Development and reliability and validity testing of a medication literacy scale for medical college students
As early as 1985, the World Health Organization (WHO) introduced the concept of “rational drug use”, emphasizing that medications prescribed to patients should be appropriate for their clinical needs, tailored to individual requirements, with sufficient treatment duration, and minimized costs for the benefit of patients and their communities . The global issue of irrational drug use poses a significant threat to human health. Widespread irrational drug use is observed worldwide, with only 50% of patients demonstrating proper knowledge of drug usage after obtaining them . The impact of drug-related adverse events cannot be underestimated, as they contribute to high rates of disease recurrence and mortality . Medication-related harm affects 1 out of every 30 patients in health care, with more than a quarter of this harm regarded as severe or life-threatening, while 50% of the avoidable harm in health care is related to medications . In the United States, it was reported that over 1 in 10 youth and young adults aged 12–25 years used two or more psychoactive prescription medications, and misuse for stimulants and tranquillisers are over 40%, respectively . China faces a severe problem of irrational drug use, too. In China, irrational drug use is 12%~30% , and at least 2.5 million people are hospitalized due to adverse reactions . Medication behavior is closely related to many factors, including self-efficacy, medication literacy (ML), medication adherence and so forth . Medication literacy, a concept that has gained prominence in recent years, encompasses the range of competencies and skills essential for the safe and effective usage of pharmaceuticals . Some studies have proven that medication-related adverse events would be preventable with better medication literacy . Hammouda thought that medication literacy is mainly reflected in the “consistency” or “drug cooperation” between pharmacists or doctors and patients . Healthcare professionals, including clinical physicians, play a pivotal role in mitigating irrational medication. But in fact, medical professionals are also bringing about this problem. In China, Among the Medication error grade B-I in 2021, 72.16% were triggered by physicians . Meanwhile, drug abuse is also serious, especially antibiotics. A comprehensive study conducted across 48 healthcare institutions spanning six provinces in China revealed that antibiotics were prescribed in 52.9% of outpatient consultations within primary care environments. Notably, over 60% of these prescriptions were deemed inappropriate . Antibiotic prescriptions in China were dispensed at a rate exceeding double the recommendations of the World Health Organization (WHO), while the administration of injections and infusions occurred at a frequency more than triple that observed in comparable nations . It is believed that substance abuse in medical school may be one of the main causes of the ongoing problem of increased substance abuse in practicing physicians . Medical students, as future doctors, pharmacists, nurses and other healthcare professionals play an important role in promoting rational medication. But unfortunately, they are not immune to drug abuse and they may even abuse drugs on themselves . For medical students and residents, drugs are easily obtainable, so self-prescription is the most common mode of obtaining the drug to abuse , which is harmful to their own health and careers. Medical students face academic stress and health risks . Moreover, it can also seriously influence their professional behavior and compromise the standard of delivered healthcare services, placing their patients in danger . At the same time, it may also increase the medical financial burden. Chinese authorities also pay attention to their medication literacy. On February 26, 2020, the Notice on Printing and Distributing the Opinions on Strengthening the Administration of Pharmaceutical Affairs in Medical Institutions to Promote Rational Use of Drugs was issued. This notice proposed measures to enhance the level of clinical rational drug use by healthcare professionals and emphasized the need for medication training. Therefore, it is particularly important to investigate and evaluate the medication literacy level of medical college students . Numerous researchers have devised scales and associated assessment instruments to appraise medication literacy. Some medication literacy assessment tools have not been psychologically tested. Previously, some researchers in China studied college students’ medicine use by self-made questionnaires only from the perspective of medicine safety . Some research used self-compiled questionnaires to investigate college students’ medicine knowledge reserves from three dimensions: understanding of OTC medicines, understanding of antibiotics, and access to medical knowledge . These studies did not pay attention to the development of the scale, the concept of medication literacy, the division of dimensions from the theory and literature, and the test of reliability and validity, which might affect the accuracy and credibility of the experimental results . The development of the scales mainly aimed at people receiving medical services, especially patients . Some medication literacy assessment tools are not applicable to students. For example, Xu compiled a scale with good reliability (Cronbach’s α = 0.901 and split-half reliability = 0.875), but it was limited to Chinese HIV-infected individuals with contact transmission, making it unsuitable for other populations . However, a more universal Chinese scale for the general adult population in Taiwan has also been developed, but this scale focuses more on some vocabulary and understanding of prescription drugs, over-the-counter drugs and drugs, and the identification of drug advertisements. The scale focuses on medication information in mass communication and explores the impact of side effects related to dietary supplements in commercial advertisements . It is difficult for the test population and needs to be further modified and tested in the future. Therefore, they cannot be used to measure medical students’ medication literacy directly. Meanwhile, some scales do not meet some of the indicators or procedures compiled by the scale, may have corresponding problems in applicability, and cannot be used directly. Some scales have indicators that do not meet the requirements or include too many items, affecting their applicability and making them unsuitable for direct use. A scale was constructed for the theoretical framework of medication literacy for hypertension, but exploratory factor analysis (EFA) explained 51.42% (< 60%), and several fitting indexes of the four-domain model did not meet the standards (GFI = 0.804 < 0.90, AGFI = 0.777 < 0.90, IFI = 0.746 < 0.90). The scale contains 37 items, making it time-consuming for patients to complete . Some scholars have reduced this scale to 18 items. Its single-factor load coefficient is < 0.40, and the AVE in the three dimensions does not reach the required standard of 0.50, so further improvement is needed . Medication literacy measurement should be comprehensive, appraising every critical aspect of the concept. However, Some existing scales are still not comprehensive enough, concentrating more on functional literacy . More importantly, medication literacy refers to the individual having the skill not only to understand the instructions on how to use the medication but also to find the information and report potential side effects, in addition to critically analyzing whether the information is appropriate for his context . Some existing measurements only focus on the part of dimensions of literacy skills, including reading comprehension and word recognition. They do not measure the “interpretation” and “use of information” actions and seeking information from others, which are more advanced literacy skills and should be assessed . Therefore, this study aims to develop a medication literacy measurement tool with good reliability and validity for medical college students. It seeks to assess their medication literacy level comprehensively, incorporating the concept of medication literacy. 

Sample This questionnaire takes college students from a medical college in Shanxi Province as the investigation objects. Shanxi Province is located in the central plain area of China, with its economic development and discipline construction at the national average level. In addition, universities have a uniform distribution of disciplines and a complete range of subjects. Our research group had academic exchanges and cooperation with universities in Shanxi before, so conducting this research has the advantage of personnel coordination. Inclusion criteria: ①Undergraduate students, full-time college students with student status in the college; ②Participating students are informed and agreed to participate in this survey; ③Have the ability to fill out questionnaires by themselves or under the guidance of researchers. Exclusion criteria: ①Part-time students in this medical college; ② Students who have failed grades or have been demoted by schools during their school years; ③Unable to cooperate for personal reasons; ④ Unable to complete the form due to severe illness or mobility impairment. Research tools Source of initial items The item development of the medication literacy measurement scale in this paper is based on an existing health literacy scale. The reasons for this are the close relationship between health literacy and medication literacy. We will provide a detailed explanation of the reasons below: Firstly, health literacy and medication literacy are closely related. Medication literacy can be considered the application of health literacy in the medication use process . It is conceptually related but involves specific skills that are not fully included in health literacy, including various information acquisition and processing of medication . Therefore, medication literacy reflects the specific literacy competencies required to act on medication-related information . Besides, the concept of drug literacy is intended to be comprehensive: it involves several dimensions, all of which are important to Medication literacy. Medication literacy is defined as the capacity of individuals to acquire, comprehend, communicate, calculate, and process specific drug-related information, and to make informed decisions regarding drug treatment and health, in order to achieve safe and effective medication use . All dimensions are important for the medication use process, including functional literacy, communicative literacy, and critical literacy . From this perspective, the concept of medication literacy is consistent with Nutbeam’s theoretical model of health literacy. It is believed that health literacy includes three levels: the first level is functional reading and writing ability, which is the basic reading and writing skill that makes a person play an effective role in daily life. The second level is communication literacy, which is an advanced skill that enables people to extract information from different forms of communication and apply new information to the changing environment. The third level is the ability of critical information, that is, the advanced skills of critically analyzing information and using information to control better life events and situations . Ishikawa, Machi Suka and others developed the Health Literacy Scale on this basis, specific to diabetic patients . Machi Suka reconstructed it into a new scale named the 14-item health literacy scale (HLS-14) for Japanese adults . The scale includes three dimensions and fourteen items, including functional health literacy, communicative health literacy, and critical health literacy with adequate reliability and validity. Therefore, the initial medication literacy scale was developed according to HLS-14. It has three dimensions: functional medication literacy, communicative medication literacy, and critical medication literacy. Functional medication literacy and communicative medication literacy have five items, respectively, and critical medication literacy has four items. Expert consultation Based on the above-mentioned health literacy model and existing related questionnaires, the items of the medication literacy questionnaire were developed, and some items were modified by consulting with two clinicians, two clinical pharmacists, one public health researcher and one social science researcher in related fields. Afterward, the content validity was assessed through an online questionnaire. Pre-survey of subjects Through convenience sampling, 30 students were selected, and the purpose and significance of this study were explained to them in detail. After obtaining informed consent, the scale was filled out. After completing the questionnaire, they were interviewed. The interview mainly includes whether the questionnaire terms are clear and easy to understand and whether there are items that make people fill in poorly. After recording the interviewees’ understanding and feedback on the items, optimizing the items according to the special language and psychological state of the students, and modifying and proofreading the scale to ensure the comprehensibility of the items in the interview. Finally, the first draft of the scale was produced. Questionnaire design The first part focused on the fundamental demographic and sociological characteristics of the research subjects. These characteristics included gender, place of birth, class, department, and so forth. The second part of the study focused on the medication literacy scale. This scale was based on the Health Literacy Scale and consists of three dimensions: functional medication literacy, communicative medication literacy, and critical medication literacy. The scale included five alternative answers: “completely consistent,” “consistent,” “uncertain,” “inconsistent,” and “completely inconsistent.” Each answer is assigned a score based on its alignment with the respective dimension. For functional medication literacy, the scores range from 1 to 5, with 1 representing “completely consistent” and 5 representing “completely inconsistent.” For communicative and critical medication literacy, the scores are assigned in reverse, with 5 representing “completely consistent” and 1 representing “completely inconsistent.” The scores for each interviewee were then accumulated to obtain the total scores for medication literacy, as well as the scores for each dimension: functional medication literacy, communicative medication literacy, and critical medication literacy. A higher score indicates a higher level of medication literacy. Data collection Sojump was used to distribute questionnaires to college students in a medical college online, and all questions were set as “required answers” in the system function interface to ensure the integrity of the data. From March 17 to May 12, 2020. Quality control: Some students whose time to fill in the questionnaire is too short are screened, and those whose time to fill in the questionnaire is less than 80 s were removed. Statistical processing SPSS 26.0 and AMOS 24.0 were used to analyze the two samples. After descriptive statistics, some samples were used for item analysis, internal consistency, reliability, structural validity, exploratory factor analysis, etc. The other samples were used for confirmatory factor analysis. Measures Evaluation of items The Medication Literacy Scale was scored by the methods described above, and the total scale score was calculated. The items were then analyzed and screened using the correlation analysis method, critical ratio method, and total correlation correction. Correlational analysis method: Calculate the correlation between each item in each dimension of the scale and the total score. The correlation between the scores of each dimension of the questionnaire and the total score of the questionnaire is analyzed. The higher the correlation between a single item or a single dimension and the total score of medication literacy, the higher the consistency between the attributes measured by the item or dimension and the total scale. Critical ratio method: From the perspective of importance and distinction, this method is to find the total score of the questionnaire and sort the total score in order of high and low. The total scores of items were calculated and arranged according to the order of high and low, with the first 27% of the scores as the high group and the last 27% as the low group. The subjects in the high group were valued at 1, and the subjects in the low group were valued at 3, and the items of the two groups were analyzed by independent sample t-test. If the t -values of each topic were greater than 3.5, it indicated a significant difference between the high and low groups, and there was discrimination between each topic. Corrected Item-Total Correlation (CITC): The relationship between each item score and the total score was calculated, with a higher r -value indicating better representativeness of the item, combining Cronbach’s α coefficients after deletion to determine whether to delete the item. Suppose after deleting the item, the α coefficient of the remaining analysis items is significantly higher than the Cronbach’ sα coefficient value. In that case, the analysis item can be considered to be deleted . Evaluation of reliability and validity Reliability: The reliability of the scale was evaluated by Cronbach’s α coefficient and Split-half reliability. Internal consistency reliability was assessed using Cronbach’s α coefficient, with a Cronbach’s alpha > 0.7 considered indicative of good internal consistency . Split-half reliability is a kind of classical approach to inter-item reliability. If the split-half reliability is high (>0.7), it indicates that the instrument produces consistent results regardless of the specific items included in each half . Content validity: Content validity was confirmed by the expert panel. If the item-level content validity index (I-CVI) of each item ≥ 0.78, it will be considered indicative of good content validity of the scale . Structural validity: EFA and CFA were carried out to test the structural validity of the scale. The total sample was divided into two parts (Sample 1 and Sample 2) for use in EFA and CFA, respectively as mentioned. The suitability of the data for factor analysis was assessed using the Kaiser-Meyer-Olkin (KMO) measure and Bartlett’s test of sphericity. In general, a KMO value > 0.7 and Bartlett’s test P -value < 0.01 are considered indicative of data suitability for factor analysis. If the data meets the standard for EFA, principal component analysis and varimax orthogonal rotation were further used to extract the number of common factors. A factor loading > 0.4 was used as the criterion for factor attribution, with eigenvalues > 1 and a cumulative percentage of variance explained by the factors > 40% as additional indicators of factor significance . If the χ²/df (chi-square fit statistics/degree of freedom) < 3, GFI (Goodness of Fit index) > 0.85, CFI (Comparative Fit Index) > 0.9, RMSEA (Root Mean Square Error of Approximation) < 0.08, NFI (Normed Fit Index) > 0.9, and TLI (Tucker-Lewis index) > 0.9, it indicates that the scale has good structural validity. Convergent validity and discriminative validity: If the average variance extraction amount is greater than 0.5, the combined reliability (CR) value is greater than 0.7, which indicates that the convergent validity of the scale is good ; If the square root of the quantity of average variance extraction (AVE), is greater than the absolute value of the correlation coefficient among the dimensions, it shows that the discriminative validity among the three dimensions of the scale is good . Criterion-related validity: The criterion-related validity of the scale was examined by the relevant method. The HLS-14 was compared with the scale developed, and Pearson correlation analysis was performed on the measured data to test the criterion-related validity of this scale. If the correlation coefficient is ≥ 0.5 ( p < 0.05), it is considered to have a good calibration . The correlation between the total scores of the HLS-14 and the ML Scale was analyzed, and if the results showed that the total score of the Health Literacy Scale is significantly positively correlated with the total score of the medication literacy Scale, it indicated that the medication literacy scale had good criterion-related validity. 

This questionnaire takes college students from a medical college in Shanxi Province as the investigation objects. Shanxi Province is located in the central plain area of China, with its economic development and discipline construction at the national average level. In addition, universities have a uniform distribution of disciplines and a complete range of subjects. Our research group had academic exchanges and cooperation with universities in Shanxi before, so conducting this research has the advantage of personnel coordination. Inclusion criteria: ①Undergraduate students, full-time college students with student status in the college; ②Participating students are informed and agreed to participate in this survey; ③Have the ability to fill out questionnaires by themselves or under the guidance of researchers. Exclusion criteria: ①Part-time students in this medical college; ② Students who have failed grades or have been demoted by schools during their school years; ③Unable to cooperate for personal reasons; ④ Unable to complete the form due to severe illness or mobility impairment. 

Source of initial items The item development of the medication literacy measurement scale in this paper is based on an existing health literacy scale. The reasons for this are the close relationship between health literacy and medication literacy. We will provide a detailed explanation of the reasons below: Firstly, health literacy and medication literacy are closely related. Medication literacy can be considered the application of health literacy in the medication use process . It is conceptually related but involves specific skills that are not fully included in health literacy, including various information acquisition and processing of medication . Therefore, medication literacy reflects the specific literacy competencies required to act on medication-related information . Besides, the concept of drug literacy is intended to be comprehensive: it involves several dimensions, all of which are important to Medication literacy. Medication literacy is defined as the capacity of individuals to acquire, comprehend, communicate, calculate, and process specific drug-related information, and to make informed decisions regarding drug treatment and health, in order to achieve safe and effective medication use . All dimensions are important for the medication use process, including functional literacy, communicative literacy, and critical literacy . From this perspective, the concept of medication literacy is consistent with Nutbeam’s theoretical model of health literacy. It is believed that health literacy includes three levels: the first level is functional reading and writing ability, which is the basic reading and writing skill that makes a person play an effective role in daily life. The second level is communication literacy, which is an advanced skill that enables people to extract information from different forms of communication and apply new information to the changing environment. The third level is the ability of critical information, that is, the advanced skills of critically analyzing information and using information to control better life events and situations . Ishikawa, Machi Suka and others developed the Health Literacy Scale on this basis, specific to diabetic patients . Machi Suka reconstructed it into a new scale named the 14-item health literacy scale (HLS-14) for Japanese adults . The scale includes three dimensions and fourteen items, including functional health literacy, communicative health literacy, and critical health literacy with adequate reliability and validity. Therefore, the initial medication literacy scale was developed according to HLS-14. It has three dimensions: functional medication literacy, communicative medication literacy, and critical medication literacy. Functional medication literacy and communicative medication literacy have five items, respectively, and critical medication literacy has four items. Expert consultation Based on the above-mentioned health literacy model and existing related questionnaires, the items of the medication literacy questionnaire were developed, and some items were modified by consulting with two clinicians, two clinical pharmacists, one public health researcher and one social science researcher in related fields. Afterward, the content validity was assessed through an online questionnaire. Pre-survey of subjects Through convenience sampling, 30 students were selected, and the purpose and significance of this study were explained to them in detail. After obtaining informed consent, the scale was filled out. After completing the questionnaire, they were interviewed. The interview mainly includes whether the questionnaire terms are clear and easy to understand and whether there are items that make people fill in poorly. After recording the interviewees’ understanding and feedback on the items, optimizing the items according to the special language and psychological state of the students, and modifying and proofreading the scale to ensure the comprehensibility of the items in the interview. Finally, the first draft of the scale was produced. Questionnaire design The first part focused on the fundamental demographic and sociological characteristics of the research subjects. These characteristics included gender, place of birth, class, department, and so forth. The second part of the study focused on the medication literacy scale. This scale was based on the Health Literacy Scale and consists of three dimensions: functional medication literacy, communicative medication literacy, and critical medication literacy. The scale included five alternative answers: “completely consistent,” “consistent,” “uncertain,” “inconsistent,” and “completely inconsistent.” Each answer is assigned a score based on its alignment with the respective dimension. For functional medication literacy, the scores range from 1 to 5, with 1 representing “completely consistent” and 5 representing “completely inconsistent.” For communicative and critical medication literacy, the scores are assigned in reverse, with 5 representing “completely consistent” and 1 representing “completely inconsistent.” The scores for each interviewee were then accumulated to obtain the total scores for medication literacy, as well as the scores for each dimension: functional medication literacy, communicative medication literacy, and critical medication literacy. A higher score indicates a higher level of medication literacy. Data collection Sojump was used to distribute questionnaires to college students in a medical college online, and all questions were set as “required answers” in the system function interface to ensure the integrity of the data. From March 17 to May 12, 2020. Quality control: Some students whose time to fill in the questionnaire is too short are screened, and those whose time to fill in the questionnaire is less than 80 s were removed. Statistical processing SPSS 26.0 and AMOS 24.0 were used to analyze the two samples. After descriptive statistics, some samples were used for item analysis, internal consistency, reliability, structural validity, exploratory factor analysis, etc. The other samples were used for confirmatory factor analysis. 

The item development of the medication literacy measurement scale in this paper is based on an existing health literacy scale. The reasons for this are the close relationship between health literacy and medication literacy. We will provide a detailed explanation of the reasons below: Firstly, health literacy and medication literacy are closely related. Medication literacy can be considered the application of health literacy in the medication use process . It is conceptually related but involves specific skills that are not fully included in health literacy, including various information acquisition and processing of medication . Therefore, medication literacy reflects the specific literacy competencies required to act on medication-related information . Besides, the concept of drug literacy is intended to be comprehensive: it involves several dimensions, all of which are important to Medication literacy. Medication literacy is defined as the capacity of individuals to acquire, comprehend, communicate, calculate, and process specific drug-related information, and to make informed decisions regarding drug treatment and health, in order to achieve safe and effective medication use . All dimensions are important for the medication use process, including functional literacy, communicative literacy, and critical literacy . From this perspective, the concept of medication literacy is consistent with Nutbeam’s theoretical model of health literacy. It is believed that health literacy includes three levels: the first level is functional reading and writing ability, which is the basic reading and writing skill that makes a person play an effective role in daily life. The second level is communication literacy, which is an advanced skill that enables people to extract information from different forms of communication and apply new information to the changing environment. The third level is the ability of critical information, that is, the advanced skills of critically analyzing information and using information to control better life events and situations . Ishikawa, Machi Suka and others developed the Health Literacy Scale on this basis, specific to diabetic patients . Machi Suka reconstructed it into a new scale named the 14-item health literacy scale (HLS-14) for Japanese adults . The scale includes three dimensions and fourteen items, including functional health literacy, communicative health literacy, and critical health literacy with adequate reliability and validity. Therefore, the initial medication literacy scale was developed according to HLS-14. It has three dimensions: functional medication literacy, communicative medication literacy, and critical medication literacy. Functional medication literacy and communicative medication literacy have five items, respectively, and critical medication literacy has four items. 

Based on the above-mentioned health literacy model and existing related questionnaires, the items of the medication literacy questionnaire were developed, and some items were modified by consulting with two clinicians, two clinical pharmacists, one public health researcher and one social science researcher in related fields. Afterward, the content validity was assessed through an online questionnaire. 

Through convenience sampling, 30 students were selected, and the purpose and significance of this study were explained to them in detail. After obtaining informed consent, the scale was filled out. After completing the questionnaire, they were interviewed. The interview mainly includes whether the questionnaire terms are clear and easy to understand and whether there are items that make people fill in poorly. After recording the interviewees’ understanding and feedback on the items, optimizing the items according to the special language and psychological state of the students, and modifying and proofreading the scale to ensure the comprehensibility of the items in the interview. Finally, the first draft of the scale was produced. 

The first part focused on the fundamental demographic and sociological characteristics of the research subjects. These characteristics included gender, place of birth, class, department, and so forth. The second part of the study focused on the medication literacy scale. This scale was based on the Health Literacy Scale and consists of three dimensions: functional medication literacy, communicative medication literacy, and critical medication literacy. The scale included five alternative answers: “completely consistent,” “consistent,” “uncertain,” “inconsistent,” and “completely inconsistent.” Each answer is assigned a score based on its alignment with the respective dimension. For functional medication literacy, the scores range from 1 to 5, with 1 representing “completely consistent” and 5 representing “completely inconsistent.” For communicative and critical medication literacy, the scores are assigned in reverse, with 5 representing “completely consistent” and 1 representing “completely inconsistent.” The scores for each interviewee were then accumulated to obtain the total scores for medication literacy, as well as the scores for each dimension: functional medication literacy, communicative medication literacy, and critical medication literacy. A higher score indicates a higher level of medication literacy. 

Sojump was used to distribute questionnaires to college students in a medical college online, and all questions were set as “required answers” in the system function interface to ensure the integrity of the data. From March 17 to May 12, 2020. Quality control: Some students whose time to fill in the questionnaire is too short are screened, and those whose time to fill in the questionnaire is less than 80 s were removed. 

SPSS 26.0 and AMOS 24.0 were used to analyze the two samples. After descriptive statistics, some samples were used for item analysis, internal consistency, reliability, structural validity, exploratory factor analysis, etc. The other samples were used for confirmatory factor analysis. 

Evaluation of items The Medication Literacy Scale was scored by the methods described above, and the total scale score was calculated. The items were then analyzed and screened using the correlation analysis method, critical ratio method, and total correlation correction. Correlational analysis method: Calculate the correlation between each item in each dimension of the scale and the total score. The correlation between the scores of each dimension of the questionnaire and the total score of the questionnaire is analyzed. The higher the correlation between a single item or a single dimension and the total score of medication literacy, the higher the consistency between the attributes measured by the item or dimension and the total scale. Critical ratio method: From the perspective of importance and distinction, this method is to find the total score of the questionnaire and sort the total score in order of high and low. The total scores of items were calculated and arranged according to the order of high and low, with the first 27% of the scores as the high group and the last 27% as the low group. The subjects in the high group were valued at 1, and the subjects in the low group were valued at 3, and the items of the two groups were analyzed by independent sample t-test. If the t -values of each topic were greater than 3.5, it indicated a significant difference between the high and low groups, and there was discrimination between each topic. Corrected Item-Total Correlation (CITC): The relationship between each item score and the total score was calculated, with a higher r -value indicating better representativeness of the item, combining Cronbach’s α coefficients after deletion to determine whether to delete the item. Suppose after deleting the item, the α coefficient of the remaining analysis items is significantly higher than the Cronbach’ sα coefficient value. In that case, the analysis item can be considered to be deleted . Evaluation of reliability and validity Reliability: The reliability of the scale was evaluated by Cronbach’s α coefficient and Split-half reliability. Internal consistency reliability was assessed using Cronbach’s α coefficient, with a Cronbach’s alpha > 0.7 considered indicative of good internal consistency . Split-half reliability is a kind of classical approach to inter-item reliability. If the split-half reliability is high (>0.7), it indicates that the instrument produces consistent results regardless of the specific items included in each half . Content validity: Content validity was confirmed by the expert panel. If the item-level content validity index (I-CVI) of each item ≥ 0.78, it will be considered indicative of good content validity of the scale . Structural validity: EFA and CFA were carried out to test the structural validity of the scale. The total sample was divided into two parts (Sample 1 and Sample 2) for use in EFA and CFA, respectively as mentioned. The suitability of the data for factor analysis was assessed using the Kaiser-Meyer-Olkin (KMO) measure and Bartlett’s test of sphericity. In general, a KMO value > 0.7 and Bartlett’s test P -value < 0.01 are considered indicative of data suitability for factor analysis. If the data meets the standard for EFA, principal component analysis and varimax orthogonal rotation were further used to extract the number of common factors. A factor loading > 0.4 was used as the criterion for factor attribution, with eigenvalues > 1 and a cumulative percentage of variance explained by the factors > 40% as additional indicators of factor significance . If the χ²/df (chi-square fit statistics/degree of freedom) < 3, GFI (Goodness of Fit index) > 0.85, CFI (Comparative Fit Index) > 0.9, RMSEA (Root Mean Square Error of Approximation) < 0.08, NFI (Normed Fit Index) > 0.9, and TLI (Tucker-Lewis index) > 0.9, it indicates that the scale has good structural validity. Convergent validity and discriminative validity: If the average variance extraction amount is greater than 0.5, the combined reliability (CR) value is greater than 0.7, which indicates that the convergent validity of the scale is good ; If the square root of the quantity of average variance extraction (AVE), is greater than the absolute value of the correlation coefficient among the dimensions, it shows that the discriminative validity among the three dimensions of the scale is good . Criterion-related validity: The criterion-related validity of the scale was examined by the relevant method. The HLS-14 was compared with the scale developed, and Pearson correlation analysis was performed on the measured data to test the criterion-related validity of this scale. If the correlation coefficient is ≥ 0.5 ( p < 0.05), it is considered to have a good calibration . The correlation between the total scores of the HLS-14 and the ML Scale was analyzed, and if the results showed that the total score of the Health Literacy Scale is significantly positively correlated with the total score of the medication literacy Scale, it indicated that the medication literacy scale had good criterion-related validity. 

The Medication Literacy Scale was scored by the methods described above, and the total scale score was calculated. The items were then analyzed and screened using the correlation analysis method, critical ratio method, and total correlation correction. Correlational analysis method: Calculate the correlation between each item in each dimension of the scale and the total score. The correlation between the scores of each dimension of the questionnaire and the total score of the questionnaire is analyzed. The higher the correlation between a single item or a single dimension and the total score of medication literacy, the higher the consistency between the attributes measured by the item or dimension and the total scale. Critical ratio method: From the perspective of importance and distinction, this method is to find the total score of the questionnaire and sort the total score in order of high and low. The total scores of items were calculated and arranged according to the order of high and low, with the first 27% of the scores as the high group and the last 27% as the low group. The subjects in the high group were valued at 1, and the subjects in the low group were valued at 3, and the items of the two groups were analyzed by independent sample t-test. If the t -values of each topic were greater than 3.5, it indicated a significant difference between the high and low groups, and there was discrimination between each topic. Corrected Item-Total Correlation (CITC): The relationship between each item score and the total score was calculated, with a higher r -value indicating better representativeness of the item, combining Cronbach’s α coefficients after deletion to determine whether to delete the item. Suppose after deleting the item, the α coefficient of the remaining analysis items is significantly higher than the Cronbach’ sα coefficient value. In that case, the analysis item can be considered to be deleted . 

Reliability: The reliability of the scale was evaluated by Cronbach’s α coefficient and Split-half reliability. Internal consistency reliability was assessed using Cronbach’s α coefficient, with a Cronbach’s alpha > 0.7 considered indicative of good internal consistency . Split-half reliability is a kind of classical approach to inter-item reliability. If the split-half reliability is high (>0.7), it indicates that the instrument produces consistent results regardless of the specific items included in each half . Content validity: Content validity was confirmed by the expert panel. If the item-level content validity index (I-CVI) of each item ≥ 0.78, it will be considered indicative of good content validity of the scale . Structural validity: EFA and CFA were carried out to test the structural validity of the scale. The total sample was divided into two parts (Sample 1 and Sample 2) for use in EFA and CFA, respectively as mentioned. The suitability of the data for factor analysis was assessed using the Kaiser-Meyer-Olkin (KMO) measure and Bartlett’s test of sphericity. In general, a KMO value > 0.7 and Bartlett’s test P -value < 0.01 are considered indicative of data suitability for factor analysis. If the data meets the standard for EFA, principal component analysis and varimax orthogonal rotation were further used to extract the number of common factors. A factor loading > 0.4 was used as the criterion for factor attribution, with eigenvalues > 1 and a cumulative percentage of variance explained by the factors > 40% as additional indicators of factor significance . If the χ²/df (chi-square fit statistics/degree of freedom) < 3, GFI (Goodness of Fit index) > 0.85, CFI (Comparative Fit Index) > 0.9, RMSEA (Root Mean Square Error of Approximation) < 0.08, NFI (Normed Fit Index) > 0.9, and TLI (Tucker-Lewis index) > 0.9, it indicates that the scale has good structural validity. Convergent validity and discriminative validity: If the average variance extraction amount is greater than 0.5, the combined reliability (CR) value is greater than 0.7, which indicates that the convergent validity of the scale is good ; If the square root of the quantity of average variance extraction (AVE), is greater than the absolute value of the correlation coefficient among the dimensions, it shows that the discriminative validity among the three dimensions of the scale is good . Criterion-related validity: The criterion-related validity of the scale was examined by the relevant method. The HLS-14 was compared with the scale developed, and Pearson correlation analysis was performed on the measured data to test the criterion-related validity of this scale. If the correlation coefficient is ≥ 0.5 ( p < 0.05), it is considered to have a good calibration . The correlation between the total scores of the HLS-14 and the ML Scale was analyzed, and if the results showed that the total score of the Health Literacy Scale is significantly positively correlated with the total score of the medication literacy Scale, it indicated that the medication literacy scale had good criterion-related validity. 

General information on the sample A total of 1,363 questionnaires were distributed, and 1,325 were returned, resulting in a response rate of 97.21%. After eliminating 78 invalid questionnaires, 1,248 valid ones remained, giving a valid response rate of 94.19%. There is a rule of thumb of the sample size of 10 participants for every question in the instrument at least . Under this rule, we would need to include at least 140 samples. But it is controversial . So we should include more samples. Meanwhile, A large sample size can affect the calculation of chi-square values . Therefore, according to the ratio of male to female 1: 2, the ratio of freshman, sophomore, junior, and the graduation grades 1: 1: 1: 1, in total 540 samples were obtained by quota sampling, and the above ratio was equally divided into two samples, for use in Exploratory factor analysis (EFA) and Confirmatory factor analysis (CFA), respectively. The sample included 180 males (33.3%) and 360 females (66.7%), with 223 urban students (41.3%) and 317 rural students (58.7%), specializing in pharmacy, mental health, dentistry, bioengineering, and other departments, as shown in Table . Item evaluation results Pearson correlation was used to examine the correlation between items of functional medication literacy dimension and functional medication literacy, items of communicative medicine dimension and communicative medication literacy, items of critical medicine dimension and critical medication literacy, and the correlation between each item and the total score. Correlation analysis showed that the correlation coefficients between functional medication literacy, communicative medication literacy and critical medication literacy and the total score were 0.657, 0.744, 0.617, respectively ( p < 0.001). After analyzing the correlation between the total score and the score of each item, correlation coefficients (r) were found to range from 0.488 to 0.634 ( p < 0.001). The correlation coefficients between 0.3 and 0.8 indicated that the items were representative of the evaluation of medication literacy. Therefore, the correlation coefficients between all dimensions and items of the scale and the total score of medication literacy reached a significant level. The total score of items was calculated in high and low order. The first 27% of the score is the high group (total score is greater than or equal to 45), and the second 27% of the score is the low group (total score is less than or equal to 52). When the first 27% of subjects were assigned to 1 and 27% to 3, the independent sample t-test measured between 7.147 and 13.201 t -values ( p < 0.001) to identify that high and low groups were significantly different. The CITC for functional medication literacy, communicative medication literacy and critical medication literacy were all equal or greater than 0.690, 0.598 and 0.671, respectively. The CITC for the whole medication literacy scale was equal to or greater than 0.376. The Cronbach’s alpha coefficients after item deletion showed that the internal consistency did not improve significantly by removing any items. The results of the item analysis indicate that the medication literacy scale has a level of discrimination that meets standards . In conclusion, our comprehensive analysis indicates that all 14 items in the medication literacy scale are valuable and should be retained. This reassures us of the scale’s comprehensiveness and its ability to provide a holistic assessment of medication literacy. Reliability test results Data processing results showed that the total Cronbach’s α coefficient was 0.826(> 0.800), while the Cronbach’s α coefficients of functional medication literacy, communicative medication literacy and critical medication literacy were 0.901, 0.858, 0.851(> 0.800).This shows that the reliability of the total scale and each subscale is good. The value of split-half reliability was 0.852(> 0.800), which indicated that the scale had good internal consistency reliability. Validity test results Constructional validity The experts panel assessed the content validity of the scale. The item-level content validity index (I-CVI) ranged from 0.833 to 1.000 (≥ 0.78). Constructional validity In Table , factor analysis of 14 items showed that KMO = 0. 852(> 0.7) and Bartlett spherical test P < 0.001, indicating that the data were very suitable for factor analysis. Three principal axis factors were extracted by exploratory factor analysis, and the cumulative interpretation rate was 69.031% (> 40%). As Fig. shows, AMOS 24.0 was used for confirmatory factor analysis to test the structure validity of the scale. The χ²/ df = 2.623 < 3 (sample size 270), GFI = 0.905 > 0.9, CFI = 0.950 > 0.9, RMSEA = 0.078 < 0.1, NFI = 0.922 > 0.9, TLI = 0.938 > 0.9, all within the acceptable range, indicating that the model fitted the survey data as a whole. The model fit was scientific, and the effective scale has high validity. The values of standard load coefficients were all above 0.67 (> 0.4), indicating a strong correlation between each term and its respective factors. 3.4.3 Convergent validity and discriminative validity In Table , on the basis of factor analysis, the values of convergent validity and discriminative validity were explored. The data showed that the average variance extracted (AVE) for the three dimensions was 0.692, 0.606, and 0.578, all greater than 0.5. The composite reliability was 0.918, 0.884, and 0.845, all greater than 0.7, indicating that the scale had high convergent validity. In Table , according to the data of the discriminative validity test, the square roots of the average variance extraction amount of the three dimensions (the value of diagonal is 0.832, 0.778, 0.760) are greater than the absolute value of the correlation coefficient among the three dimensions (the absolute value of the lower triangle is 0.748, 0.101, 0.037), which shows that the discriminative validity among the three dimensions of the scale is good. Criterion-related validity In Table , the correlation between the total score of the health literacy scale and the total score of the medication literacy scale was analyzed. The results showed that the total score of the health literacy scale was significantly positively correlated with the total score of the medication literacy scale ( r = 0.805, p < 0.001), and the total score of the health literacy scale was significantly positively correlated with the scores of each dimension of the medication literacy scale. Pearson correlation coefficients were all above 0.528 ( p < 0.001). 

A total of 1,363 questionnaires were distributed, and 1,325 were returned, resulting in a response rate of 97.21%. After eliminating 78 invalid questionnaires, 1,248 valid ones remained, giving a valid response rate of 94.19%. There is a rule of thumb of the sample size of 10 participants for every question in the instrument at least . Under this rule, we would need to include at least 140 samples. But it is controversial . So we should include more samples. Meanwhile, A large sample size can affect the calculation of chi-square values . Therefore, according to the ratio of male to female 1: 2, the ratio of freshman, sophomore, junior, and the graduation grades 1: 1: 1: 1, in total 540 samples were obtained by quota sampling, and the above ratio was equally divided into two samples, for use in Exploratory factor analysis (EFA) and Confirmatory factor analysis (CFA), respectively. The sample included 180 males (33.3%) and 360 females (66.7%), with 223 urban students (41.3%) and 317 rural students (58.7%), specializing in pharmacy, mental health, dentistry, bioengineering, and other departments, as shown in Table . 

Pearson correlation was used to examine the correlation between items of functional medication literacy dimension and functional medication literacy, items of communicative medicine dimension and communicative medication literacy, items of critical medicine dimension and critical medication literacy, and the correlation between each item and the total score. Correlation analysis showed that the correlation coefficients between functional medication literacy, communicative medication literacy and critical medication literacy and the total score were 0.657, 0.744, 0.617, respectively ( p < 0.001). After analyzing the correlation between the total score and the score of each item, correlation coefficients (r) were found to range from 0.488 to 0.634 ( p < 0.001). The correlation coefficients between 0.3 and 0.8 indicated that the items were representative of the evaluation of medication literacy. Therefore, the correlation coefficients between all dimensions and items of the scale and the total score of medication literacy reached a significant level. The total score of items was calculated in high and low order. The first 27% of the score is the high group (total score is greater than or equal to 45), and the second 27% of the score is the low group (total score is less than or equal to 52). When the first 27% of subjects were assigned to 1 and 27% to 3, the independent sample t-test measured between 7.147 and 13.201 t -values ( p < 0.001) to identify that high and low groups were significantly different. The CITC for functional medication literacy, communicative medication literacy and critical medication literacy were all equal or greater than 0.690, 0.598 and 0.671, respectively. The CITC for the whole medication literacy scale was equal to or greater than 0.376. The Cronbach’s alpha coefficients after item deletion showed that the internal consistency did not improve significantly by removing any items. The results of the item analysis indicate that the medication literacy scale has a level of discrimination that meets standards . In conclusion, our comprehensive analysis indicates that all 14 items in the medication literacy scale are valuable and should be retained. This reassures us of the scale’s comprehensiveness and its ability to provide a holistic assessment of medication literacy. 

Data processing results showed that the total Cronbach’s α coefficient was 0.826(> 0.800), while the Cronbach’s α coefficients of functional medication literacy, communicative medication literacy and critical medication literacy were 0.901, 0.858, 0.851(> 0.800).This shows that the reliability of the total scale and each subscale is good. The value of split-half reliability was 0.852(> 0.800), which indicated that the scale had good internal consistency reliability. 

Constructional validity The experts panel assessed the content validity of the scale. The item-level content validity index (I-CVI) ranged from 0.833 to 1.000 (≥ 0.78). Constructional validity In Table , factor analysis of 14 items showed that KMO = 0. 852(> 0.7) and Bartlett spherical test P < 0.001, indicating that the data were very suitable for factor analysis. Three principal axis factors were extracted by exploratory factor analysis, and the cumulative interpretation rate was 69.031% (> 40%). As Fig. shows, AMOS 24.0 was used for confirmatory factor analysis to test the structure validity of the scale. The χ²/ df = 2.623 < 3 (sample size 270), GFI = 0.905 > 0.9, CFI = 0.950 > 0.9, RMSEA = 0.078 < 0.1, NFI = 0.922 > 0.9, TLI = 0.938 > 0.9, all within the acceptable range, indicating that the model fitted the survey data as a whole. The model fit was scientific, and the effective scale has high validity. The values of standard load coefficients were all above 0.67 (> 0.4), indicating a strong correlation between each term and its respective factors. 3.4.3 Convergent validity and discriminative validity In Table , on the basis of factor analysis, the values of convergent validity and discriminative validity were explored. The data showed that the average variance extracted (AVE) for the three dimensions was 0.692, 0.606, and 0.578, all greater than 0.5. The composite reliability was 0.918, 0.884, and 0.845, all greater than 0.7, indicating that the scale had high convergent validity. In Table , according to the data of the discriminative validity test, the square roots of the average variance extraction amount of the three dimensions (the value of diagonal is 0.832, 0.778, 0.760) are greater than the absolute value of the correlation coefficient among the three dimensions (the absolute value of the lower triangle is 0.748, 0.101, 0.037), which shows that the discriminative validity among the three dimensions of the scale is good. Criterion-related validity In Table , the correlation between the total score of the health literacy scale and the total score of the medication literacy scale was analyzed. The results showed that the total score of the health literacy scale was significantly positively correlated with the total score of the medication literacy scale ( r = 0.805, p < 0.001), and the total score of the health literacy scale was significantly positively correlated with the scores of each dimension of the medication literacy scale. Pearson correlation coefficients were all above 0.528 ( p < 0.001). 

The experts panel assessed the content validity of the scale. The item-level content validity index (I-CVI) ranged from 0.833 to 1.000 (≥ 0.78). 

In Table , factor analysis of 14 items showed that KMO = 0. 852(> 0.7) and Bartlett spherical test P < 0.001, indicating that the data were very suitable for factor analysis. Three principal axis factors were extracted by exploratory factor analysis, and the cumulative interpretation rate was 69.031% (> 40%). As Fig. shows, AMOS 24.0 was used for confirmatory factor analysis to test the structure validity of the scale. The χ²/ df = 2.623 < 3 (sample size 270), GFI = 0.905 > 0.9, CFI = 0.950 > 0.9, RMSEA = 0.078 < 0.1, NFI = 0.922 > 0.9, TLI = 0.938 > 0.9, all within the acceptable range, indicating that the model fitted the survey data as a whole. The model fit was scientific, and the effective scale has high validity. The values of standard load coefficients were all above 0.67 (> 0.4), indicating a strong correlation between each term and its respective factors. 

In Table , on the basis of factor analysis, the values of convergent validity and discriminative validity were explored. The data showed that the average variance extracted (AVE) for the three dimensions was 0.692, 0.606, and 0.578, all greater than 0.5. The composite reliability was 0.918, 0.884, and 0.845, all greater than 0.7, indicating that the scale had high convergent validity. In Table , according to the data of the discriminative validity test, the square roots of the average variance extraction amount of the three dimensions (the value of diagonal is 0.832, 0.778, 0.760) are greater than the absolute value of the correlation coefficient among the three dimensions (the absolute value of the lower triangle is 0.748, 0.101, 0.037), which shows that the discriminative validity among the three dimensions of the scale is good. 

In Table , the correlation between the total score of the health literacy scale and the total score of the medication literacy scale was analyzed. The results showed that the total score of the health literacy scale was significantly positively correlated with the total score of the medication literacy scale ( r = 0.805, p < 0.001), and the total score of the health literacy scale was significantly positively correlated with the scores of each dimension of the medication literacy scale. Pearson correlation coefficients were all above 0.528 ( p < 0.001). 

In this study, a measurement scale was developed to assess medical college students’ medication literacy. The initial medication literacy scale was developed according to HLS-14  and combined with an expert consultation interview with 30 students. It has three dimensions: functional medication literacy (5 items), communicative medication literacy (5 items), and critical medication literacy (4 items), unlike some existing scales that only focus on functional literacy . These three dimensions can be used to assess different aspects of medication literacy, as the scholars thought , including understanding the medication’s instructions, finding the information and reporting potential side effects, and critically analyzing whether the information is appropriate for his context. Each item is also verified by correlational analysis, critical ratio method, and correction of total correlation. Through EFA and CFA, each dimension and the whole scale also meet the standards of reliability and validity . The Medication Literacy Scale for medical students is a vital tool for enhancing medical education within the Chinese healthcare system. It evaluates students’ understanding of medication-related information, a critical competency for future healthcare providers . By assessing the medication literacy of medical students, the scale helps identify knowledge gaps in medication knowledge, information acquisition, decision-making, communication with others, and safe medication use, enabling timely and targeted educational interventions. This ensures that future healthcare professionals possess the necessary knowledge of medication before entering clinical practice, thereby helping reduce medication errors stemming from insufficient understanding. Furthermore, improving medication literacy is important for promoting the self-medication safety of medical students . Consequently, this contributes to a more competent and informed healthcare workforce, ensuring healthcare professionals administer medications correctly and ultimately leading to improved patient outcomes and keeping their own health to some degree . The result of content validity supports the successful transformation of the dimensions from a health literacy scale to a medication literacy scale. Meanwhile, the scale meets the criterion of criterion-related validity, which is an operationalization of a construct, such as a test, that relates to or predicts a theoretically related behavior or outcome . Therefore, using the HLS-14 as a foundation provides an opportunity to leverage the existing body of research and knowledge on health literacy. It allows for comparisons and connections between health literacy and medication literacy, contributing to a more holistic understanding of how these concepts intersect and impact health outcomes. Labeling it as a medication literacy scale specifically for medical college students enhances its practical relevance for healthcare professionals, educators, and policymakers. For healthcare professionals, the medication literacy scale can be used to evaluate medical college students’ medication literacy. This targeted approach helps identify specific areas where students may need additional education or practice regarding medications. As mentioned, drug abuse in medical school may be the root of the ongoing problem of increased drug abuse in practicing physicians . Inadequate knowledge and poor training of health professionals have been shown to be highly correlated with a high prevalence of Irrational Use of Medicine in low-and middle-income countries . There are differences in the distribution of professionals who misuse drugs. In China, for medication error grades B-I in 2021, 72.16% were triggered by physicians, 20.52% by pharmacists, and 2.80% by nurses . Therefore, understanding the level of medication literacy among medical students enables healthcare professionals involved in training to tailor their teaching strategies more effectively. Enhancing students’ medication literacy offers significant benefits for interprofessional teaching, learning, and collaboration. A common knowledge base in medication management among healthcare professionals—such as physicians, pharmacists, and nurses—facilitates clearer communication and reduces the risk of errors. Fostering a shared understanding encourages teamwork across different healthcare roles, ultimately leading to improved patient outcomes. Integrating medication literacy into the curriculum bridges gaps between specialties, allowing students to better appreciate the roles and contributions of their peers in other fields. Educators can take advantage of the medication literacy scale to develop more effective educational programs that address common gaps in understanding specific to medication use for patients  and also medical students . This ensures that training materials are relevant and directly applicable to clinical prac tice. The study surveyed medication literacy among medical students from different specialties. In the future , it will analyze differences in their literacy overall and across various dimensions. This analysis will provide a basis for educational interventions and classroom optimization. Therefore, medication literacy allows for the creation of personalized educational interventions that cater to the specific needs of medical students, improving their competency in medication of every dimension . Meanwhile, educators can use the scale to assess the effectiveness of their educational programs, providing valuable feedback for continuous improvement and ensuring that learning objectives related to medication use are met . For policymakers, designing policies to improve medication literacy can be achieved through curriculum reforms, standardized assessments, and targeted educational initiatives. These efforts can help reduce medication errors, hospital readmissions, and chronic disease management costs. Curriculum reforms could involve embedding comprehensive medication literacy training into existing courses. Such reforms would not only aim to enhance students’ professional standards but also emphasize the importance of self-medication. These changes would help students acquire professional knowledge in medication management while also cultivating a more cautious and responsible attitude toward medication use in their daily lives. Integrating suggested improvements into pharmacology and therapeutics courses for medical students can significantly impact both the quality of medical education and healthcare outcomes. By equipping students with better skills and knowledge, future physicians can develop a stronger understanding of drug mechanisms, interactions, and patient-specific considerations. This, in turn, can lead to more accurate and effective prescribing practices, fewer medication errors, and improved management of chronic conditions through appropriate medication regimens. Additionally, enhanced training in pharmacology and therapeutics can help reduce hospital readmissions and lower healthcare costs associated with adverse drug events . Ultimately, these improvements benefit not only individual patients but also the healthcare system as a whole by promoting safer and more efficient treatment protocols. Standardized assessments can be used to consistently evaluate students’ competencies in medication management. These assessments help identify knowledge gaps early in their education, allowing for timely interventions to address deficiencies. By ensuring all students reach a standardized level of competence, variability in prescribing practices can be reduced, thereby enhancing medication safety. This knowledge also enables students to select appropriate medications for self-treatment when necessary or seek professional medical advice promptly. Moreover, they are better equipped to recognize and avoid drug misuse, protecting themselves and their future patients from medication-related harm. Research on medication literacy among medical students can substantially aid policymakers in optimizing and reforming targeted educational initiatives. Insights from this research can inform the development of comprehensive medication management policies. These policies can improve the safe distribution, prescription, and administration of drugs within healthcare systems, ultimately reducing medication errors and enhancing patient safety. Medical students, transitioning from laypersons to healthcare professionals, represent an ideal group for studying the evolution of medication literacy. This research not only developed a medication literacy scale but also investigated students across different academic years. Future studies can build upon these data to analyze the development and changes in medication literacy more deeply, providing valuable insights into its progression and enhancement. This study has several limitations. Firstly, the development and application of the medication literacy scale are still in the initial stages, and the tool has not yet been tested in practice. Practical application may require adjustments and revisions to scientifically measure medication literacy, such as further evaluating computational ability for medication. Additionally, due to funding and regional limitations, a convenience sampling method was adopted, focusing on a single university. This may introduce biases, such as volunteer bias. The use of self-evaluation scales can also be influenced by participants’ subjective factors, potentially differing from their actual medication behavior. Comprehensive evaluation using other methods, like actual medication behavior records, is necessary. In future stages, we hope to conduct broader research across universities and further refine the scale. Moreover, medication safety is a global issue, and developing an English version of the scale is important, although this study does not address it. 

A new scale for evaluating the medication literacy of medical college students was developed in the Chinese language preliminarily. The reliability and validity of this scale were verified in the study, suggesting its appropriateness and applicability to measure medication literacy level for Chinese students from medical college from three dimensions: functional medication literacy, communicative medication literacy, and critical medication literacy, including 14 items. It may help assess and deal with the problem of medical students and healthcare providers’ inappropriate medication. However, due to the limitation of this study, the practical use of the scale needs to be further examined in a bigger sample and should be modified in future studies. 

