The Dutch-translated Climate and Health Tool for nurses: Cross-cultural adaptation and validation

Background : Health systems in the Netherlands must be equipped to respond to climate-related challenges. As a trusted interface between society and healthcare, nurses play a critical leadership role in mitigating and addressing climate-sensitive health risks. Establishing a baseline understanding of nurses' awareness, concern, motivation and behaviors related to climate change is therefore essential. However, no validated Dutch instrument exists to assess these competencies. The Climate and Health Tool, originally developed and validated in the United States of America, has demonstrated strong reliability and validity and offers a promising foundation for adaptation. Objective : To translate, culturally adapt and validate the Climate and Health Tool from American-English into Dutch. Methods : The study followed a six-stage process. The first five stages focused on cross-cultural adaptation and translation, including forward-backward translation, expert committee review, and field pre-testing. The sixth stage consisted of psychometric evaluation. Nurses from across the Netherlands were recruited through the Dutch Nurses Association and other in- and external networks, starting from the 19 th of June 2025. Data were analyzed using a confirmatory factor analysis. Internal consistency was evaluated using McDonald's omega and Cronbach's alpha. Results : Translation procedures, expert committee review, and pre-testing interviews indicated good overall comprehensibility, with minor revisions implemented to improve interpretability. Psychometric evaluation was conducted in a sample of 292 nurses with varied ages, work experience and healthcare backgrounds. The 22-item, five-factor Dutch version of the Climate and Health Tool demonstrated moderate model fit, good internal consistency, and acceptable standardized factor loadings. Conclusions : This study provides a reliable and validated Dutch instrument for assessing nurses' awareness, concern, motivation, and behavior regarding climate change and health. The Dutch version of the Climate and Health Tool offers researchers, educators, and healthcare organizations a robust method for evaluating climate-related competencies and supports broader efforts to prepare Dutch health systems for current and emerging climate-related challenges.