Validation and improvement of the mental health literacy scale to assess undergraduate nursing students in South Africa

Background: Mental Health Literacy (MHL) refers to knowledge, skills and attitudes related to mental health and is often measured by the revised Mental Health Literacy Scale (MHLS). This scale has been validated on a group of primary healthcare (PHC) workers in Zambia and South Africa, but its usefulness for a group of nursing students has not been investigated until now. Aim: To investigate the psychometric properties of the revised scale for a group of undergraduate nursing students at a South African university, while also assessing the level of MHL in the group under investigation. Setting: = 121) studying for their Bachelor of Nursing degree at a South African public university. Methods: A quantitative, cross-sectional survey was conducted between July 2023 and August 2023, using a purposive sampling technique. A socio-demographic data form and a revised version of the MHLS were used to collect data online. Descriptive statistics, Cronbach's alpha, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to analyse the data. Results: The EFA and CFA seemed to confirm a new 5-factor structure, including only 17 items. This structure holds similar factors to the MHL subscales. The reliability of most of the new factors was good, with two factors that need further intervention. This version of the MHLS proposed satisfactory levels of MHL for this group. Conclusion: This study proposes a shortened, 5-factor structure version of the MHLS to be used to assess nursing students. Contribution: The revised 5-factor structure measure can potentially identify gaps in the MHL of students, and this can inform appropriate interventions to address the MHL needs in South Africa generally.