Development and Validation of Mental Health Literacy Assessment Scale among Community Health Workers 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. Objective: To develop and validate the Mental Health Literacy Assessment Scale (MHLAS)for assessing mental health literacy among community health workers. Method: A total of 24 items were initially generated and refined through cognitive interviews and expert evaluation. The final scale consisted of 20 items. Face validity was ensured through cognitive interviews conducted in two phases with community health workers and volunteers. Content validity was assured based on theratings of six experts. Cross-sectional survey was performed among 233 CHWs. 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 root mean square error of approximation (RMSEA) < 0.05, standardized root mean square residual (SRMR) < 0.08, comparative fit index (CFI) ≥ 0.90, and tucker-lewis index (TLI) ≥ 0.90. Reliability was assessed through Cronbach’s alpha where alpha coefficient >0.70 indicated internal consistency. Results: EFA identified four factors explaining 50.75% 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 (1.31), CFI (0.95), TLI (0.94), and RMSEA (0.03). The scale displayed strong convergent and discriminant validity, with an average variance extracted (AVE) > 0.43 and composite reliability (CR) >0.70 for all factors. Internal consistency was confirmed, with a Cronbach’s alpha value of 0.78 for the overall scale. Conclusion: The MHLAS has demonstrated robust psychometric properties and comprehensive coverage of mental health literacy components, making it a valuable tool for both research and practical applications among CHWs in Nepal. While these findings support its utility in this context, further validation is needed to establish its applicability across other low- and middle-income countries to assess its effectiveness in diverse cultural and geographic settings.