Development and validation of a pictorial assessment tool for safety health literacy in preschool children aged 5–6 years

Fostering safety health literacy in early childhood is crucial for preventing unintentional injuries and reducing health-related risks. However, direct assessment tools that are developmentally appropriate for preschool children remains scarce. Guided by the Knowledge-Attitude-Practice model and the preschool safety health literacy indicator system proposed by Xiao et al. (2025), this study developed and validated an 18-item pictorial assessment tool for preschool children aged 5-6 years. Tool development proceeded through phased item generation and refinement, followed by exploratory factor analysis using Sample 1 ( N 1 = 204) and confirmatory factor analysis using Sample 2 ( N 2 = 217). The final instrument comprises 18 pictorial items representing a five-factor structure, demonstrating acceptable internal consistency, satisfactory content validity, and significant convergent validity with a parent-report measure of children’s safety health literacy. The results indicate that this pictorial assessment tool provides a promising approach for directly assessing safety health literacy in preschool children aged 5-6 years and has practical implications for early childhood safety and health education, as well as future cross-cultural adaptation.