Psychometric validation of the school health assessment tool for primary schools in Southeast Nigeria.

Background: School health programs are critical for promoting the physical, psychological, and social well-being of students and staff, particularly in low- and middle-income countries. Effective evaluation of these programs requires comprehensive and context-sensitive tools. The School Health Assessment Tool for Primary Schools (SHAT-PS), originally developed and validated in Iran, offers a biopsychosocial framework for evaluating key dimensions of school health. Designed for use in low- and middle-resource settings and emphasizing both staff and student well-being, the SHAT-PS provides a promising foundation for addressing gaps in school health assessment. However, although this tool has demonstrated strong psychometric properties in its original context, its applicability in other cultural and educational settings remains underexplored.

Aim: This study aimed to validate the SHAT-PS in Nigerian primary schools by examining its factor structure, internal consistency, and contextual relevance.

Method: A total of 706 primary school teachers and school staff from the Nsukka education zone in southeast Nigeria completed the original 76 items of the SHAT-PS. Although the tool was originally developed in Persian, an English version, produced by the original developers through a standard forward and back translation process, was available and used in this study. As English is the official language of instruction in Nigeria, no additional translation was required. Instead, adaptation efforts focused on ensuring contextual and conceptual relevance of the items for the Nigerian educational setting, including expert review and evaluation by Nigerian educational psychologists and school administrators. We employed a cross-sectional design and conducted an Exploratory factor analysis (EFA) on half of the sample and a confirmatory factor analysis (CFA) on the remaining half. Internal consistency was assessed using Cronbach's alpha (α).

Results: EFA and CFA supported a six-factor structure (52 items): (1) School Health Policies, (2) Health Education and Psychological Services, (3) Health Services, Nutrition, and Staff Health, (4) School Hygiene, (5) School Area and Comfort, and (6) Physical Environment. The tool demonstrated good internal consistency (α = 0.66-0.89) and strong construct validity. Variations in responses highlighted its sensitivity to local discrepancies in infrastructure, services, and staff well-being.

Conclusion: The SHAT-PS was successfully validated for use in Nigerian primary schools. Its robust psychometric performance and contextual alignment with national school health priorities make it a valuable tool for monitor school health and inform targeted interventions. Further validation in other regions and among broader stakeholder groups is recommended to enhance its generalizability and support nationwide implementation.