Development of the eye health scale-kids (EHS-kids): An eye health perception picture measurement tool for preschool children.

PURPOSE: This study aimed to develop and validate the Eye Health Scale-Kids (EHS-Kids), a multidimensional, pictorial instrument designed to assess eye health perceptions directly among preschool children. METHODS: This methodological study was conducted in two phases. In Phase 1, items were generated through a literature review and expert consultation. Content validity was evaluated by seven experts, and face validity was tested with five preschool children. In Phase 2, the psychometric properties of the EHS-Kids were evaluated using a convenience sample of 146 preschool children aged 4-6 years and their caregivers in South Korea. Construct validity was verified using exploratory factor analysis (EFA), and parallel analysis was used to determine the optimal number of factors. Criterion validity and internal consistency, measured using Cronbach's α with 95% confidence intervals (CIs), were also assessed. RESULTS: The final EHS-Kids consists of 13 items across four subdomains: eye protection behaviors, electronic device viewing habits, lifestyle habits, and perception of severity. Parallel analysis confirmed a four-factor structure, which explained 61.1% of the total variance. Factor loadings ranged from 0.587 to 0.808. The KMO statistic was 0.646, and Bartlett's test of sphericity was significant (p < .001). Criterion validity was supported by significant correlations with an established eye health behavior tool (r = 0.51-0.79). The overall Cronbach's α was 0.77 (95% CI [0.71, 0.82], with subscale values ranging from 0.52 to 0.72. PRACTICAL IMPLICATIONS: The EHS-Kids may provide a useful foundation for assessing preschool children's perceptions of eye health and supporting early interventions aimed at preventing eye health problems.