Validity and reliability of the Persian version of the gender equity scale in nursing education

Nursing is a humanistic and compassionate profession that serves communities by caring for human beings without considering their gender, race, socioeconomic status, culture, and even religion [1]. In the present era, the immigration rate has increased within and between countries owing to financial and security issues as the result of climate change, economic crises, and war [2], particularly among countries in the Middle East area like Iran. Therefore, health and nursing faculties should focus more on the diversity and inclusion of nurses in careers and provide empathy training for improving health equity and social justice [1]. Embracing diversity and inclusion in education can enhance teaching, learning, and research in healthcare. By fostering a welcoming and equitable university environment, nursing students can feel empowered to engage with diverse perspectives and better address healthcare disparities through effective disease management [3].

Gender equity in nursing education means treating all individuals fairly and equally, regardless of gender, in educational settings. It aims to provide equal opportunities and resources for both men and women in the traditionally female-dominated nursing profession. This includes addressing disparities in access to education and professional opportunities, as well as challenging stereotypes and biases related to gender roles in the field [4‐6]. Gender equity in nursing education refers to the fair treatment and representation of all genders within nursing programs, ensuring that both men and women have equal opportunities and resources to succeed. This concept is crucial in addressing the historical gender imbalances in the nursing profession, where women comprise a significant majority, often leading to perceptions of nursing as a predominantly female field [7]. Despite the benefits explained, fostering diversity in healthcare requires a cultural revolution due to cognitive biases and traditional stereotypes that hinder gender equity in nursing [8]. Following Florence Nightingale’s perspective, nursing is often viewed as a female-dominated field. Some authors argue that the quality of care may differ when provided by male nurses [9‐11]. These stereotypes may discourage men from pursuing nursing because they may feel inadequate in caring roles and expressing compassion [12]. Furthermore, these biases are social forces that lead to negative impacts, such as the marginalization and dissatisfaction of male nurses in the workplace or even their departure from the profession [8].

Nursing education encounters several significant challenges that impede the promotion of gender equity within the field. One of the foremost issues is the prevalence of gender stereotypes. Historically, nursing has been viewed as a “feminine” profession, which has led to the underrepresentation of men and reinforced societal norms that discourage gender diversity [13]. These stereotypes not only hinder the recruitment of male students but also negatively impact their training experiences, often resulting in bias and feelings of isolation.

Moreover, educational practices within nursing programs can inadvertently perpetuate these gender norms. Research indicates that implicit biases embedded in curricula and teaching methodologies can marginalize male students by excluding them from discussions focused on women-centered care. At the same time, female students may receive inadequate encouragement to pursue leadership roles, thereby entrenching existing disparities [14].

Cultural barriers further complicate these challenges, particularly in regions such as the Middle East and South Asia. In these contexts, societal expectations and cultural norms can severely restrict women’s participation in professional education while confining men to caregiving roles [15]. Addressing these multifaceted challenges is crucial for fostering a more inclusive and equitable nursing workforce.

Promoting gender equity in nursing education is significant not only for individual fairness but also for enhancing the overall quality of healthcare. Gender-balanced classrooms foster diverse perspectives, which can lead to improved patient care outcomes by preparing nurses to effectively address the needs of varied populations [16]. Additionally, equitable representation helps dismantle professional stereotypes, encouraging a broader range of individuals to enter the field and contribute to its growth. To promote gender equity, several strategies can be implemented. Curriculum reforms that include gender-sensitive training and discussions about equity can raise awareness and challenge biases among nursing students and educators [6]. Establishing mentorship and support networks for underrepresented genders can reduce feelings of isolation and improve retention rates. Furthermore, instituting policies related to attrition, financial aid, and leadership development can address structural inequities and enhance gender diversity in nursing programs [4].

Female nurses, like their male counterparts, often face unfair stereotypes and social discrimination. They are wrongly perceived as lacking professional skills and are unjustly denied higher pay and senior positions, especially in Asian countries with patriarchal values [17, 18]. Meanwhile, male nurses are promoted more quickly and attain leadership positions at a higher rate than their female counterparts [19, 20]. Based on the previously mentioned issues, it is essential to promote gender equity in order to improve the health and welfare of both care providers and recipients. Addressing the problem of gender biases and eliminating stereotypes in nursing education requires careful examination and evaluation, using valid scales.

Following the discussion on the necessity of promoting gender equity, it is essential to examine this concept through the lens of social critical theories, which emphasize power dynamics and social justice. These theories highlight how systemic inequalities, including those based on gender, shape educational environments and professional practices in nursing. By applying a critical perspective, we can better understand how entrenched stereotypes and biases not only influence individual experiences in nursing education but also perpetuate broader societal inequities. This understanding is crucial for developing strategies that foster an inclusive educational framework, empowering all nursing students to challenge discriminatory practices and advocate for equitable treatment in their future careers.

Critical theory in education focuses on studying power dynamics within the system. It explores how these dynamics impact the treatment and portrayal of genders in nursing education, revealing biases that may deter male students and devalue female nurses. This analysis uncovers how societal norms and institutional practices perpetuate gender disparities [21]. Social critical theories emphasize how dominant cultural narratives and institutional practices perpetuate gender biases within the field of nursing. Through a thorough analysis of these power dynamics, educators are able to pinpoint barriers that impede the fair and equal treatment and representation of individuals of all genders in nursing programs [22]. These theories promote the cultivation of critical consciousness among nursing students, empowering them to identify and challenge societal norms and stereotypes surrounding gender. This heightened awareness creates a more inclusive learning environment, where students are emboldened to champion gender equity in their future professional endeavors [4, 23]. Several studies have looked at gender-based barriers and the male-friendliness of the nursing profession, using various assessment scales. Although these scales are valid and useful for exploring gender inequality, they do not address equity. Therefore, a comprehensive understanding of the concept is crucial for promoting gender equity in nursing education [7].

Recent research has highlighted the importance of assessing gender equity in nursing education through validated scales. For instance, the Gender Equitable Men Scale (GEM-Scale) has been adapted in various contexts, including a study in Iran that evaluated its validity and reliability among male nursing students, emphasizing the need for culturally relevant tools to measure attitudes toward gender equality [24]. Similarly, studies conducted in Spain have utilized the Nijmegen Gender Awareness in Medicine Scale to assess gender-related health knowledge among nursing students, revealing significant gaps in gender sensitivity and suggesting that traditional teaching methods may be insufficient for fostering awareness [25]. Furthermore, a comprehensive evaluation of the Gender Equity Scale in Nursing Education demonstrated its effectiveness in identifying perceptions of gender roles and discrimination among nursing students, thereby contributing to improved educational practices and environments [7].

Cultural and linguistic differences play a significant role in the adaptability and validity of the Gender Equity Scale, particularly after its translation into Persian. Ensuring cultural fit involves a thorough process of adaptation that goes beyond direct translation; it requires a careful examination of cultural nuances and societal norms that influence gender perceptions in the Iranian context. For instance, potential cultural biases may arise if the scale’s items are not reflective of local values or practices, which could lead to misinterpretations of respondents’ attitudes toward gender equity. To address this, we recommend conducting cognitive interviews with diverse groups of nursing students to identify any ambiguities or culturally irrelevant items in the scale. Additionally, involving local experts in gender studies during the adaptation process can help ensure that the scale resonates with the cultural context and accurately captures the constructs it aims to measure.

Currently, there is no validated Persian scale for measuring gender equity in nursing education. Therefore, this study aims to investigate the reliability and validity of the Gender Equity Scale in Nursing Education (GES-NE) in Iraninan nursing students.

This methodological study was conducted April to July 2024. Nursing students from the northern region of Iran were recruited in this study. The online scale was created using Google Form. Participants were sent the survey link through email or social media platforms such as WhatsApp or Telegram. The original scale was developed by Cho et al. in South Korea [7]. In this study, the scale was translated into Persian and its psychometric properties were determined. An English language version of the adapted scale has been uploaded as a supplementary file.

Gender equality in nursing education is a crucial issue that needs attention. It involves ensuring that both female and male nursing students have equal opportunities, treatment, and experiences [6]. This study focused on assessing the psychometric properties of the Persian version of the gender equity scale in nursing education (P- GES-NE). The results of this study show that the P-GES-NE has a reliable factor structure, validity, and reliability.

This study found that the Persian version of the GES-NE had 14 items divided into three factors, explaining 43.77% of the gender equity in nursing education among Iranian nursing students. This is one factor and nine items less than the original GES-NE version [7]. Variations in factors, retained items, and explained variance could be attributed to cultural, linguistic, or contextual differences between the two samples.

Social critical theories in education push for changes in policies to promote gender equality in nursing education. This involves introducing training programs that are sensitive to gender and creating a supportive atmosphere that allows all nursing students to have equal opportunities [4]. Critical theory challenges traditional ideas about gender roles in nursing, promoting reflection on the stereotype that nursing is a female-only profession. By valuing diverse gender identities, it can create more inclusive curricula for nursing students to better prepare them for a diverse workforce [42]. Critical theory in education focuses on addressing systemic inequities by advocating for structural changes within institutions. This includes policies and practices that promote gender equity, such as inclusive hiring practices, equitable treatment guidelines, and diversity and inclusion training programs. By emphasizing the need for systemic reform, critical theory offers a guide for creating a more equitable environment in nursing education [43]. By incorporating social critical theories into nursing curricula, educators can create teaching methods that highlight inclusivity and cultural competence. This innovative approach equips nursing students with the skills needed to provide care that honors diverse gender identities and effectively addresses the unique health requirements of different populations [42].

In comparing our findings on the validity and reliability of P- GES-NE with existing literature, it is evident that our results align with studies conducted in various cultural contexts. For instance, a study in South Korea demonstrated that gender equity perceptions among nursing students significantly influenced their educational experiences and professional development, highlighting similar themes of gender discrimination and biases as observed in our research [7]. Furthermore, research from Spain utilizing the Nijmegen Gender Awareness in Medicine Scale revealed critical gaps in gender sensitivity among nursing students, reinforcing the necessity for effective measurement tools like ours to foster awareness and promote equitable educational environments [25]. Additionally, findings from a recent study indicated that gender equity in nursing education positively impacts job satisfaction among male nurses, suggesting that addressing these equity issues not only benefits educational outcomes but also enhances professional satisfaction and retention [6, 25]. These comparisons underscore the global relevance of our findings and the importance of implementing culturally adapted scales to assess and improve gender equity in nursing education worldwide.

Gender discrimination in nursing education is the first factor discussed. This refers to the unfair treatment, prejudice, or bias against individuals based on their gender within nursing education programs [8]. Gender discrimination in nursing education creates obstacles for individuals of all genders to pursue and excel in the nursing profession. It also reinforces harmful gender stereotypes [44]. To address these issues, there needs to be a collective effort to promote gender equality and inclusivity in nursing education programs. University professors and officials play a crucial role in eliminating gender discrimination by providing equal learning opportunities for both male and female nursing students [16]. This can be accomplished by ensuring that male students have equal access to clinical training and experiences as their female counterparts, without being excluded from specific procedures or specialties due to gender biases.

The second factor was named gender-based exclusion and alienation in nursing education. This refers to biased attitudes, communication, and behaviors of female nursing staff and faculty that can make male nursing students feel excluded, alienated, and undervalued, especially in clinical settings like obstetrics. Gender-biased attitudes, communication, and behaviors of female nursing staff and faculty that can make male nursing students feel excluded, alienated, and devalued, especially in clinical settings like obstetrics [45]. Additionally, the intersection of gender with other factors such as ethnicity, socioeconomic status, and culture can worsen exclusion and marginalization in nursing education, particularly for women [46]. To address these biases and promote inclusivity, both nursing faculty and practicing nurses need to make a concerted effort. Educators should avoid using gender-biased language and teaching practices that could deter men or women from pursuing any nursing specialty.

The final factor was named gender biases in nursing education. Gender bias refers to stereotypical beliefs about individuals based on their gender, leading to differential treatment of females and males. It involves favoring one gender over another [47]. In nursing education, gender bias can result in discrimination against male students, hinder the recruitment and retention of males in the profession, and create different learning experiences for male and female students [48]. To address this issue, nurse educators need to identify and address inequities, offer equal learning opportunities, and challenge traditional stereotypes to eliminate gender bias in nursing education.

The findings of the CFA showed that the data fit the model well, suggesting that the factor structure identified in the MLEFA was supported by the new dataset. This study’s results suggest that the items in GES-NE demonstrate strong convergent and divergent validity for all constructs. Divergent validity means that there is a clear distinction between different constructs, while convergent validity is shown when the components of a construct are closely related in meaning and explain variance [49]. These findings strongly suggest that the items in each factor are closely connected and accurately assess the concept of gender equality in nursing education. They also show that the factors measured by this scale are distinct and measure various aspects of gender equality in nursing education, supporting the idea that GES-NE has divergent validity.

The internal consistency coefficient of P-GES-NE indicates that the items within each factor are strongly correlated. This suggests that the items are measuring the same thing and that the factors are highly reliable.

In a study conducted by Cho et al. (2022), a satisfactory level of internal consistency was discovered, mirroring the results of this research. This confirms that both scales effectively evaluate gender equity within the realm of nursing education [7]. Additionally, the study by Mirzaii Najmabadi et al. revealed a two-factor structure with a Cronbach’s alpha of 0.79, indicating a commendable level of internal consistency [24]. This aligns with the findings from this study regarding strong internal reliability, though it emphasizes attitudes towards gender equity specifically among male student.

The findings from the P-GES-NE are consistent with other studies in terms of demonstrating strong validity and reliability measures. The comparative analysis underscores the importance of reliable psychometric tools in assessing gender equity in nursing education across different cultural contexts. These studies collectively contribute to understanding how gender dynamics influence nursing education and practice, highlighting an ongoing need for effective measurement tools to foster equitable educational environments.

The invariance analysis for sex demonstrated that metric invariance was supported, as indicated by acceptable changes in CFI and RMSEA. However, scalar and means invariance were not supported due to significant Δχ2\Delta \chi^2Δχ2 and unacceptable changes in CFI and RMSEA. Thus, factor loadings are invariant across sex, but item intercepts and means are not. The results of our gender invariance analysis reveal that while metric invariance is upheld, scalar and mean invariance are not, which holds significant implications for understanding factor structures across gender groups. The confirmation of metric invariance suggests that the relationships between latent variables remain consistent across genders, enabling meaningful interpretations of how these constructs interact. However, the absence of scalar invariance indicates that item intercepts vary between genders, implying that men and women may interpret or respond to specific items differently. This discrepancy complicates comparisons of latent means across groups, as any disparities in means could be due to measurement bias rather than genuine differences in underlying constructs. As a result, researchers should approach conclusions about gender differences cautiously when relying on means derived from measures lacking scalar invariance. Future research should explore alternative measurement strategies or qualitative approaches to delve deeper into how gender influences responses to specific items, enhancing the reliability of findings on gender differences.

Research indicates that higher levels of gender equity in nursing education correlate positively with job satisfaction among nurses. For instance, male nurses report greater job esteem and professional pride when they perceive their educational environment as equitable [7]. Despite improvements, challenges remain, such as underrepresentation of male nurses and biases in educational climates. Strategies to promote gender equity include implementing mentoring programs for male students, increasing male faculty representation, and fostering an inclusive curriculum that addresses gender biases [50].

The scale consists of three factors containing a total of 14 items, which collectively account for 43.77% of the total variance in Persian version of the gender equity in nursing education among Iranian nursing students. The findings affirm the appropriateness of employing the Persian iteration of the P-GES-NE as a dependable and valid instrument for assessing gender equity in nursing education among nursing students. P-GES-NE is a psychometrically sound instrument that provides a comprehensive assessment of gender equity in nursing education. It can help nursing programs identify and address gender equity concerns to create a more equitable learning environment for all students.