 0.91 to 0.92. The results from the exploratory factor analysis demonstrated construct validity with interpretable factors and 58.98% variance in knowledge and 66.36% variance in application and confidence explained by the factors. The correlation analyses also demonstrated significant relationships between knowledge and application as well as application and confidence was established. This reliable and valid HLKACS can be used in future research and education to determine knowledge levels, application of strategies, and confidence among nursing students.
","abstract_html":"<p>Health literacy continues to be a pervasive issue faced by adults today within the healthcare environment. One in four adults cannot make informed decisions regarding their own care and do not understand basic healthcare information. Nursing provides the majority of healthcare teaching, yet little is known about the current knowledge level of such providers about health literacy knowledge and strategies. The purpose of this study was to determine the reliability and validity of the Health Literacy Knowledge, Application, and Confidence scale (HLKACS) with nursing students enrolled in baccalaureate and associate degree nursing programs in the state of Michigan. The study sample completed 344 surveys that consisted of demographic variables and the HLKACS, which was created to measure knowledge, application, and confidence in health literacy. The 29-item HLKACS instrument includes nine items measuring knowledge, 13 items measuring the application, and seven items measuring confidence. The results demonstrated satisfactory (or good) reliability for application and confidence subscale with internal consistencies of Cronbach’s alpha’s ranging from 0.91 to 0.92. The results from the exploratory factor analysis demonstrated construct validity with interpretable factors and 58.98% variance in knowledge and 66.36% variance in application and confidence explained by the factors. The correlation analyses also demonstrated significant relationships between knowledge and application as well as application and confidence was established. This reliable and valid HLKACS can be used in future research and education to determine knowledge levels, application of strategies, and confidence among nursing students.</p>","abstract_has_math":false,"creators":["DeBello, Marguerite Catherine"],"institution":null,"degree_name":"Doctor of Philosophy (PhD)","degree_level":"Open Access Dissertation","degree_discipline":"Teacher Education","degree_department":null,"school":null,"contributors":["Tsu Yin Wu, Ph.D., RN, FAAN, Chair","Delbert Raymond, Ph.D., RN","Stephen Wellinski, Ph.D."],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2016,"date_issued":"2016-11-10T08:00:00Z","date_published":"2016-11-10T08:00:00Z","updated_at":"2026-07-24T02:17:06Z","subjects":["application","confidence","health literacy","knowledge","nursing students","Nursing"],"languages":[],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://commons.emich.edu/theses/686","outbound_label":"Repository record","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Tsu Yin Wu, Ph.D., RN, FAAN, Chair","Delbert Raymond, Ph.D., RN","Stephen Wellinski, Ph.D."]},{"key":"dc:creator","label":"Author","values":["DeBello, Marguerite Catherine"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.available","label":"Dc Date Available","values":["2017-05-30T07:00:00Z"]},{"key":"thesis:degree_discipline","label":"Discipline","values":["Teacher Education"]},{"key":"thesis:degree_level","label":"Degree Level","values":["Open Access Dissertation"]},{"key":"thesis:degree_name","label":"Degree Name","values":["Doctor of Philosophy (PhD)"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["application","confidence","health literacy","knowledge","nursing students","Nursing"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["https://commons.emich.edu/theses/686"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Health literacy continues to be a pervasive issue faced by adults today within the healthcare environment. One in four adults cannot make informed decisions regarding their own care and do not understand basic healthcare information. Nursing provides the majority of healthcare teaching, yet little is known about the current knowledge level of such providers about health literacy knowledge and strategies. The purpose of this study was to determine the reliability and validity of the Health Literacy Knowledge, Application, and Confidence scale (HLKACS) with nursing students enrolled in baccalaureate and associate degree nursing programs in the state of Michigan. The study sample completed 344 surveys that consisted of demographic variables and the HLKACS, which was created to measure knowledge, application, and confidence in health literacy. The 29-item HLKACS instrument includes nine items measuring knowledge, 13 items measuring the application, and seven items measuring confidence. The results demonstrated satisfactory (or good) reliability for application and confidence subscale with internal consistencies of Cronbach’s alpha’s ranging from 0.91 to 0.92. The results from the exploratory factor analysis demonstrated construct validity with interpretable factors and 58.98% variance in knowledge and 66.36% variance in application and confidence explained by the factors. The correlation analyses also demonstrated significant relationships between knowledge and application as well as application and confidence was established. This reliable and valid HLKACS can be used in future research and education to determine knowledge levels, application of strategies, and confidence among nursing students.
"]},{"key":"dc:title","label":"Title","values":["The development and psychometric testing of the health literacy knowledge, application, and confidence scale (HLKACS)"]}]}],"canonical_facts":{"dc:contributor":["Tsu Yin Wu, Ph.D., RN, FAAN, Chair","Delbert Raymond, Ph.D., RN","Stephen Wellinski, Ph.D."],"dc:creator":["DeBello, Marguerite Catherine"],"dc:date.available":["2017-05-30T07:00:00Z"],"dc:description.abstract":["Health literacy continues to be a pervasive issue faced by adults today within the healthcare environment. One in four adults cannot make informed decisions regarding their own care and do not understand basic healthcare information. Nursing provides the majority of healthcare teaching, yet little is known about the current knowledge level of such providers about health literacy knowledge and strategies. The purpose of this study was to determine the reliability and validity of the Health Literacy Knowledge, Application, and Confidence scale (HLKACS) with nursing students enrolled in baccalaureate and associate degree nursing programs in the state of Michigan. The study sample completed 344 surveys that consisted of demographic variables and the HLKACS, which was created to measure knowledge, application, and confidence in health literacy. The 29-item HLKACS instrument includes nine items measuring knowledge, 13 items measuring the application, and seven items measuring confidence. The results demonstrated satisfactory (or good) reliability for application and confidence subscale with internal consistencies of Cronbach’s alpha’s ranging from 0.91 to 0.92. The results from the exploratory factor analysis demonstrated construct validity with interpretable factors and 58.98% variance in knowledge and 66.36% variance in application and confidence explained by the factors. The correlation analyses also demonstrated significant relationships between knowledge and application as well as application and confidence was established. This reliable and valid HLKACS can be used in future research and education to determine knowledge levels, application of strategies, and confidence among nursing students.
"],"dc:identifier":["https://commons.emich.edu/theses/686"],"dc:subject":["application","confidence","health literacy","knowledge","nursing students","Nursing"],"dc:title":["The development and psychometric testing of the health literacy knowledge, application, and confidence scale (HLKACS)"],"thesis:degree_discipline":["Teacher Education"],"thesis:degree_level":["Open Access Dissertation"],"thesis:degree_name":["Doctor of Philosophy (PhD)"]},"updated_at":"2026-07-24T02:17:06Z"}