Reliability and validity tests and application of the strategic flexibility scale among rural medical alliance personnel in China

Abstract

As rural medical alliances enter a phase of in-depth implementation, frequent policy changes are exacerbating uncertainty. Strategic flexibility has become key to operational effectiveness. However, the applicability of existing strategic flexibility scale in this context remains to be verified. This study aims to evaluate their validity and reliability, thereby providing a reliable tool for future research. This study introduced the strategic flexibility scale into the context of rural medical alliance for the first time, and verified its validity and reliability across organizational types. From October to November 2023, 430 medical staff from 6 rural medical alliances in Zhejiang Province were selected as the participants. The strategic flexibility scale was used for measurement. Cronbach’s α coefficient, split-half reliability, confirmatory factor analysis (CFA), and convergent validity were assessed, and multiple linear regression was used for statistical analysis. The Cronbach’s α coefficient for the scale was 0.91, with split-half reliabilities of 0.90 and 0.76 respectively. Confirmatory factor analysis indicated a good model fit [RMSEA = 0.071, CFI = 0.994, GFI = 0.998, AGFI = 0.956, IFI = 0.994]. The total score for strategic flexibility within rural medical alliances in Zhejiang Province was (20.73 ± 3.24) points. Hierarchical regression analysis revealed that holding an intermediate professional title had a stable negative effect ( P < 0.05). After controlling for the fixed effects of rural medical alliances, the organizational-level variables significantly improved model fit ( p < 0.01). The strategic flexibility scale demonstrates good reliability and validity, and can adequately assess the strategic flexibility of rural medical alliances. The scale is simple and easy to administer and may serve as a measurement tool for rural medical alliances in Zhejiang Province; further validation in other regions is needed.

The authors' abstract, as published at the source. BMC Health Services Research, 2026 · DOI ↗