Transcultural adaptation of an environmental health questionnaire with attitude, knowledge and skills scales for Portuguese nursing students

<b>Background/Objectives</b>: Climate change adversely affect some of the fundamental determinants of health and children are the population group most vulnerable to exposure to environmental risk factors. The main objective of this study was to validate in the Portuguese context three scales to assess attitudes, knowledge and skills on children's environmental health. <b>Methods</b>: A cross-sectional observational study was developed to translate, adapt and validate the questionnaire consisting of the following three scales: Attitude Scale (SANS_2), knowledge scale (ChEHK-Q) and skills scale (ChEHS-Q). This was carried out in two phases: Translation and adaptation process and validation process using the classical measure theory and item response theory with undergraduate nursing students. <b>Results</b>: We obtained a valid and reliable questionnaire to measure children's environmental health competence consisting of an attitude scale (α = 0.84), a knowledge scale (Infit = 0.98, Outfit = 0.97, item reliability = 0.98 and people reliability = 0.75) and a skills scale (Infit = 1.00, Outfit = 0.99, item reliability = 0.82 and people reliability = 0.88). The mean score in the attitude scale was 28.15 (5-35) ± 4.61, in the knowledge scale was 14.92 (0-26) ± 4.51 and in the skills scale was 42.51 (24-60) ± 6.41. <b>Conclusions</b>: We found that most of the Portuguese nursing students have very good pro-environmental attitudes and good knowledge and skills in dealing with children's environmental health. The questionnaire obtained in this study will be useful to make comparative studies with other countries and to evaluate the effectiveness of educational interventions.