Date Approved


Degree Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department or School

Teacher Education

Committee Member

Tsu Yin Wu, Ph.D., RN, FAAN, Chair

Committee Member

Delbert Raymond, Ph.D., RN

Committee Member

Stephen Wellinski, Ph.D.


Health literacy continues to be a pervasive issue faced by adults today within the healthcare environment. One in four adults cannot make informed decisions regarding their own care and do not understand basic healthcare information. Nursing provides the majority of healthcare teaching, yet little is known about the current knowledge level of such providers about health literacy knowledge and strategies. The purpose of this study was to determine the reliability and validity of the Health Literacy Knowledge, Application, and Confidence scale (HLKACS) with nursing students enrolled in baccalaureate and associate degree nursing programs in the state of Michigan. The study sample completed 344 surveys that consisted of demographic variables and the HLKACS, which was created to measure knowledge, application, and confidence in health literacy. The 29-item HLKACS instrument includes nine items measuring knowledge, 13 items measuring the application, and seven items measuring confidence. The results demonstrated satisfactory (or good) reliability for application and confidence subscale with internal consistencies of Cronbach’s alpha’s ranging from 0.91 to 0.92. The results from the exploratory factor analysis demonstrated construct validity with interpretable factors and 58.98% variance in knowledge and 66.36% variance in application and confidence explained by the factors. The correlation analyses also demonstrated significant relationships between knowledge and application as well as application and confidence was established. This reliable and valid HLKACS can be used in future research and education to determine knowledge levels, application of strategies, and confidence among nursing students.

Included in

Nursing Commons