Abstract
Background: Death literacy encompasses the knowledge and skills enabling individuals and communities to access, understand, and act on end-of-life care options. For nurses, it influences communication, decision-making, and palliative care quality. However, few studies have examined death literacy among healthcare providers, and no validated Chinese instruments exist for its assessment.
Purpose: To translate the Death Literacy Index (DLI) into Chinese and examine its reliability and validity among nursing students in Taiwan.
Methods: A cross-sectional correlational study was conducted. The DLI underwent translation and back-translation to ensure conceptual and linguistic equivalence, followed by expert review for content validity. Convenience sampling was applied in two stages: Stage I involved 237 nursing students for exploratory factor analysis (EFA), and Stage II included 238 students in clinical practicum for confirmatory factor analysis (CFA). Additional instruments were the Chinese Revised Death Anxiety Scale (RDAS), Bugen’s Coping with Death Scale, and a demographic questionnaire. Analyses were performed using SPSS 25.0 and AMOS 24.0.
Results: The overall content validity index (CVI) was 0.98, with item-level CVIs ranging from 0.80 to 1.00. Cronbach’s α was 0.895, and subscale α values ranged from 0.760 to 0.920, showing strong internal consistency. Test–retest reliability was 0.90. EFA revealed six factors explaining 70.24% of variance, with loadings of 0.433–0.897. CFA confirmed the six-factor model with acceptable fit indices (GFI = 0.850, AGFI = 0.820, NFI = 0.97, SRMR = 0.049). The six subscales were: (1) Practical knowledge–communication care, (2) Practical knowledge–action care, (3) Experiential learning, (4) Factual knowledge, (5) Social interaction–seeking help, and (6) Social interaction–community support. Criterion validity was supported by a negative correlation with RDAS (r = −.129, p < .01) and a positive correlation with Bugen’s Coping with Death Scale (r = .547, p < .001).
Conclusion: The Chinese Death Literacy Index exhibits excellent reliability, construct, and criterion-related validity. It is a culturally appropriate instrument for assessing death literacy among nursing students and can be utilized in nursing education and palliative care training to evaluate learning outcomes, enhance end-of-life care competence, and foster compassionate practice.
Notes
References:
Leonard, R., Noonan, K., Horsfall, D., Psychogios, H., Kelly, M., Rosenberg, J. P., . . . Rahn, A. (2020). Death Literacy Index: A Report on its Development and Implementation.
Noonan, K., Horsfall, D., Leonard, R., & Rosenberg, J. (2016). Developing death literacy. Progress in Palliative Care, 24(1), 31-35. https://doi.org/10.1080/09699260.2015.1103498
Norwood, S. L. (2000). Research strategies for advanced practice nurses: Prentice Hall.
Sarmento, V. P., Gysels, M., Higginson, I. J., & Gomes, B. (2017). Home palliative care works: but how? A meta-ethnography of the experiences of patients and family caregivers. BMJ Supportive & Palliative Care, bmjspcare-2016001219.58-64. http://dx.doi.org/10.1016 /j.healthplace.2017.04.003
Sigma Membership
Lambda Beta at-Large
Type
Poster
Format Type
Text-based Document
Study Design/Type
Cross-Sectional
Research Approach
Quantitative Research
Keywords:
Death Literacy Index, Chinese Version of Death Literacy Index, Reliability, Validity, Nursing Students, Hospice Care, Palliative Care, End-of-Life Care, Terminal Care, Public and Community Health, China
Recommended Citation
Wu, Shu-Fen; Hung, Li-Er; Liao, Hsiu-Chen; Lo, Shih-Ting; and Chen, Chia-Yu, "Psychometric Evaluation of the Chinese Version of the Death Literacy Index Among Nursing Students" (2026). International Nursing Research Congress (INRC). 13.
https://www.sigmarepository.org/inrc/2026/posters_2026/13
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-07-22
Psychometric Evaluation of the Chinese Version of the Death Literacy Index Among Nursing Students
Toronto, Ontario, Canada
Background: Death literacy encompasses the knowledge and skills enabling individuals and communities to access, understand, and act on end-of-life care options. For nurses, it influences communication, decision-making, and palliative care quality. However, few studies have examined death literacy among healthcare providers, and no validated Chinese instruments exist for its assessment.
Purpose: To translate the Death Literacy Index (DLI) into Chinese and examine its reliability and validity among nursing students in Taiwan.
Methods: A cross-sectional correlational study was conducted. The DLI underwent translation and back-translation to ensure conceptual and linguistic equivalence, followed by expert review for content validity. Convenience sampling was applied in two stages: Stage I involved 237 nursing students for exploratory factor analysis (EFA), and Stage II included 238 students in clinical practicum for confirmatory factor analysis (CFA). Additional instruments were the Chinese Revised Death Anxiety Scale (RDAS), Bugen’s Coping with Death Scale, and a demographic questionnaire. Analyses were performed using SPSS 25.0 and AMOS 24.0.
Results: The overall content validity index (CVI) was 0.98, with item-level CVIs ranging from 0.80 to 1.00. Cronbach’s α was 0.895, and subscale α values ranged from 0.760 to 0.920, showing strong internal consistency. Test–retest reliability was 0.90. EFA revealed six factors explaining 70.24% of variance, with loadings of 0.433–0.897. CFA confirmed the six-factor model with acceptable fit indices (GFI = 0.850, AGFI = 0.820, NFI = 0.97, SRMR = 0.049). The six subscales were: (1) Practical knowledge–communication care, (2) Practical knowledge–action care, (3) Experiential learning, (4) Factual knowledge, (5) Social interaction–seeking help, and (6) Social interaction–community support. Criterion validity was supported by a negative correlation with RDAS (r = −.129, p < .01) and a positive correlation with Bugen’s Coping with Death Scale (r = .547, p < .001).
Conclusion: The Chinese Death Literacy Index exhibits excellent reliability, construct, and criterion-related validity. It is a culturally appropriate instrument for assessing death literacy among nursing students and can be utilized in nursing education and palliative care training to evaluate learning outcomes, enhance end-of-life care competence, and foster compassionate practice.
Description
Focus: Academic
Status: Completed Work/Project
This study validated the reliability and validity of the Chinese version of the Death Literacy Index among nursing students. Using translation–back translation and a two-stage cross-sectional design, 475 participants completed EFA and CFA. The scale showed excellent content validity (CVI = 0.98), internal consistency (α = 0.895), and test–retest reliability (r = 0.90). Six factors explained 70.24% of variance, supporting strong psychometric properties for educational and clinical use.