Psychometric validation of the short-form Swedish “attitudes to and knowledge of oral health” (S-AKO) questionnaire in Chinese nursing professionals: a cross-sectional study

Strengthening nursing professionals’ oral health–related knowledge, attitudes, and clinical practices is essential for improving patient outcomes. While the Swedish Attitudes to and Knowledge of Oral Health (S-AKO) questionnaire is a well-established tool, its validity in China remains unknown. Accordingly, the present study was designed to adapt the S-AKO to the Chinese context and to examine its psychometric properties among nursing professionals. A convenience sample of 558 nursing professionals was drawn from three universities and twelve tertiary hospitals across China between September and October 2025. The short-form Swedish S-AKO questionnaire was translated following Brislin’s model, and its Chinese version was administered to collect data. Item analysis, reliability, and validity were assessed with SPSS version 25.0 and AMOS version 24.0. Following item-level screening, 13 items were retained for inclusion in the Chinese adaptation of the S-AKO. The instrument demonstrated satisfactory reliability, including internal consistency (Cronbach’s α = 0.810), split-half reliability (0.726), and temporal stability (test–retest reliability = 0.923). Content validity was well supported, as indicated by an item-level CVI of 0.857 and a scale-level CVI of 0.907. Exploratory factor analysis (EFA) revealed a three-factor structure: “Attitudes to Oral Hygiene,” “Implementation Possibilities,” and “Knowledge of Importance,” which together accounted for 80.94% of the variance observed in the data. Subsequent, confirmatory factor analysis (CFA) provided further evidence for the adequacy of the proposed model, demonstrating acceptable model fit (CMIN/DF = 2.466, RMSEA = 0.073, CFI = 0.970, IFI = 0.970, NFI = 0.951, TLI = 0.962). The adapted S-AKO in Chinese demonstrated acceptable validity and reliability among nursing professionals. Its application may inform adjustments to nursing curricula and support the integration of evidence-informed oral care in education and clinical practice.