Examination and testing of structural validity of the Confidence in Dementia Scale with nursing students. An international perspective

Background: As the prevalence of dementia continues to rise globally, nurses are increasingly at the forefront of providing care. Effective dementia care relies on not just knowledge, but also the confidence to translate this knowledge into meaningful action. Enhancing nursing education programmes to build both knowledge and confidence is critical. As no studies have explored measuring confidence in dementia care over an extended period (beyond six months), there is a need for a rigorous and robust analysis of the Confidence in Dementia
(CODE) Scale, to determine whether it is a psychometrically sound tool for assessing confidence over time.
Methods: A cross-sectional series design was used to collect longitudinal data from a census of nursing students over a 3-year period. A standardized instrument, the Confidence in Dementia Scale was administered repeatedly
to a sample (time 1 n = 247; time 2 n = 239; time 3 = n = 216). Analyses were performed using SPSS for
descriptive statistics and JASP for structural equation modelling. An initial exploratory factor analysis was
conducted using the first data set to explore the factor structure. A confirmatory factor analysis was performed (on the second and third data sets) to confirm the factor structure and assess the model’s overall validity.
COSMIN guidelines inform the analysis process, and the findings are reported using STROBE guidelines.
Results: The factor structure replicated and confirmed the one factor structure identified by international findings. The findings confirm its usefulness of the Confidence in Dementia scale to gauge health professionals’ confidence in dementia care before going into practice.
Conclusions: This study highlights the need for psychometrically valid tools that can measure confidence over an extended period, encompassing the three-year degree programme and beyond.