Climate change presents critical challenges to public health, and healthcare professionals play a vital role in addressing its effects. The Climate and Health Tool (CHAT) assesses awareness, concern, motivation, and behaviors regarding climate change and health. This study aimed to adapt the CHAT into Turkish and evaluate its psychometric properties among healthcare professionals in Türkiye. A cross-sectional validation study was conducted with 496 participants using international adaptation standards, including forward-backward translation and cognitive interviews. Confirmatory factor analysis confirmed the original five-factor structure with excellent model fit (RMSEA = .038, CFI = .971). Internal consistency was high (Cronbach’s α = .886), and convergent validity was supported through positive correlations with the Carbon Footprint Awareness Scale and Climate Change Worry Scale. Measurement invariance testing demonstrated equivalence across gender groups. The Turkish CHAT is a valid and reliable tool for assessing climate-health competencies in research, education, and clinical settings.
AronssonJ.NicholsA.WarwickP.ElfM. (2024). Nursing students’ and educators’ perspectives on sustainability and climate change: An integrative review. Journal of Advanced Nursing, 80(8), 3072–3085. https://doi.org/10.1111/jan.15950
2.
Baykara MatS. T.YilmazB. N. (2024). Is awareness of climate change a predictor of eco-anxiety? Research within the scope of nursing students. Nurse Education Today, 140(2024), Article 106274. https://doi.org/10.1016/j.nedt.2024.106274
3.
BeatonD. E.BombardierC.GuilleminF.FerrazM. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25(24), 3186–3191. https://doi.org/10.1097/00007632-200012150-00014
4.
BrislinR. W. (1973). Comparative research methodology: Cross-cultural studies. International Journal of Psychology, 11(3), 215–229. https://doi.org/10.1080/00207597608247359
5.
BrunnerM.SüβH. M. (2005). Analyzing the reliability of multidimensional measures: An example from intelligence research. Educational and Psychological Measurement, 65(2), 227–240. https://doi.org/10.1177/00131644042686
6.
BulutA.İnce KasapR. (2023). Hemşirelerin çevre bilinci ölçeği Türkçe formunun psikometrik özellikleri. Turk Turizm Arastirmalari Dergisi, 6(10), 1384–1403. https://doi.org/10.26677/TR1010.2023.1320
7.
ChenF. F. (2007). Sensitivity of goodness of fit indexes to lack of measurement invariance. Structural Equation Modeling: A Multidisciplinary Journal, 14(3), 464–504. https://doi.org/10.1080/10705510701301834
8.
ChungS. J.JangS. J.LeeH. (2024). Validation of the Sustainability Attitudes in Nursing Survey-2 for nurses: A cross-sectional study. Nurse Education in Practice, 75(2024), Article 103898. https://doi.org/10.1016/j.nepr.2024.103898
9.
CicchettiD. V. (1994). Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychological Assessment, 6(4), 284–290. https://doi.org/10.1037/1040-3590.6.4.284
10.
ClarkL. A.WatsonD. (2019). Constructing validity: New developments in creating objective measuring instruments. Psychological Assessment, 31(12), 1412–1427. https://doi.org/10.1037/pas0000626
CohenL.ManionL.MorrisonK. (2002). Research methods in education. Routledge.
13.
ÇoklukD. Ö.BüyüköztürkD. Ş. (2018). Sosyal bilimler İçin çok değişkenli İstatistik SPSS ve LISREL uygulamaları. Pegem.
14.
CrimminsA.BalbusJ.GambleJ. L.BeardC. B.BellJ. E.DodgenD.EisenR. J.FannN.HawkinsM. D.HerringS. C.JantarasamiL.MillsD. M.SahaS.SarofimM. C.TrtanjJ.ZiskaL. (2016). The impacts of climate change on human health in the United States: A scientific assessment. U.S. Global Change Research Program. https://doi.org/10.7930/J0R49NQX
15.
CronbachL. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16(3), 297–334. https://doi.org/10.1007/BF02310555
16.
DemorestS.CookC.SchenkE.Whitfield HarrisL.EarleyA. (2024). School of nursing climate commitment: Nursing faculty bring climate to the classroom. Public Health and Healthcare. https://doi.org/10.20944/preprints202402.0196.v1
17.
DimitrovD. M. (2010). Testing for factorial invariance in the context of construct validation. Measurement and Evaluation in Counseling and Development, 43(2), 121–149. https://doi.org/10.1177/0748175610373459
18.
DingX.VancleefK. (2022). Test–retest reliability and practice effect of the Leuven Perceptual Organisation Screening Test. Behavior Research Methods, 54(5), 2457–2462. https://doi.org/10.3758/s13428-021-01741-z
19.
DiStefanoC.MorganG. B. (2014). A comparison of diagonal weighted least squares robust estimation techniques for ordinal data. Structural Equation Modeling: A Multidisciplinary Journal, 21(3), 425–438. https://doi.org/10.1080/10705511.2014.915373
20.
ErginE.AltinelB.AktasE. (2021). A mixed method study on global warming, climate change and the role of public health nurses from the perspective of nursing students. Nurse Education Today, 107(8), Article 105144. https://doi.org/10.1016/j.nedt.2021.105144
21.
FornellC.LarckerD. F. (1981). Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research, 18(1), 39–50. https://doi.org/10.1177/002224378101800104
GliemJ. A.GliemR. R. (2003). Calculating, ınterpreting, and reporting Cronbach’s alpha reliability coefficient for Likert-type scales. 2003 Midwest Research to Practice Conference in Adult, Continuing, and Community Education, Columbus, 82–87.
HackettF.GotT.KitchingG. T.MacQueenK.CohenA. (2020). Training Canadian doctors for the health challenges of climate change. The Lancet Planetary Health, 4(1), e2–e3. https://doi.org/10.1016/S2542-5196(19)30242-6
HairJ. F.BlackW. C.BabinB. J.AndersonR. E. (2019). Multivariate data analysis. Cengage.
29.
HayesA. F.CouttsJ. J. (2020). Use omega rather than cronbach’s alpha for estimating reliability. But…. Communication Methods and Measures, 14(1), 1–24. https://doi.org/10.1080/19312458.2020.1718629
30.
HenselerJ.RingleC. M.SarstedtM. (2015). A new criterion for assessing discriminant validity in variance-based structural equation modeling. Journal of the Academy of Marketing Science, 43(1), 115–135. https://doi.org/10.1007/s11747-014-0403-8
31.
HuL. T.BentlerP. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. https://doi.org/10.1080/10705519909540118
32.
JagalsP.EbiK. (2021). Core competencies for health workers to deal with climate and environmental change. International Journal of Environmental Research and Public Health, 18(8), 3849. https://doi.org/10.3390/ijerph18083849
33.
JASP Team. (2023). [Computer software] (Version 0.18.1). University of Amsterdam. https://jasp-stats.org/
34.
JeongD. W.KimG. S.ParkM. K. (2022). Validity and reliability of the Korean version of the climate, health, and nursing tool. Journal of Korean Academy of Nursing, 52(2), 173–186. https://doi.org/10.4040/jkan.21211
35.
KlineR. B. (2023). Principles and practice of structural equation modeling (4th ed.). Guilford publications.
36.
KooT. K.LiM. Y. (2016). A guideline of selecting and reporting ıntraclass correlation coefficients for reliability research. Journal of Chiropractic Medicine, 15(2), 155–163. https://doi.org/10.1016/j.jcm.2016.02.012
37.
KotcherJ.MaibachE.MillerJ.CampbellE.AlqodmaniL.MaieroM.WynsA. (2021). Views of health professionals on climate change and health: A multinational survey study. The Lancet Planetary Health, 5(5), e316–e323. https://doi.org/10.1016/S2542-5196(21)00053-X
38.
LeeH.PaganoI.BorthA.CampbellE.HubbertB.KotcherJ.MaibachE. (2021). Health professional’s willingness to advocate for strengthening global commitments to the Paris climate agreement: Findings from a multi-nation survey. The Journal of Climate Change and Health, 2(2021), Article 100016. https://doi.org/10.1016/j.joclim.2021.100016
39.
LiT.WehrK. (2007). The validity of the factor structure of the general social survey environmentalism scales across gender and ethnicity in the United States. Organization & Environment, 20(3), 367–385. https://doi.org/10.1177/1086026607306461
40.
LishinskiA. (2018). lavaanPlot: Path diagrams for Lavaan models via DiagrammeR. R Package Version 0, 5(1)–2018.
41.
LiuD. W. y.Fairweather-schmidtA. K.BurnsR. A.RobertsR. M. (2016). The utility of non-specific measures of resilience across the lifespan: An investigation of structural invariance across gender and age cohorts. Australian Journal of Psychology, 68(1), 3–10. https://doi.org/10.1111/ajpy.12091
42.
Luque-AlcarazO. M.GomeraA.RuízÁ.Aparicio-MartinezP.Vaquero-AbellanM. (2022). Validation of the Spanish version of the questionnaire on environmental awareness in nursing (NEAT). Healthcare, 10(8), 1420. https://doi.org/10.3390/healthcare10081420
43.
MaibachE.FrumkinH.AhdootS. (2021). Health professionals and the climate crisis: Trusted voices, essential roles. World Medical & Health Policy, 13(1), 137–145. https://doi.org/10.1002/wmh3.421
MilfontT. L.SibleyC. G. (2016). Empathic and social dominance orientations help explain gender differences in environmentalism: A one-year Bayesian mediation analysis. Personality and Individual Differences, 90(2016), 85–88. https://doi.org/10.1016/j.paid.2015.10.044
48.
MoserS.KleinhückelkottenS. (2018). Good intentions, but low impacts: Diverging importance of motivational and socioeconomic determinants explaining pro-environmental behavior, energy use, and carbon footprint. Environment and Behavior, 50(6), 626–656. https://doi.org/10.1177/0013916517710685
49.
ÖzdamarK. (1999). Paket programlar ile istatistiksel veri analizi-1: SPSS-MINITAB. Kaan Kitabevi.
50.
PetersN.BorgeR. H.SkarA.-M. S.EgelandK. M. (2022). Measuring implementation climate: Psychometric properties of the Implementation Climate Scale (ICS) in Norwegian mental health care services. BMC Health Services Research, 22(1), 23. https://doi.org/10.1186/s12913-021-07441-w
51.
PollittP.SattlerB.ButterfieldP. G.AnderkoL.BrodyC.MoodL.HufflingK.SchenkE.CookK. (2020). Environmental nursing: Leaders reflect on the 50th anniversary of Earth Day. Public Health Nursing, 37(4), 614–625. https://doi.org/10.1111/phn.12703
52.
PuahS.Bin Mohmad KhalidM. I. S.LooiC. K.KhorE. T. (2021). Working adults’ intentions to participate in microlearning: Assessing for measurement invariance and structural invariance. Frontiers in Psychology, 12, Article 759181. https://doi.org/10.3389/fpsyg.2021.759181
53.
RaykovT.MarcoulidesG. A. (2019). Thanks coefficient alpha, we still need you. Educational and Psychological Measurement, 79(1), 200–210. https://doi.org/10.1177/0013164417725127
54.
ReichenheimM. E.MoraesC. L. (2007). Operationalizing the cross-cultural adaptation of epidemological measurement instruments. Revista de Saúde Pública, 41(4), 665–673. https://doi.org/10.1590/S0034-89102006005000035
55.
RomanelloM.McGushinA.Di NapoliC.DrummondP.HughesN.JamartL.KennardH.LampardP.Solano RodriguezB.ArnellN.Ayeb-KarlssonS.BelesovaK.CaiW.Campbell-LendrumD.CapstickS.ChambersJ.ChuL.CiampiL.DalinC.HamiltonI. (2021). The 2021 report of the Lancet Countdown on health and climate change: Code red for a healthy future. The Lancet, 398(10311), 1619–1662. https://doi.org/10.1016/S0140-6736(21)01787-6
56.
RosseelY. (2012). Lavaan: An R package for structural equation modeling. Journal of Statistical Software, 48(2), 1–36. https://doi.org/10.18637/jss.v048.i02
57.
RyanE. C.DubrowR.ShermanJ. D. (2020). Medical, nursing, and physician assistant student knowledge and attitudes toward climate change, pollution, and resource conservation in health care. BMC Medical Education, 20(1), 200. https://doi.org/10.1186/s12909-020-02099-0
58.
SchenkE. C.CookC.DemorestS.BurduliE. (2019). CHANT: Climate, health, and nursing tool: Item development and exploratory factor analysis. Annual Review of Nursing Research, 38(1), 97–112. https://doi.org/10.1891/0739-6686.38.97
59.
SchenkE. C.CookC.DemorestS.BurduliE. (2021). Climate, health, and nursing tool (CHANT): Initial survey results. Public Health Nursing, 38(2), 152–159. https://doi.org/10.1111/phn.12864
60.
SorensenC.CampbellH.DepouxA.FinkelM.GildenR.HadleyK.HaineD.MantillaG.McDermott-LevyR.PotterT. M.SackT. L.TunS.WellberyC. (2023). Core competencies to prepare health professionals to respond to the climate crisis. PLOS Climate, 2(6), Article e0000230. https://doi.org/10.1371/journal.pclm.0000230
61.
StewartA. E. (2021). Psychometric properties of the climate change worry scale. International Journal of Environmental Research and Public Health, 18(2), 494. https://doi.org/10.3390/ijerph18020494
62.
TahkolD. (2023). Hemşirelik öğrencilerinin sürdürülebilir kalkınma tutumları ve Iklim değişikliğine yönelik bilgi düzeyleri [doctoral dissertation]. Dokuz Eylul Universitesi.
63.
TanS.AtikA. D.Yurdakok-DikmenB.FilaziA.YurdakokK.ErkocF. (2021). Endocrine disruptor chemicals awareness scale development for health sector professionals. Human and Ecological Risk Assessment: An International Journal, 27(9–10), 2359–2374. https://doi.org/10.1080/10807039.2021.2004876
64.
TavakolM.DennickR. (2011). Making sense of Cronbach’s alpha. International Journal of Medical Education, 2, 53–55. https://doi.org/10.5116/ijme.4dfb.8dfd
65.
TiittaI.KopraJ.McDermott-LevyR.JaakkolaJ. J. K.KuosmanenL. (2025). Climate change perceptions among nursing students: A comparative study between Finland and the United States. Nurse Education Today, 146(2025), Article 106541. https://doi.org/10.1016/j.nedt.2024.106541
ÜstgörülS.AkkayaB.PalazzoM.MicozziA. (2024). Development and validation of carbon footprint awareness scale for boosting sustainable circular economy. Sustainability, 16(18), 8199. https://doi.org/10.3390/su16188199
68.
Van De SchootR.LugtigP.HoxJ. (2012). A checklist for testing measurement invariance. European Journal of Developmental Psychology, 9(4), 486–492. https://doi.org/10.1080/17405629.2012.686740
69.
Von ElmE.AltmanD. G.EggerM.PocockS. J.GøtzscheP. C.VandenbrouckeJ. P.STROBE Initiative. (2008). The strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. Journal of Clinical Epidemiology, 61(4), 344–349. https://doi.org/10.1016/j.jclinepi.2007.11.008
70.
WattsN.AmannM.ArnellN.Ayeb-KarlssonS.BelesovaK.BoykoffM.ByassP.CaiW.Campbell-LendrumD.CapstickS.ChambersJ.DalinC.DalyM.DasandiN.DaviesM.DrummondP.DubrowR.EbiK. L.EckelmanM.MontgomeryH. (2019). The 2019 report of The Lancet Countdown on health and climate change: Ensuring that the health of a child born today is not defined by a changing climate. The Lancet, 394(10211), 1836–1878. https://doi.org/10.1016/S0140-6736(19)32596-6
71.
WinquistA.SchenkE. C.CookC.DemorestS.BurduliE. (2023). Climate, health, and nursing tool (CHANT): A confirmatory factor analysis. Public Health Nursing, 40(2), 306–312. https://doi.org/10.1111/phn.13161
72.
WuebblesD. J.FaheyD. W.HibbardK. A.DeAngeloB.DohertyS.HayhoeK.HortonR.KossinJ. P.TaylorP. C.WapleA. M.YoheC. P. (2017). Executive summary. Climate science special report: Fourth national climate assessment (Vol. I). U.S. Global Change Research Program. https://doi.org/10.7930/J0DJ5CTG
73.
XieB.BrewerM. B.HayesB. K.McDonaldR. I.NewellB. R. (2019). Predicting climate change risk perception and willingness to act. Journal of Environmental Psychology, 65(2019), Article 101331. https://doi.org/10.1016/j.jenvp.2019.101331
74.
YinP.FanX. (2003). Assessing the factor structure invariance of self-concept measurement across ethnic and gender groups: Findings from a national sample. Educational and Psychological Measurement, 63(2), 296–318. https://doi.org/10.1177/0013164403251328
75.
ZinbargR. E.RevelleW.YovelI.LiW. (2005). Cronbach’s α, Revelle’s β, and Mcdonald’s ωH: Their relations with each other and two alternative conceptualizations of reliability. Psychometrika, 70(1), 123–133. https://doi.org/10.1007/s11336-003-0974-7
