The vocational adaptation scale for primary health workers: development and validation in a cohort of working village doctor students in China

Village doctors form the backbone of China’s rural health system, yet no instrument has been validated specifically to systematically assess their multidimensional vocational adaptation, particularly against the backdrop of rapid digitalization. This study aimed to develop and validate the Vocational Adaptation Scale for Primary Health Workers (VAS-PH), and to describe the vocational adaptation status of the study sample. Following AMEE Guide No. 87, a 55-item initial pool was constructed through literature review and qualitative interviews. After expert review ( n = 5) and pilot testing ( n = 50), a cross-sectional survey was conducted among 1,553 working village doctor students in Anhui Province, and 53 items entered formal testing. The sample was randomly split into two subsamples for exploratory factor analysis (EFA, n = 776) and confirmatory factor analysis (CFA, n = 777). Reliability and validity were assessed using composite reliability (CR), average variance extracted (AVE), the Fornell-Larcker criterion, and the heterotrait-monotrait ratio (HTMT). Subgroup comparisons were performed with false discovery rate (FDR) correction. EFA yielded a four-factor structure: Work Support, Professional Identity, Job Burnout, and Digital Adaptation. CFA confirmed acceptable model fit (CFI = 0.909, RMSEA = 0.054, SRMR = 0.055). The final 46-item scale demonstrated satisfactory composite reliability (CR = 0.871–0.938) and discriminant validity (HTMT < 0.85). Preliminary application revealed pronounced depersonalization, a “high value cognition–low behavioral commitment” split within professional identity, and adequate basic digital literacy contrasting with deficiencies in cross-system collaborative applications. The VAS-PH demonstrates acceptable initial psychometric evidence, with generally satisfactory reliability and validity, though some limitations were noted. It integrates job demands, resources, and digital adaptation within a single framework and may serve as a preliminary tool for needs assessment and intervention evaluation among primary health workers, pending further validation. Not applicable.