Development and Validation of Mental Health Literacy Assessment Scale among Community Health Workers and Volunteers in Nepal

Background: Mental health literacy (MHL) is crucial for effective mental health care, especially in low- and middle-income countries like Nepal. Community health workers (CHWs) and volunteers play pivotal role in improving mental health, but their level of MHL is unknown as the existing assessment tools are not tailored to them. This study aims to develop and validate the Mental Health Literacy Assessment Scale (MHLAS) among CHWs and health volunteers. Method: The authors reviewed online literatures and consulted experts to generate an item pool that was refined through cognitive interviews with CHWs. Content validity was assured on the basis of the ratings of six experts. A cross-sectional survey was performed among 233 CHWs and health volunteers. Exploratory factor analysis (EFA) using Varimax rotation was performed to identify latent variables with factor loadings > 0.4. Confirmatory factor analysis (CFA) was employed to validate the model, using indices such as RMSEA < 0.05, SRMR < 0.08, CFI ≥ 0.90, and TLI ≥ 0.90. Reliability was assessed through Cronbach’s alpha where alpha coefficient > 0.70 indicated internal consistency. Result: The EFA resulted in a four-factor structure, with 50.75% of the total variance explained by positive mental health behaviors (21.44%), misconceptions about mental health (14.24%), symptoms of mental distress (8.70%), and mental health stigma (6.37%). The CFA demonstrated excellent model fit, with indices such as the normed chi-square (1.307), CFI (0.951), TFI (0.943), and RMSEA (0.036). The scale displayed strong convergent and discriminant validity, with an AVE > 0.431 and a CR > 0.7 for all factors. Internal consistency was confirmed, with a Cronbach’s alpha value of 0.797 for the overall scale. Conclusion: The MHLAS has robust psychometric properties and comprehensive coverage of mental health literacy components, making it a valuable tool for both research and practical applications among community health workers and volunteers in low- and middle-income countries.