Development and validation of a multidimensional student health assessment scale for primary and secondary school students

Background: Student health is increasingly understood as a multidimensional construct shaped by both individual functioning and contextual support. However, existing school-based measures often focus on single domains and provide limited coverage of holistic health in primary and secondary school populations. Objective: This study aimed to develop and validate the Multidimensional Student Health Assessment Scale for Primary and Secondary School Students. Methods: A multi-stage psychometric design was used to develop and validate the Multidimensional Student Health Assessment Scale for Primary and Secondary School Students. Item generation was guided by multidimensional health theory, ecological perspectives, and the Chinese holistic health perspective, followed by expert review for content validity. Five independent samples were used: 385 students for pilot testing and item analysis, 400 for exploratory factor analysis, 1,014 for confirmatory factor analysis and construct validity evaluation, 87 for test-retest reliability, and 3,818 for preliminary known-groups validation. Reliability and construct validity were evaluated using internal consistency, composite reliability, average variance extracted, discriminant validity, temporal stability, and preliminary known-groups evidence. Additional analyses included parallel analysis, measurement invariance testing across educational stages and gender, and McDonald's omega. Results: A four-factor structure was retained, comprising Relational-Contextual Support and Prosocial Orientation, Health Resource and Physical Activity Literacy, Healthy Lifestyle, and Psychosocial Competence. The four-factor model showed acceptable CFA fit and adequate internal consistency. However, parallel analysis suggested a more conservative factor solution, and educational-stage comparisons were therefore interpreted cautiously. Test-retest reliability over a 3-week interval was acceptable. Known-groups analyses showed systematic differences across educational stages and self-reported vision-status groups, providing preliminary known-groups evidence. Conclusions: The scale provides initial psychometric evidence for group-level assessment of holistic student health. However, further validation using external criterion measures, robust estimators, alternative structural models, and developmentally sensitive methods is needed.