Adaptation and validation of HowULearn 2 student questionnaire for use in Italian tertiary education

Healthcare students face multiple academic, clinical, and psychosocial stressors that may affect their well-being and academic performance. The HowULearn 2 questionnaire, developed at the University of Helsinki, is a research-based tool designed to explore students’ experiences of teaching and learning and to provide feedback that supports self-regulated learning and teaching improvement. However, the questionnaire has not yet been validated for the Italian language and cultural context. This study aimed to translate, culturally adapt, and evaluate the HowULearn 2 questionnaire for Italian undergraduate healthcare students, assessing face and content validity, structural validity, internal consistency, and test–retest reliability. Face validity was assessed in 40 students and content validity by an eight-member expert panel. Structural validity was examined using exploratory factor analysis with principal-axis factoring and oblique Promax rotation. Internal consistency was assessed using Cronbach’s alpha, and test–retest reliability using intraclass correlation coefficients (ICC [3, 1]) after four weeks. Of 351 invited students, 345 provided questionnaire data; 343 (99.42%) had ≤ 6 missing item responses, and 294 complete cases were included in the exploratory factor analysis. Face validity was supported: 52 of 61 items (85.2%) met the predefined clarity criterion. Content validity was high (S-CVI/Ave = 0.91). Test–retest reliability was assessed in 63 participants who completed both administrations. Horn’s parallel analysis, based on 1,000 random replications and the 95th-percentile criterion, supported seven factors. A five-factor solution was retained as a theory-driven exploratory solution consistent with the intended questionnaire dimensions. KMO was 0.923 and Bartlett’s test was statistically significant (χ² = 11,533.725, df = 1,830, p < 0.001). Cronbach’s alpha coefficients ranged from 0.785 to 0.930 across subscales (overall alpha = 0.952). Test–retest ICCs ranged from 0.607 to 0.838. The Italian HowULearn 2 showed satisfactory face and content validity, high sampling adequacy, and a theoretically interpretable five-factor exploratory solution, with acceptable-to-excellent internal consistency and moderate-to-good test–retest reliability. Further independent and multicentre studies, including confirmatory factor analysis, are warranted to assess the stability and generalisability of the measurement structure.