Self-perceived digital literacy, creative self-efficacy, and self-reported innovative behavior among undergraduate nursing students in Anhui, China: a multi-institutional cross-sectional study.

Authors

Tong Wu, Xudong Fan, Xinle Zhou, Yingying Wang, Miao Wang

Published in

Frontiers in public health. Volume 14. Pages 1938122. Epub Sep 30, 2026.

Abstract

Nursing studies have separately linked self-perceived digital literacy with self-reported innovative behavior and the clinical practice environment with creative self-efficacy and innovative behavior. A related association pattern has been reported among Chinese medical students, but joint evidence from multi-institutional nursing samples remains limited.
To evaluate the measurement structure and examine the three-variable association pattern among self-perceived general digital literacy, creative self-efficacy, and self-reported innovative behavior in nursing students recruited from three institutions.
A multi-institutional cross-sectional online survey conducted from September to December 2025 included 502 undergraduate nursing students from three medical higher-education institutions in Anhui Province, China. Item-level confirmatory factor analyses compared five theoretically plausible measurement models, and convergent and discriminant validity were evaluated before PROCESS Model 4 was applied to observed total scores. The primary analysis used 5,000 bootstrap resamples and eight theory-informed covariates.
Self-perceived general digital literacy was correlated with creative self-efficacy (r = 0.574) and self-reported innovative behavior (r = 0.584), while creative self-efficacy was strongly correlated with self-reported innovative behavior (r = 0.834; all p < 0.001). The theory-consistent higher-order three-construct model showed acceptable fit (χ ² = 1314.15, df = 426, CFI = 0.935, TLI = 0.929, RMSEA = 0.065, SRMR = 0.068), fitted substantially better than the one-factor model, and significantly outperformed the corresponding model combining creative self-efficacy and innovative behavior (Δχ ² = 151.76, Δdf = 2, p < 0.001). Their latent correlation was 0.907, HTMT was 0.902 (95% CI, 0.858-0.941), and the Fornell-Larcker criterion was not met. In the adjusted observed-score model, the total coefficient, direct coefficient, and bootstrap product term involving creative self-efficacy were 0.145 (95% CI, 0.127-0.163), 0.040 (95% CI, 0.025-0.055), and 0.105 (95% CI, 0.087-0.124), respectively. The product-term confidence interval excluded zero, and its estimate was materially similar without covariate adjustment. A supplementary post hoc reparameterization based on the observed-score correlations indicated that the data did not uniquely determine the directional ordering.
In this pooled three-institution nursing-student sample, the three self-report constructs showed a coherent cross-sectional association pattern across measurement-model comparisons and adjusted and unadjusted specifications. This finding connects two previously separate lines of nursing evidence and extends the complete pattern beyond a single-campus nursing sample. Creative self-efficacy was a theoretically relevant correlate within the contemporaneous statistical decomposition, not an established temporal or causal mechanism. Longitudinal studies with objective or observer-rated measures are needed to test temporal ordering and educational or practice-relevant implications.

PMID:
42876740
Bibliographic data and abstract were imported from PubMed on 15 Oct 2026.

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