Development and validation of the Medical Second Language Anxiety Scale for Nurses (MSLAS-N).

BACKGROUND: Language proficiency is crucial in healthcare, and non-native English-speaking nurses may experience significant anxiety when communicating in English, which can potentially impact their performance and patient outcomes. AIM: This study aims to develop and validate a survey to measure second language anxiety among nurses who use English in medical settings. METHOD: Methodological (tool development) research design was utilized and tested on a sample of 455 non-native English-speaking nurses in the Philippines across various healthcare settings. The MSLAS-N is a 24-item Likert scale survey that targets five key constructs: communication anxiety with colleagues, confidence in medical terminology, patient interactions, fear of negative evaluation, and perceived language proficiency. The study employs reliability and validity testing, including construct reliability to assess internal consistency, exploratory factor analysis (EFA) to investigate the survey's structural validity, and confirmatory factor analysis (CFA) to validate the hypothesized second-order, five-factor model. RESULTS: To ensure construct validity, exploratory factor analysis (Ordinary Least Squares with oblimin rotation) was conducted following verification of factorability (KMO = 0.92; Bartlett's test of sphericity, p < 0.001). Confirmatory factor analysis using Diagonally Weighted Least Squares estimation indicated good model fit, CFI = 0.99, TLI = 0.99, RMSEA = 0.070, SRMR = 0.054. The results confirm strong internal consistency for each construct and the hypothesized second-order, five-factor structure. Average item loadings for EFA on each factor ranged from 0.432 to 0.801, with an overall mean of 0.595. The scale demonstrated excellent internal consistency (Cronbach's α = 0.94), strong construct reliability (CR = 0.95), and acceptable average variance extracted (AVE = 0.78). These outcomes support the development of a psychometrically sound instrument capable of reliably measuring second language anxiety in professional medical contexts for nurses. CONCLUSION: The findings are expected to provide valuable insights into language-related anxiety not just among Filipino nurses but for all healthcare professionals whose first language is not English. The scale is recommended for use in professional development, onboarding, and continuing education to identify and address communication challenges among nurses who are non-native English speakers. The MSLAS-N is a psychometrically robust tool for identifying and addressing second-language anxiety among nurses, with implications for workforce training and international mobility. CLINICAL TRIAL NUMBER: Not applicable.