Development and validation of dysphagia knowledge and self-reported competence questionnaire for nurses

Background: Dysphagia is a common condition across healthcare settings and is associated with serious complications. Nurses play a key role in early identification and safe management. However, substantial gaps exist in nurses’ knowledge and competence. The scope of existing dysphagia questionnaires is limited, and most are designed for specialised populations. This study aimed to develop and validate a comprehensive tool to assess nurses’ knowledge and perceived competence in dysphagia care. Methods: The Dysphagia Knowledge and Self-reported Competence Questionnaire for Nurses (DKSCQ-N) was developed and validated in two phases. Phase 1 included item generation through literature review, mapping items across six domains, and expert evaluation using a Table of Specification and the Content Validity Index. Cognitive interviews with nurses were conducted to assess clarity, relevance and usability. In Phase 2, data were collected from 537 nurses from hospitals across Pakistan to establish reliability and construct validity. Reliability was assessed using internal consistency and test-retest reliability. Validity was assessed using confirmatory factor analysis and convergent validity. Results: Expert review demonstrated strong content validity (S-CVI = 0.95). Minor revisions were made after cognitive interviews to improve clarity. Confirmatory factor analysis supported a 21-item, two-factor model with acceptable fit (χ2/df = 4.062, CFI = 0.93, TLI = 0.921, RMSEA = 0.076, GFI = 0.88). Both factors demonstrated good convergent and discriminant validity. Significant correlation between the signs and symptoms, complication and management domains of DKSCQ-N and Dysphagia knowledge Scale supported convergent validity. Internal consistency was high (Cronbach’s α = 0.906) and test-retest reliability indicated excellent stability over two-weeks period (ICC = 0.829). Conclusion: The DKSCQ-N is a valid and reliable instrument to assess dysphagia knowledge and self-reported competence of nurses. It provides a comprehensive and contextually relevant measure that can help identify learning needs and assess training outcomes in hospital settings.