Measuring Advanced Practice in Health Visiting: Development and Psychometric Testing of the Health Visiting Advanced Practice Scale in Public Health Nursing

Unsworth, John ORCID: https://orcid.org/0000-0002-4150-6513, Whittaker, Karen, Fanner, Michael ORCID: https://orcid.org/0000-0002-4167-7582, Beauchamp, Hilda, Morton, Alison ORCID: https://orcid.org/0000-0001-5870-0024, Atkinson, Joanne ORCID: https://orcid.org/0000-0003-0823-0110, Nichol, Bethany ORCID: https://orcid.org/0000-0002-7642-1448, Comparcini, Dania ORCID: https://orcid.org/0000-0003-3622-6370, Simonetti, Valentina ORCID: https://orcid.org/0000-0002-7185-4850, Cicolini, Giancarlo ORCID: https://orcid.org/0000-0002-2736-1792 and Tomietto, Marco ORCID: https://orcid.org/0000-0002-3813-1490 (2026) Measuring Advanced Practice in Health Visiting: Development and Psychometric Testing of the Health Visiting Advanced Practice Scale in Public Health Nursing. Journal of Clinical Nursing, 35 (7). pp. 3078-3097. doi:10.1111/jocn.70260

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Abstract

Background The debate about whether health visiting, a specialist community public health nursing role, is at the level of advanced practice nurse has gone on for more than a decade. There is little empirical evidence that the role matches the traditional role of an advanced practice nurse, although many of the attributes of advanced practice nursing such as prescribing rights, managing complex cases, caseloads with undifferentiated need and advanced assessment and decision-making are certainly present. Aim The current study aimed to develop, refine and test the Health Visiting Advanced Practice Scale to assess the scope of advanced practice of UK health visitors. Design A cross-sectional and methodological scale validation design, following classical test theory. Methods The design consisted of three phases; the first involved scale development including item generation, phase two assessed the content validity index, and the third phase involved a cross-sectional survey to establish construct validity, content validity, and internal consistency reliability, and conduct exploratory and confirmatory factor analysis. Results The initial 44-item scale underwent iterative exploratory and confirmatory factor analyses, leading to a refined 5-factor structure with 29 items covering domains such as family-centred care, leadership, prescribing, diagnostic reasoning, and professional practice. This final version demonstrated strong reliability and construct validity in the EFA but mixed fit indices in the CFA, supporting both internal consistency and validity of the scale. Conclusion The final scale offers a rigorously validated tool for assessing advanced practice among UK health visitors, capturing core domains such as family-centred care, leadership, prescribing, and diagnostic reasoning. By bridging theoretical frameworks with real-world practice, it fills a critical gap in evaluating and supporting the professional scope of this public health nursing specialty. Impact These findings provide valid and reliable insights for measuring and improving health visitors' advanced practice and developing future professional policies. Patient or Public Contribution No patient or public contribution. Reporting Method STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for cross-sectional studies. Key Points—Summary What Does This Paper Contribute to the Wider Global Clinical Community? ○ Provides the first validated scale to assess advanced practice in health visiting, addressing a gap in the public health nursing roles globally. ○ Enables the international comparison of advanced nursing practice in health visiting, facilitating international policies to promote advanced practice in healthcare and public health. ○ Highlights health visiting as advanced practice of nursing with specific focus on breaking the cycle of deprivation and on reducing health inequalities.

Item Type:	Article
Article Type:	Article
Uncontrolled Keywords:	advanced practice nursing; cross-sectional survey; health visiting; public health nursing; scale development
Subjects:	R Medicine > R Medicine (General) R Medicine > RT Nursing
Divisions:	Schools and Research Institutes > School of Education, Health and Sciences
Depositing User:	Charlotte Crutchlow
Date Deposited:	05 Nov 2026 10:59
Last Modified:	05 Nov 2026 11:15
URI:	https://eprints.glos.ac.uk/id/eprint/16630

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