Factor structure validation of the nurses&rsquo; behavior toward confirmed and suspected HIV/AIDS patients (NB-CSHAP) scale

Janet Alexis  A. De los Santos,; Norberto  E. Milla,

Factor structure validation of the nurses’ behavior toward confirmed and suspected HIV/AIDS patients (NB-CSHAP) scale

Norberto E. Milla | Janet Alexis A De los Santos

Abstract:

Behavioral responses of nurses toward people living with HIV are critical determinants of care quality, patient trust, and treatment outcomes. Stigma-driven practices continue to undermine ethical and inclusive healthcare delivery in many clinical settings. However, limitations in validated behavioral measurement tools hinder the systematic evaluation of inclusive and discriminatory nursing behaviors. This study validates the factor structure of the Nurses' Behavior Toward Confirmed and Suspected HIV/AIDS Patients (NB-CSHAP) scale, a novel instrument developed to assess the spectrum of inclusive and discriminatory service behaviors in stigma-sensitive healthcare settings. We evaluated the scale using responses from a sample of 400 nurses with direct experience in caring for suspected or confirmed HIV/AIDS cases. The psychometric properties were rigorously tested using Confirmatory Factor Analysis (CFA) with five-fold crossvalidation. Model fit statistics (CFI=0.905, RMSEA=0.071, SRMR=0.070) confirmed that the hypothesized four-factor model provides a good fit to the data, and standardized factor loadings supported item convergence. Internal consistency was strong for the overall scale, with composite reliability (CR) values ranging from 0.459 to 0.827. The Discriminatory factor showed the highest internal consistency and convergent validity. Moreover, HTMT ratios confirmed discriminant validity across all latent constructs. Factor covariances revealed theoretically consistent relationships, particularly the expected inverse association between the Service-Oriented and Discriminatory behaviors. While most factors performed well, the Perceptiveness and Openhandedness factors demonstrated weaker reliability and convergence, suggesting the need for targeted item refinement in future research. The NB-CSHAP scale is a contextually grounded and psychometrically sound tool for measuring behavioral diversity in sensitive healthcare settings, making it highly valuable for guiding stigma-reduction interventions and research in HIV care