Cross-cultural adaptation and psychometric validation of the Chinese version of the Attitudes of Nursing Staff towards Oral Healthcare for Care-Dependent Older Adults (ANOCO) scale

To translate, culturally adapt, and psychometrically evaluate the Chinese version of the Attitudes of Nursing Staff towards Oral Healthcare for Care-Dependent Older Adults (ANOCO) questionnaire. A cross-sectional descriptive design was used for this study. Guided by the Brislin translation model, we produced the Chinese ANOCO and enriched its content through qualitative interviews. Cross-cultural adaptation and item refinement were completed via expert consultation ( n = 14) and cognitive testing with 30 nursing staff. A cross-sectional survey was administered to 240 registered nurses from 12 tertiary hospitals across six regions and 318 undergraduate nursing interns from three universities. Psychometric testing included exploratory and confirmatory factor analyses, Cronbach’s alpha, Spearman–Brown split-half reliability, and intraclass correlation coefficients. The finalized questionnaire contains 22 items organized into four dimensions. Item-level content validity indices ranged from 0.938 to 1.000, while the scale-level index reached 0.922. EFA extracted four factors explaining 73.261% of the total variance, and CFA demonstrated strong structural validity with good model fit. Reliability analyses yielded a Cronbach’s alpha of 0.947, split-half reliability. The Chinese ANOCO is a reliable, valid, and clinically applicable tool for assessing nursing attitudes toward oral care for older adults, offering guidance for managerial decision-making, intervention planning, and educational evaluation.