Evaluation of the Chinese version of the attitude of people toward male nurses questionnaire

Abstract

Background

The nursing profession in China is predominantly female, with male nurses significantly underrepresented. Societal attitudes and stereotypes contribute to this gender disparity. A reliable instrument to measure public attitudes toward male nurses in China is crucial for addressing these issues.

Methods

This methodological study validated the Chinese version of the Attitude of People Toward Male Nurses Questionnaire (AMnQ) using a cross-sectional design conducted among 480 Chinese adults from both urban and rural areas. To enhance the generalizability of the findings and capture broader societal attitudes, the sample included both healthcare and non-healthcare participants. The original AMnQ was translated into Chinese following standardized forward–backward translation procedures. Psychometric assessment covered internal consistency, split-half reliability, test–retest reliability, expert review, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA).

Results

The Chinese version of the AMnQ demonstrated strong internal consistency (Cronbach’s α = 0.823) and reliability (split-half = 0.904; test-retest = 0.747). Content validity was robust, with an S-CVI of 0.981. EFA revealed a three-factor structure, which was further validated by CFA, showing acceptable model fit indices.

Conclusion

The Chinese AMnQ is a reliable and valid tool for assessing public attitudes toward male nurses in China. This instrument can guide interventions aimed at reducing gender bias and fostering diversity within the nursing profession.

Clinical trial number

Not applicable.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-025-04204-4.

Introduction

Nursing remains a predominantly female profession globally, with significant gender disparities across healthcare systems [1, 2]. Historical perceptions since the mid-19th century have reinforced nursing as a feminine occupation [3, 4], contributing to the underrepresentation and marginalization of men within the profession [5, 6]. The global nursing shortage has intensified focus on gender diversity [7], yet male nurses represent only 9% in New Zealand [8], 11.4% in the UK [9] and 9.1% in the USA [10], and merely 2.3% of China’s 4.09 million registered nurses [11]. Encouraging male participation addresses workforce shortages while promoting professional diversity [12, 13]. Traditional stereotypes perpetuate societal biases against male nursing students and professionals [14, 15], resulting in peer exclusion [16, 17] and patient refusal of care during intimate procedures [13, 18, 19]. Male nurses face inappropriate labeling and scrutiny that undermines their professional competence [20, 21].

In China, cultural factors profoundly shape career choices and gender role expectations in ways distinct from Western contexts. Traditional Chinese culture emphasizes careers that enhance familial honor and economic stability, typically steering men toward engineering, business, and technology rather than nursing [22–24]. Confucian values, which stress that men should be the family’s main providers, further discourage them from pursuing careers perceived as offering modest economic returns. Nursing is also viewed as an extension of women’s caregiving roles, rooted in traditional expectations of gentleness and nurturing, creating additional social barriers for men. These cultural and gender role dynamics highlight the necessity of culturally adapted instruments to accurately assess attitudes toward male nurses in China. Although the COVID-19 pandemic increased recognition of healthcare professionals, significant social obstacles persist for men pursuing nursing.

Given these distinct cultural dynamics, Western-developed instruments may not adequately capture attitude dimensions specific to the Chinese context. Measuring attitudes toward male nurses requires culturally sensitive tools that account for Chinese gender role schemas, collectivist values, and profession-related prestige hierarchies. Sharma et al. developed the Attitude of People Toward Male Nurses Questionnaire (AMnQ), a validated instrument designed to systematically assess societal perceptions of male nursing professionals [25]. Although the AMnQ has proven effective elsewhere, its suitability for the Chinese healthcare context—with its distinct cultural views on gender, careers, and family—still requires careful testing.

This study aims to evaluate the reliability and validity of the Chinese version of the AMnQ for assessing attitudes toward male nurses among healthcare professionals, nursing students, and diverse community members. Understanding attitudes through a culturally adapted instrument is essential for designing interventions to promote gender diversity and inclusivity in nursing, ultimately fostering a healthcare environment that values professional competence over gender stereotypes.

Methods

Participants

This methodological study aimed to adapt the AMnQ for use in the Chinese context and to evaluate the reliability and validity of the adapted version. The study was conducted from April to August 2023 at a tertiary Grade A general hospital and two universities in Jinzhou, Liaoning Province. Purposive sampling was used to ensure adequate representation of diverse stakeholder groups with relevant experience regarding male nurses, for the following reasons: (1) it enabled intentional selection of participants across key demographic variables to capture the multidimensional nature of societal attitudes; (2) it ensured inclusion of multiple stakeholder perspectives essential for construct validation, including healthcare professionals who work alongside male nurses, patients who have received care from both male and female nurses, and nursing students who represent the future workforce; and (3) psychometric validation requires theoretical diversity in participant characteristics to adequately test scale properties across different subgroups. In each purposively selected setting, eligible participants were recruited using convenience sampling, and questionnaires were distributed to them (Table 1). Following sample size recommendations of 5–10 participants per item [26], 75–150 participants were required for the 15-item AMnQ. Using a simple random sampling method, 500 questionnaires were distributed, and 480 valid responses were obtained, yielding a 96% response rate. The mean survey completion time was 9.6 min. Participants included 64 registered nurses, 33 physicians, 43 other healthcare workers, 53 patients, 32 caregivers, 43 non-nursing university students, 42 nursing students, and 170 professionals from other fields. Inclusion criteria were: (1) Patients aged ≥ 18 years, fluent in Mandarin, who had received care from both male and female nurses, and had no history of psychiatric disorders; (2) Healthcare professionals (physicians or nurses) who had worked with male nurses.

Table 1.

Frequency distribution of demographic characteristics (n = 480)

Factors	Group	n (%)	The AMnQ scores
			Mean ± SD	t / F	P
Sex	Male	192 (40.0)	47.56 ± 0.59	0.460	0.645
	Female	288 (60.0)	47.22 ± 0.46
Age (years)	18–24	65 (13.5)	46.28 ± 1.08	1.828	0.141
	25–34	298 (62.1)	47.89 ± 0.45
	35–44	111 (23.1)	46.85 ± 0.76
	≥ 45	6 (1.3)	42.17 ± 2.15
Marital status	Single/lives alone	309 (64.4)	47.26 ± 0.46	0.128	0.721
	Married/cohabits	171 (35.6)	47.53 ± 0.59
Position	Nurse	64 (13.3)	46.27 ± 0.98	1.608	0.131
	Doctor	33 (6.9)	46.91 ± 1.61
	Health worker other than a nurse or doctor	43 (9.0)	48.28 ± 1.01
	Patient	53 (11.0)	44.47 ± 1.26
	Caretaker	32 (6.7)	48.66 ± 1.30
	Non-nursing university student	43 (9.0)	48.21 ± 1.05
	Nursing student	42 (8.8)	47.71 ± 1.30
	Other (civil servant, teacher, office worker, owner–operator, farmer, housewife, unemployed, service industrial employee)	170 (35.4)	47.97 ± 0.61

Procedure

Data collection procedure

Researchers were organized into three teams of three members each and received standardized training before data collection. The AMnQ was administered anonymously to nurses, physicians, nursing students, and other stakeholders. Of the 497 questionnaires returned, 17 were excluded due to incomplete responses, resulting in a final sample of 480 participants. To evaluate test–retest reliability, 40 participants were randomly selected to complete the questionnaire again after two weeks.

Scale translation procedure

With authorization from Professor Suresh K. Sharma, the AMnQ was translated following Brislin’s forward–backward translation method. First, two bilingual Chinese professors independently translated the scale into Chinese. The translated version was then back-translated into English by two native English-speaking educators. Psychologists compared the original scale, the Chinese translation, and the back-translated version, revising items to resolve linguistic or cultural discrepancies and ensure cultural relevance. A pilot survey was subsequently conducted using convenience sampling. Participants included two male nurses, two female nurses, one male patient, one female patient, one healthy male, and one healthy female. Their feedback on item clarity and layout confirmed the scale’s comprehensibility, resulting in the finalized Chinese translation.

Transcultural adaptation

Step 1: Expert consultation

An expert panel was convened to refine the scale, ensuring its linguistic clarity and cultural appropriateness. Experts were selected based on the following criteria: (1) senior professional title (associate professor or above) or a master’s degree in nursing or higher; (2) minimum of 10 years of clinical nursing or nursing education experience; (3) expertise in nursing management or psychometrics; and (4) willingness to participate in the study. The panel comprised three nursing professors from Jinzhou Medical University with 15–22 years of nursing education experience, specializing in nursing management, psychometric scale development, and qualitative research respectively. Additionally, four postgraduate-trained nurses (two male, two female) with 10–15 years of clinical experience in tertiary hospitals were included to provide practical clinical perspectives on male nurses’ experiences and societal attitudes. They reviewed the Chinese version for semantic clarity, cultural appropriateness, and professional relevance. These revisions produced the third version of the scale.

Step 2: Pretest

Eight eligible participants were recruited by convenience sampling. Before the survey, researchers explained the study objectives and obtained informed consent. Participants were interviewed to identify items that were unclear or unacceptable. Their feedback was analyzed and used to revise the instrument, resulting in the final AMnQ adaptation.

Measures

Background characteristics

Demographic data were collected using a tailored survey instrument informed by relevant literature. The survey captured gender, age, marital status, and professional position.

The attitude of people toward men nurses questionnaire (AMnQ)

The AMnQ was originally developed by Professor Suresh K. Sharma and colleagues to assess public attitudes toward male nurses [25]. The instrument comprises 15 items across three dimensions: (1) the perception of nursing as a feminine profession with low professional prestige (2), the belief that men are better suited for technically demanding or high-pressure clinical tasks, and (3) the association of empathy and caring behaviors with femininity. Each item is rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Five items are reverse-scored, and total scores are calculated by summing all item responses, with higher scores reflecting more positive attitudes toward male nurses.

Data analyses

Data were analyzed using SPSS version 25.0 (IBM Corp., Armonk, NY, USA) and AMOS version 23.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to summarize demographic characteristics, reported as means and standard deviations for continuous variables and frequencies with percentages for categorical variables. Group differences were examined using t-tests or one-way ANOVA.

Items analysis

To evaluate item discrimination, total scale scores were ranked, and the highest 27% (high-score group) and lowest 27% (low-score group) were compared. Correlation coefficients between individual item scores and the total scale score, as well as Cronbach’s α values after item deletion, were calculated to assess internal consistency.

Reliability analysis

The scale’s reliability was evaluated using various methods, including Cronbach’s alpha coefficients, split-half reliability, and test-retest reliability. A Cronbach’s α of ≥ 0.70 was considered acceptable [27], and a corrected item–total correlation of ≥ 0.30 was used as the retention criterion [28]. For split-half reliability, items were divided into odd and even groups, and the correlation between the two halves was computed [29]. Test–retest reliability was assessed with 40 randomly selected participants who completed the questionnaire again after two weeks. Test–retest reliability was considered good when the correlation coefficient was ≥ 0.70 [30].

Validity analysis

Content validity

A panel of experts, including three nursing professors and two male and two female nurses, evaluated all items using the Delphi method. The Content Validity Index (CVI) was calculated at both the item level (I-CVI) and the scale level (S-CVI) [31]. Experts rated each item on a 4-point scale, where 1 = no relevance, 2 = low relevance, 3 = relevant, and 4 = highly relevant.

Structural validity

Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were employed to examine the factor structure of the translated scale. A random sample of 480 cases was divided into two groups: one for EFA (n = 240) and the other for CFA (n = 240). The Kaiser-Meyer-Olkin (KMO) measure [32] and Bartlett’s sphericity test [28] assessed the adequacy of the correlation matrix for EFA. EFA was conducted when KMO exceeded 0.6 and Bartlett’s test was statistically significant (p < 0.05). The EFA utilized maximum variance rotation, with contributions over 50% considered acceptable and over 70% regarded as good [33].

CFA was conducted to confirm the factor structure and assess model fit [34]. Model fit was evaluated using the χ²/DF ratio, Comparative Fit Index (CFI), Goodness of Fit Index (GFI), Tucker-Lewis Index (TLI), Incremental Fit Index (IFI), and the Root Mean Square Error of Approximation (RMSEA). A χ²/DF ratio < 5.0 was considered indicative of an acceptable model fit, with values approaching 1.0 suggesting a better fit [35, 36]. CFI, GFI, TLI, and IFI values ≥ 0.90 were regarded as reflecting good model fit [37], and RMSEA values < 0.08 indicated acceptable fit, while values < 0.05 indicating excellent fit [38]. The data analysis process is illustrated in Fig. 1.

Fig. 1.

The data analysis procedure for Chinese version of the AMnQ

The distribution of continuous variables was summarized using means and standard deviations, and group differences were examined using t-tests or one-way ANOVA.

Ethics committee

The research protocol was reviewed and approved by the Ethics Committee of Jinzhou Medical University (JZMULL2022025). All participants provided informed consent after being fully informed about the study’s purpose, procedures, potential risks and benefits, and their right to withdraw at any time without penalty. To ensure confidentiality, all data were anonymized and assigned unique identification codes, with no personal identifiers collected or stored. Completed questionnaires were stored securely in a password-protected electronic database accessible only to the research team. All data handling procedures complied with relevant data protection regulations and institutional guidelines for research ethics.

Results

Demographics and sample characteristics

A total of 480 participants met the inclusion criteria: 288 were female (60.0%) and 192 were male (40.0%). Most participants (62.1%) were between 25 and 34 years old, and 64.4% reported being single or living alone. Independent samples t-tests and one-way ANOVA were performed to assess differences in AMnQ scores across sociodemographic groups. The results showed no significant differences in scores by gender, age, marital status, or position (P > 0.05). Detailed demographic characteristics are presented in Table 1.

Item analysis

A critical ratio (CR) exceeding 3.000 signifies that items exhibit strong discriminability. The translated scale’s 15 items demonstrated good discrimination, with CRs ranging from 9.498 to 19.753. Each item’s score correlated positively with the total score (r = 0.358–0.596, p < 0.001), indicating a relationship between the items and the scale. When each item was removed, the Cronbach’s α for the translated scale ranged from 0.801 to 0.818, which did not exceed the α value for the original scale (0.823; Supplementary Table 1).

Descriptive statistics of attitudes

The mean total AMnQ score among the 480 participants was 47.36 ± 8.01. Mean scores for each factor were as follows: Factor 1 (Perception of nursing as a feminine profession with lower professional prestige): 20.50 ± 5.45; Factor 2 (Belief in enhanced suitability of male nurses in technical and challenging scenarios): 12.84 ± 3.65; Factor 3 (Association of empathy and care with femininity): 14.02 ± 3.06.

Reliability analysis

Reliability analysis evaluates the precision, stability, and consistency of a scale; higher reliability correlates with more dependable measurement outcomes. Based on Cronbach’s α, the translated scale’s reliability was 0.823, with dimensions scoring between 0.833 and 0.896. The study also reported a split-half reliability of 0.904. Retesting 40 randomly selected participants after two weeks yielded a test-retest reliability of 0.747, suggesting minimal disturbance and good stability of the scale. These findings indicate that the translated scale possesses good reliability (Table 2).

Table 2.

Reliability analysis for the Chinese version of the AMnQ

The scale and Its dimension	Score	Cronbach’s Alpha	Split-half reliability	Test-retest reliability
The AMnQ	47.36 ± 8.01	0.823	0.904	0.747
Factor 1	20.50 ± 5.45	0.896
Factor 2	12.84 ± 3.65	0.889
Factor 3	14.02 ± 3.06	0.833

Validity analysis

Content validity

The content validity of the translated scale was evaluated by a panel of seven experts. As per Supplementary Table 2, the item-level Content Validity Index (I-CVI) for the translated scale ranged from 0.857 to 1.000, and the scale-level Content Validity Index (S-CVI) was 0.981.

Structure validity

Exploratory factor analysis (EFA)

The Kaiser-Meyer-Olkin Measure of Sampling Adequacy was 0.871, and the Bartlett test of sphericity was significant (χ² = 2217.240 P < 0.001). Hence, the matrix in question is not an identity matrix, which is suitable for factor extraction. Following Kaiser’s criterion, three factors were identified with initial eigenvalues greater than 1, accounting for a total of 68.922% of the variance. The three-factor structure, aligned with the original scale, was further substantiated by the scree plot, where the slope noticeably flattened after the third factor (Fig. 2). After varimax rotation, these three factors accounted for 33.083%, 27.183%, and 8.657% of the variance, respectively. Additionally, the factor loadings were satisfactory and are presented in Table 3.

Fig. 2.

Scree plot of exploratory factor analysis for Chinese version of the AMnQ

Table 3.

Factor loadings of exploratory factor analysis for Chinese version of the AMnQ

Item	Factor 1	Factor 2	Factor 3
a1: People prefer to be cared by female nurses only	0.928	-	-
a2: Nursing is suitable only for the females	0.747	-	-
a3: Male patients also prefer to be cared by the female nurses only	0.795	-	-
a4: Nursing is considered as low-level occupation for the males	0.713	-	-
a5: Nursing is considered as purely a female profession	0.685	-	-
a6: Hospitals prefer to appoint female nurses	0.701	-	-
a7: Nursing is very challenging and frustrating occupation for males	0.737	-	-
a8: Male nurses are more supportive and helpful in crisis	-	0.903	-
a9: Male nurses are more confident and technically sound than female nurses	-	0.886	-
a10: Male and female nurses both are equally required in nursing profession	-	0.867	-
a11: Male nurses are more suitable for some of the hospital units such as psychiatry, emergency, Operation Theater, and critical care units	-	0.853	-
a12: People do not prefer to send males for the nursing profession	-	-	0.857
a13: Female patients do not prefer to be cared by male nurses	-	-	0.639
a14: Female nurses are more caring and tender heart than male nurses	-	-	0.831
a15: Female nurses are more polite and courteous in patient care	-	-	0.806

Confirmatory factor analysis (CFA)

Validation factor analysis is a research method used to determine whether the correspondence between factors and scale items remains consistent with the researcher’s expectations. The results of confirmatory factor analysis are shown in Fig. 3. The validation findings indicated that the accessories exhibited favorable outcomes. The values for these indicators are provided as follows: χ²/DF = 1.193, GFI = 0.944, AGFI = 0.923, CFI = 0.987, RMSEA = 0.028, IFI = 0.987, TLI = 0.984.

Fig. 3.

Standardized three-factor structural model of the AMnQ

Discussion

This study represents the first introduction of the AMnQ to the Chinese healthcare context. Through a rigorous process of translation and cultural adaptation, the scale was successfully rendered into Chinese, maintaining semantic clarity, professional relevance, and alignment with local cultural norms. Seven nursing experts reviewed the translation for content validity, confirming its equivalence with the original scale. The final Chinese version consists of 15 items organized into a three-factor framework.

The Chinese version of AMnQ has suitable distinction

Following Brislin’s translation principles [39], nursing professionals were engaged to adapt and refine the AMnQ to ensure it was consistent with Chinese linguistic and cultural conventions. This rigorous process resulted in the creation of the Chinese version of the AMnQ, ensuring its equivalence with the original instrument. Preliminary investigations involving eight participants from diverse roles confirmed that the Chinese version of the AMnQ exhibited clear semantic expression and ease of comprehension while maintaining a rational structural framework. The CR values for each item surpassed the established standards, and item-total score correlations were all above 0.30, indicating strong internal consistency. Additionally, the Cronbach’s α values after the exclusion of each item did not surpass the original value of the translated scale. These findings suggest that all 15 items of the Chinese version of the AMnQ are valid and can be retained, demonstrating their effectiveness in differentiating among the constructs they measure.

When discussing the distinction and applicability of the AMnQ in the Chinese context, it is essential to consider the broader cultural implications. In Chinese culture, traditional gender roles and expectations can significantly influence public attitudes towards male nurses. Historically, nursing has been regarded as a female-dominated profession, as is the case in many cultures [40, 41]. However, with evolving societal norms, the valuable role of male nurses is gaining recognition. Successfully adapting the AMnQ to the Chinese context not only highlights the robustness of the scale but also emphasizes the need for culturally sensitive tools to understand changing attitudes, particularly as gender equality becomes a greater focus across professions, including healthcare.

Societal attitudes toward male nurses

The descriptive statistics provide meaningful insight into Chinese societal attitudes toward male nurses, with an overall mean AMnQ score of 47.36 ± 8.01 indicating generally positive perceptions. Factor 1 results suggest that participants are beginning to question the traditional notion of nursing as a women-only profession, though this stereotype has not been completely dispelled. Factor 2 reflects participants’ recognition of the important role male nurses play in technically demanding and high-pressure clinical settings, which is consistent with their increasing visibility in emergency, intensive care, and surgical units. In contrast, Factor 3 scores indicate that many participants continue to associate empathy and nurturing primarily with women, which may explain persistent discomfort with male nurses providing intimate or emotional care.

These findings reveal important patterns in how Chinese society views male nurses. According to social role theory, people develop gender stereotypes by observing who typically performs certain jobs [42]. Since nursing has historically been dominated by women, many people still view caregiving as a feminine trait. Our data show this perception is changing but remains strong - the low number of men in nursing continues to reinforce the idea that nursing is “women’s work.” Gender schema theory helps explain why these attitudes are hard to change [43]. People tend to interpret what they see based on their existing beliefs about gender roles. When participants in our study continued to associate caring and empathy primarily with women, it shows how these mental frameworks shape their comfort level with male nurses, particularly in situations requiring emotional support or intimate care. Factor 2 presents an interesting finding: participants were more willing to accept male nurses in technically demanding or high-pressure roles. This suggests that society accepts male nurses mainly by emphasizing traditionally “masculine” traits, such as technical expertise and crisis management skills, rather than fully recognizing men as caregivers.

Beyond the overall attitudinal trends, this study further examined potential variations in AMnQ scores across gender, age, marital status, and professional position. The analyses revealed no statistically significant differences among these demographic variables. This suggests that attitudes toward male nurses in this sample tended to be relatively consistent across diverse groups. One possible explanation is that professional values emphasizing patient-centered care may override traditional gender expectations, reducing demographic variability. Moreover, as male participation in nursing becomes gradually normalized within the Chinese healthcare workforce, both male and female professionals might view nursing less through a gendered lens and more as a skilled occupation requiring compassion and technical expertise.

The Chinese version of AMnQ has good reliability

Reliability analysis assesses the consistency of a scale’s structure over time [44]. The Chinese version of the AMnQ demonstrates reliability comparable to the original English version [25]. In this study, the reliability of the AMnQ was assessed using Cronbach’s α coefficient, test-retest reliability, and split-half reliability. The Cronbach’s α coefficient for the Chinese version of the AMnQ was determined to be 0.823, which suggests that the scale’s measurement of attitudes towards male nurses is stable and reliable. In the test-retest study, a reliability coefficient of 0.747 was obtained, indicating that public attitudes towards male nurses demonstrate reasonable temporal consistency. Therefore, considering educational interventions to alter public attitudes towards male nurses is valuable. These results demonstrate that the Chinese version of the AMnQ can consistently measure the construct or variable in question. Overall, the Chinese version of the AMnQ exhibits adequate reliability.

In the context of Chinese healthcare, high reliability is critical for ensuring the accuracy and reproducibility of study results. Given the significant regional variation in attitudes across China, from urban to rural areas, the consistent performance of the AMnQ makes it a dependable tool for capturing these perspectives. Urban regions, which may have more progressive views, differ from rural areas where traditional attitudes still dominate. Therefore, a reliable instrument is essential for designing targeted interventions that address region-specific attitudes and cultural differences.

The Chinese version of the AMnQ has excellent validity

Validity refers to the extent to which a measurement instrument accurately reflects the constructs it is designed to measure [45]. In this research, the scale’s validity was assessed through two perspectives: content validity and structural validity. The content validity analysis yielded I-CVI and S-CVI values exceeding established benchmarks, highlighting strong alignment with the intended content. The I-CVI and S-CVI values were derived from the ratings of seven experts who evaluated the relevance and clarity of each item. Feedback from these experts confirmed that the translated items were culturally sensitive and linguistically accurate, ensuring that the scale effectively captures attitudes toward male nurses in the Chinese context.

The EFA showed that the three factors accounted for 68.92% of the total variance, which was higher than the original scale’s 61.89%, demonstrating strong explanatory power in assessing societal attitudes toward male nurses. The factor attribution for all items was consistent with the original scale [25], with factor loadings ranging from 0.639 to 0.928. Additionally, the CFA indicated acceptable model fit indices, affirming the appropriateness of the three-dimensional structure of the Chinese AMnQ.

The cultural validity of the AMnQ is particularly relevant in the Chinese context, where traditional views on gender roles may shape perceptions of men in nursing. By ensuring that the AMnQ is culturally adapted and validated, this study provides a tool that can accurately reflects societal attitudes in China. This cultural alignment is crucial for developing targeted interventions that can effectively address and mitigate gender biases in nursing. The scale’s validity ensures that the measures are not just a reflection of linguistic translation but also a true representation of cultural attitudes towards male nurses in China.

Beyond research implications, the validated Chinese AMnQ can play a strategic role in guiding nursing policy and education. By systematically identifying public and professional attitudes toward male nurses, healthcare administrators can design recruitment campaigns that directly challenge stereotypes and promote nursing as a gender-inclusive profession. For instance, insights from the AMnQ could inform media messaging or admissions outreach that highlights male nurses’ contributions in patient-centered care and professional competence. Furthermore, nursing schools can integrate AMnQ findings into training curricula—emphasizing gender sensitivity, role modeling, and inclusive communication—to foster balanced learning environments. Policymakers may also use this evidence base to support incentive programs encouraging male participation in nursing, thereby addressing the persistent gender imbalance within the Chinese nursing workforce.

Limitations

Several limitations should be acknowledged. First, although purposive and convenience sampling were appropriate for this exploratory study, they may limit the generalizability of the findings. Future research could adopt random or stratified sampling to enhance representativeness and reduce potential selection bias. Second, the data were collected from a single province, which may have introduced cultural homogeneity among participants. This shared sociocultural environment could lead to more uniform attitudes toward male nurses, thereby masking regional variations or divergent values present in other parts of China. To address this limitation, future studies should include participants from multiple provinces and ethnic backgrounds to capture a more culturally nuanced spectrum of attitudes and minimize cultural bias. Third, the sample was predominantly younger, whose perspectives might not fully represent older generations that were socialized under traditional gender norms. Expanding the age distribution of participants would allow for more comprehensive comparisons across generational cohorts. Fourth, as the study relied on self-reported data, responses may have been influenced by social desirability bias, with participants providing answers they perceived as more acceptable rather than their true opinions. This tendency could lead to an underestimation of negative or stereotypical perceptions toward male nurses. To mitigate this bias, future studies could supplement quantitative data with qualitative interviews to capture more authentic attitudes. Using mixed-methods designs and triangulating data sources would further enhance the depth and validity of the findings.

Conclusions

The Chinese version of the AMnQ contains 15 items, confirming that it supports a three-factor structure with good reliability and validity. After cultural adjustments, the scale exhibits applicability and validity within the Chinese cultural framework. The scale was used to assess attitudes toward men in the nursing profession, providing valuable insights for managers and policymakers. By gaining a comprehensive understanding of societal perceptions of men’s roles in nursing, targeted policies and interventions can be developed to minimize gender bias in nursing and encourage more men to participate in the field, leading to a more diverse and inclusive healthcare environment. The results of this study have positive societal implications for promoting both gender equality and professional diversity.

Supplementary Information

Below is the link to the electronic supplementary material.

Abbreviations

AMnQ

the Attitude of People Toward Male Nurses Questionnaire

CMIN/DF

chi-square/degree of freedom

CR

Critical Ratio

EFA

Exploratory Factor Analysis

CFA

Confirmatory Factor Analysis

CFI

Comparative Fit Index

TLI

Tucker-Lewis Index

RMSEA

Root Mean Square Error of Approximation

Author contributions

WL, YF, GC and QY conceived and designed the study. GC and QY assisted in the collection of data. YF and QL provided statistical advice on the study design and analysed the data. WL and QL were involved in the preparation and revision of the manuscript. All authors read and approved the final manuscript.

Funding

No external funding.

Data availability

The data that support the fndings of this study are available upon reasonable request to the corresponding author, Qiujie Li (liqiujie1949@163.com).

Declarations

Ethics approval and consent to participate

All individuals have provided informed consent before the data collection. Participating students were promised that the information provided would remain anonymous. The research proposal was approved by the Ethics Committee of Jinzhou Medical University (JZMULL2022025), and all methods were performed in accordance with the relevant guidelines and regulations.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.