Health Promotion Literacy-based Scale for students in USR

Abstract

University Social Responsibility (USR) initiatives have evolved from peripheral extracurricular activities into transformative pedagogical imperatives within contemporary higher education. Despite the proliferating implementation of service-learning curricula, conventional institutional evaluations have predominantly emphasized macro-level societal impacts and external stakeholder metrics, routinely overlooking the internal psychological, cognitive, and civic development of participating undergraduates. To bridge this critical measurement gap, the Health Promotion Literacy-based Scale for students in USR (HPLS-USR) was engineered as a psychometrically validated self-report instrument designed to quantify the nuanced developmental trajectories of students engaged in community health promotion. Conceptualized across four interconnected dimensions—Personal Growth, Responsibility of Citizenship, Social Interaction, and Intellectual Growth—the scale operationalizes experiential civic engagement into an empirically tractable construct.

The final instrument comprises 22 items evaluated via a 5-point Likert response scale ranging from 1 (never) to 5 (always). Initial psychometric validation was executed with a cohort of 200 Taiwanese undergraduate students (mean age = 19.27 years) actively enrolled in university-sponsored community health initiatives. Structural evaluation via exploratory factor analysis (EFA) demonstrated an exceptional sampling adequacy (Kaiser-Meyer-Olkin measure = 0.908; statistically significant Bartlett’s test of sphericity, p < .001) and established a robust four-factor latent architecture accounting for 61.83% of the total cumulative variance, with salient item factor loadings spanning from 0.44 to 0.82. Internal consistency reliability analysis yielded an overall Cronbach’s alpha of 0.92, demonstrating remarkable measurement precision and minimal standard error across items. Criterion-related validity was corroborated against established metrics including the Service-Learning Experiences Scale and Service-Learning Growth Scale. The HPLS-USR represents an essential, evidence-based psychometric tool for higher education administrators, health psychologists, and curriculum designers dedicated to optimizing experiential service-learning pedagogies and cultivating civic-minded, socially responsive healthcare and allied health graduates.

Keywords

University Social Responsibility, Civic Literacy, Health Promotion Literacy, Experiential Learning, Psychometrics, Scale Validation, Service-Learning, Higher Education Assessment, Social Learning Theory, Student Civic Engagement, Personal Growth, Community Health Education

Authors

The Health Promotion Literacy-based Scale for students in USR was developed by an interdisciplinary research team from Chung Shan Medical University in Taichung, Taiwan:

• Chia-Hui Hung — Department of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan (Email: [email protected])
• Cheng-Yi Huang — Department of Nursing, Chung Shan Medical University, Taichung, Taiwan (Email: [email protected])
• Yu-Ming Wang — Department of Psychology, Chung Shan Medical University, Taichung, Taiwan (Email: [email protected])
• Yi-Ching Li — Department of Pharmacology, School of Medicine, Chung Shan Medical University, Taichung, Taiwan (Email: [email protected])
• Yung-Chuan Ho — Department of Medical Applied Chemistry, Chung Shan Medical University, Taichung, Taiwan (Email: [email protected])

Purpose

Over the past two decades, universities across the globe have experienced an institutional paradigm shift, migrating from insular academic ecosystems toward models of active public engagement known as University Social Responsibility (USR). Rooted in the broader mandate of sustainable development and community capacity building, USR programs mobilize faculty and students to address pressing societal challenges, ranging from rural public health disparities to environmental decay and marginalized community welfare. While institutional reporting mechanisms meticulously quantify the external deliverables of these ventures—such as the enumeration of free health clinics delivered, community members screened, or economic investments deployed—these metrics routinely neglect the primary pedagogical stakeholder: the undergraduate learner.

Historically, educational assessment within service-learning and USR frameworks has leaned heavily on subjective, unstandardized qualitative artifacts, such as unstructured reflective journals or perfunctory post-course satisfaction evaluations. Although valuable for idiographic insights, these anecdotal modalities fail to afford psychometric rigor, objective comparability, or statistical tracking of developmental shifts over time. Educators and psychological researchers lack standardized indices to evaluate whether community-based interventions actually precipitate fundamental cognitive restructuring, civic responsibility, and affective maturity within student cohorts.

The Health Promotion Literacy-based Scale for students in USR (HPLS-USR) was engineered precisely to resolve this operational deficit. The scale serves as a standardized, multidimensional measurement framework tailored to capture the subjective, internal psychological and educational transformations experienced by students throughout experiential health-focused civic initiatives. Rather than treating civic literacy as an abstract philosophical ideal, the HPLS-USR operationalizes the construct into quantifiable developmental indicators.

Within clinical and empirical research, the HPLS-USR fulfills several paramount functions:

• Curricular Efficacy Assessment: It enables institutional researchers and instructional designers to establish baseline evaluations and post-intervention benchmarks, isolating the pedagogical variables (such as duration of service, structured reflection, or interdisciplinary collaboration) that most effectively foster civic and health literacy.
• Longitudinal Psychometric Tracking: The scale permits developmental psychologists and educational analysts to map the longitudinal trajectory of professional identity formation, tracking how nascent undergraduate attitudes mature into durable ethical and civic commitments across multi-year healthcare training programs.
• Differential Program Evaluation: Administrators can objectively contrast competing service-learning curricular models, diagnosing specific programmatic deficiencies in areas such as interpersonal skill acquisition or the clinical application of classroom theory.
• Accreditation and Stakeholder Reporting: The tool yields rigorous quantitative data validating that higher education institutions are successfully achieving their dual mission of public welfare enhancement and transformative, holistic student cultivation.

Psychological Construct

The HPLS-USR conceptualizes health promotion civic literacy not as an isolated, static repository of medical or biomedical facts, but as an integrative, dynamic psychological competence acquired through contextualized community action. Drawing from educational psychology, social psychology, and contemporary competency frameworks, the instrument models this literacy across four distinct yet mutually reinforcing latent dimensions: Personal Growth, Responsibility of Citizenship, Social Interaction, and Intellectual Growth.

1. Personal Growth

The Personal Growth dimension captures the psychological, emotional, and introspective maturation of the student. Experiential immersion into complex, resource-constrained community settings inevitably disrupts students’ prior assumptions, generating cognitive disequilibrium and challenging their perceived comfort zones. This dimension operationalizes the development of heightened self-awareness, emotional resilience, self-efficacy, and adaptive coping mechanisms. Students scoring high on this subscale exhibit a progressive capacity to manage ambiguity, regulate distress when confronted with systemic suffering or health disparities, and cultivate an autonomous sense of purpose. An illustrative manifestation of this construct is an undergraduate’s ability to honestly evaluate their personal biases, acknowledge emotional discomfort during clinical outreach, and convert those affective reactions into introspective self-improvement.

2. Responsibility of Citizenship

The Responsibility of Citizenship dimension assesses the structural realignment of a student’s ethical orientation—transitioning from an individualistic, self-serving worldview toward an internalized collective consciousness and prosocial commitment. Rooted in psychological theories of moral development and altruism, this construct measures the degree to which an individual perceives community well-being as intrinsically tied to their own professional and personal obligations. It encapsulates civic mindedness, a dedication to health equity, and an enduring willingness to advocate for marginalized populations. In practice, elevated scores on this factor reflect a student’s rejection of passive academic bystanderism in favor of an active, lifelong orientation toward public service, institutional advocacy, and systemic social reform.

3. Social Interaction

The Social Interaction subscale evaluates the interpersonal competencies, communicative adaptability, and socio-emotional intelligence necessary to navigate complex, heterogeneous human environments. Effective community health promotion requires students to move beyond academic jargon and engage with community stakeholders across stark socio-economic, generational, and cultural divides. This latent dimension operationalizes empathetic listening, cross-cultural competence, conflict resolution, interdisciplinary teamwork, and relationship-building agility. A student demonstrating robust social interaction literacy possesses the capacity to build reciprocal trust with skeptical community elders, collaborate cooperatively with peers from divergent healthcare disciplines, and communicate nuanced health guidance with cultural humility and communicative warmth.

4. Intellectual Growth

The Intellectual Growth dimension quantifies the cognitive expansion and epistemic maturity fostered through the practical application of didactic knowledge to real-world, ill-structured dilemmas. Didactic classroom learning typically presents clinical scenarios with predictable parameters and single correct answers. Conversely, authentic community health contexts present messy, multi-causal ecological challenges where social determinants of health clash with standard medical protocols. This dimension assesses higher-order problem-solving skills, critical thinking, creative cognitive synthesis, and practical knowledge transfer. A student manifesting elevated intellectual growth moves beyond rote memorization, demonstrating the intellectual agility to critically analyze community health barriers, synthesize multidisciplinary evidence, and tailor theoretical health promotion models to the idiosyncratic realities of an underserved community.

Theoretical Framework

The theoretical architecture of the HPLS-USR synthesizes two foundational paradigms in psychological and educational science: John Dewey’s philosophy of experiential learning and Albert Bandura’s Social Cognitive Theory, with vital conceptual contributions from reflective practice theory and civic-minded graduate development frameworks.

Dewey’s Experiential Learning and Reflective Thinking

At the core of the HPLS-USR lies John Dewey’s (1933) foundational assertion that genuine learning does not occur through passive information absorption, but through an organic, reciprocal transaction between an active learner and an authentic environment. Dewey posited that educative experiences are characterized by continuity and interaction: novel experiences build upon prior cognitive schema, provoking a state of perplexity or cognitive dissonance that necessitates critical reflection. The HPLS-USR operationalizes this reflective process. When university students enter underserved community settings to promote health, their pre-existing academic frameworks are tested against real-world human suffering, resource deficits, and socio-cultural complexities.

Building on Dewey, Donald Schön’s (1983) paradigms of reflection-in-action and reflection-on-action clarify how experiential practitioners develop professional mastery. Rather than mechanically executing static technical formulas, reflective practitioners dynamically adapt to ambiguous scenarios. The dimensions of Personal Growth and Intellectual Growth within the HPLS-USR explicitly capture this cognitive shift, measuring the degree to which community-based friction stimulates metacognitive recalibration, epistemic humility, and adaptive problem-solving capacities.

Bandura’s Social Cognitive and Social Learning Theory

The sociological and interpersonal axes of the HPLS-USR are deeply grounded in Albert Bandura’s (1977, 1986) Social Cognitive Theory, which posits that human psychological functioning operates through triadic reciprocal causation—the continuous, dynamic interaction between personal internal factors (cognitive, affective, and biological events), environmental influences, and behavioral patterns. Within USR initiatives, the community acts as a complex socio-cultural environment where observational learning, behavioral modeling, vicarious reinforcement, and direct social feedback converge.

Crucially, Bandura’s construct of self-efficacy—an individual’s conviction in their capability to organize and execute courses of action to manage prospective situations—serves as the psychological engine driving student development. Through experiential community interaction, students accumulate enactive mastery experiences, observe peer and mentor models, and receive verbal persuasion from community members and faculty mentors. This experiential loop expands both specific task-oriented health promotion self-efficacy and broad civic self-efficacy, directly underpinning the scale’s Social Interaction and Responsibility of Citizenship dimensions. By observing the tangible impact of their actions on community well-being, students experience an internal shift in their perceived agency, transitioning from passive recipients of educational instruction to active agents of community health transformation.

The Civic-Minded Professional Framework

Complementing Dewey and Bandura, the instrument integrates contemporary civic learning models, notably the Civic-Minded Graduate framework articulated by Steinberg, Hatcher, and Bringle (2011). This framework posits that the overarching goal of community-engaged higher education is the cultivation of a civic identity—a developmental state wherein an individual’s academic knowledge, technical skills, and professional identity are explicitly aligned with a commitment to public welfare. The HPLS-USR translates this theoretical trajectory into four quantifiable vectors, enabling psychometric measurement of how health professional students evolve into socially responsible practitioners.

Validity

The psychometric integrity and structural validity of the HPLS-USR were established through systematic empirical testing following classical test theory and best practices in educational measurement (DeVellis, 2012; Nunnally, 1978).

Sampling Adequacy and Structural Suitability

To verify the empirical viability of the correlation matrix for factor identification, the authors conducted formal data suitability diagnostics on the validation dataset (N = 200). The Kaiser-Meyer-Olkin (KMO) Measure of Sampling Adequacy yielded an outstanding index of 0.908, substantially exceeding the recommended psychometric benchmark of 0.80 and confirming that the item pool exhibited shared common variance exceptionally suitable for factor extraction. Simultaneously, Bartlett’s Test of Sphericity yielded a statistically significant result (p < .001), rejecting the null hypothesis that the inter-item correlation matrix was an identity matrix and verifying that the linear dependencies among the items warranted structural latent modeling.

Content and Construct Validity

The initial generation of the item pool was governed by an extensive synthesis of the USR, health literacy, and service-learning literature, supplemented by expert qualitative review. Content validity was evaluated by an interdisciplinary panel comprising specialists in occupational therapy, nursing, psychology, pharmacology, and medical chemistry, following standardized protocols for content quantification (Lynn, 1986; Zamanzadeh et al., 2015). Items judged to be ambiguous, conceptually overlapping, or displaying insufficient relevance to the target constructs were systematically revised or pruned.

Construct validity was empirically verified through exploratory factor analysis, which confirmed that all retained items aligned cleanly with their theorized conceptual dimensions without substantial anomalous cross-loadings. The extraction of four robust latent dimensions confirmed the multidimensional structure hypothesized by the developers, providing rigorous statistical proof that the HPLS-USR successfully operationalizes the multidimensional construct of health promotion civic literacy.

Criterion-Related, Convergent, and Discriminant Validity

To establish criterion-related and convergent validity, the developers benchmarked the HPLS-USR against two gold-standard external psychometric instruments widely utilized in service-learning research: the Service-Learning Experiences Scale (SLES) and the Service-Learning Growth Scale (SLGS) (Chen, 2016). Bivariate correlation analyses revealed statistically significant positive correlations between total HPLS-USR scores and scores on both the SLES and SLGS, confirming that the scale accurately captures the intended psychological phenomena associated with experiential community service.

Furthermore, convergent validity was substantiated at the subscale level: items designated to each factor exhibited robust, statistically significant loadings on their respective latent variables, indicating that the indicators share a high proportion of common variance. Discriminant validity was supported by factor correlation matrices and inter-factor variance shares, demonstrating that while the four dimensions are moderately interrelated—as theoretically expected within an overarching civic literacy construct—each factor accounts for unique, non-redundant psychological variance.

Reliability

A psychometric scale’s utility in educational and clinical research depends strictly on its measurement precision, stability, and internal consistency. The HPLS-USR displays exceptional reliability across its constituent elements.

For the complete 22-item instrument, the overall internal consistency coefficient (Cronbach’s alpha) was established at 0.92. In psychometric theory, an alpha coefficient surpassing 0.90 reflects an outstanding degree of internal consistency, indicating that the item battery reliably measures the overarching latent construct while maintaining minimal standard error of measurement (Tabachnick & Fidell, 2007). This high reliability confirms that individual student scores obtained from the HPLS-USR reflect genuine differences in civic literacy and personal development rather than random measurement error or semantic ambiguity in item formulation.

At the dimensional level, each of the four extracted subscales demonstrated strong internal reliability coefficients, meeting or exceeding conventional psychometric thresholds for applied research (alphas generally > 0.80). Item-total correlations across the retained 22 items confirmed that every individual item contributed meaningfully to overall scale variance, with no item redundancy or deleterious suppression effects. The scale’s high reliability guarantees that it can be confidently utilized in longitudinal cohort studies, pre-test/post-test experimental designs, and comparative educational program evaluations.

Factor Analysis

The latent dimensionality of the HPLS-USR was formally investigated utilizing Exploratory Factor Analysis (EFA) to identify the underlying structural framework of the instrument.

Extraction Methodology and Criteria

Factor extraction was conducted utilizing principal axis factoring and principal component techniques, guided by multiple extraction criteria: Kaiser’s eigenvalue criterion (retaining factors with eigenvalues > 1.0), inspection of Cattell’s scree plot, and Horn’s parallel analysis (Horn, 1965). The EFA cleanly extracted a four-factor solution that fully mirrored the conceptual framework designed by the authors.

Variance Explanation and Factor Loadings

The extracted four-factor model accounted for a substantial 61.83% of the total cumulative variance across the 22 items. In behavioral, educational, and psychological measurement, an explained variance exceeding 60% is universally regarded as a rigorous threshold indicating that the latent dimensions adequately capture the construct space. Individual item factor loadings across the four domains ranged from 0.44 to 0.82, satisfying the conservative psychometric threshold (loading > 0.40) for meaningful indicator retention (Tabachnick & Fidell, 2007; DeVellis, 2012).

Factor Structure Overview

• Factor 1: Personal Growth: Encompasses items measuring the student’s evolving self-awareness, emotional resilience, self-efficacy, and personal maturation resulting from real-world community challenges.
• Factor 2: Responsibility of Citizenship: Encompasses items indexing the internalization of altruism, social responsibility, dedication to public welfare, and community-oriented civic duties.
• Factor 3: Social Interaction: Encompasses items evaluating empathetic communication, cross-cultural competence, relationship building, and interprofessional teamwork within diverse community environments.
• Factor 4: Intellectual Growth: Encompasses items capturing critical cognitive synthesis, problem-solving, and the creative application of theoretical classroom learning to unstructured, real-world public health issues.

The clean factor patterns, absence of severe cross-loadings, and high explanatory variance confirm that the HPLS-USR possesses an exceptionally stable and interpretable internal structure, validating its deployment either as a composite global score or as a four-dimensional developmental profile.

Instrument / Measurement Tool

The practical administration parameters and structural specifications of the Health Promotion Literacy-based Scale for students in USR are summarized below:

• Test Type: Standardized self-report psychological questionnaire.
• Construct Assessed: Civic literacy, personal development, social competency, and intellectual growth developed through university community health service.
• Item Count: 22 items.
• Dimensional Structure: Multidimensional (4 subscales): Personal Growth, Responsibility of Citizenship, Social Interaction, and Intellectual Growth.
• Response Format: 5-point Likert scale (1 = never, 2 = rarely / once in a while, 3 = sometimes, 4 = fairly often / frequently, 5 = always).
• Target Population: Undergraduate college and university students participating in USR programs, service-learning curricula, or community-based healthcare initiatives.
• Validation Cohort: 200 undergraduate university students from Taiwan (mean age: 19.27 years).
• Original Language: Traditional Chinese (developed and validated in Taiwan).
• Administration Mode: Self-administered (pen-and-paper or digital online survey software; approximate completion time: 7 to 10 minutes).
• Scoring Instructions: A composite global score is computed by summing all 22 items, generating a total score range from 22 to 110. Alternatively, dimensional subscale scores can be derived by summing the items corresponding to each respective factor or calculating mean item scores per dimension. Higher total and dimensional scores signify higher levels of civic literacy, deeper reflective learning, and more positive developmental outcomes from the USR curriculum.

Permissions & Fee and Test Year

The Health Promotion Literacy-based Scale for students in USR was formally published in 2022 by Hung, Huang, Wang, Li, and Ho in the peer-reviewed journal International Journal of Environmental Research and Public Health (IJERPH). The validation study is accessible under an open-access licensing framework (Creative Commons Attribution 4.0 International License, CC BY 4.0).

While the conceptual framework, psychometric metrics, and validation statistics are published openly, the complete proprietary item inventory remains under the copyright of the primary research team at Chung Shan Medical University. Non-commercial educational researchers and institutional analysts seeking to utilize, translate, or adapt the complete 22-item instrument for empirical investigations are required to obtain permission from the corresponding author:

Chia-Hui Hung
Department of Occupational Therapy, Chung Shan Medical University
Taichung 40201, Taiwan
Email: [email protected]

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Items of the Scale