Liao Yang, Mohd Hairon Suhaily, Majdi Yaacob Najib, Alina Tengku Ismail Tengku, Luo Li
Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China.
PLoS One. 2025 Sep 3;20(9):e0331279. doi: 10.1371/journal.pone.0331279. eCollection 2025.
This study aimed to validate a culturally adapted Health Belief Model (HBM) questionnaire for assessing breast cancer screening beliefs among Chinese women and to evaluate its structural validity and measurement invariance. A cross-sectional survey was conducted with 314 women aged 18-70 in Guizhou Province, China, using multistage sampling. The original HBM questionnaire underwent cultural adaptation and expert content review. Exploratory and confirmatory factor analyses were conducted to examine the factor structure, and measurement invariance was tested across residential settings and age groups. A seven-factor solution was identified, encompassing all six core HBM constructs, with self-efficacy splitting into two empirically distinct dimensions. The final 41-item model demonstrated strong model fit (CFI = 0.914, TLI = 0.906, RMSEA = 0.059, SRMR = 0.060), high internal consistency (ω ≥ 0.88), and full invariance across subgroups. Convergent validity and inter-construct correlations aligned with theoretical expectations. In particular, strong positive associations were observed among self-efficacy, perceived benefits, and cues to action, while perceived barriers showed inverse relationships with perceived severity and risk perception. These findings offer empirical justification for both single-construct and multi-construct intervention strategies. The validated scale provides a psychometrically sound and culturally grounded tool for identifying psychological barriers to screening among Chinese women. It may guide the design of theory-informed public health interventions that address individual belief profiles and promote screening uptake.
本研究旨在验证一份经过文化调适的健康信念模型（HBM）问卷，以评估中国女性对乳腺癌筛查的信念，并评估其结构效度和测量不变性。在中国贵州省，采用多阶段抽样方法对314名年龄在18至70岁之间的女性进行了横断面调查。原始的HBM问卷经过了文化调适和专家内容审查。进行了探索性和验证性因素分析以检验因素结构，并在居住环境和年龄组之间测试了测量不变性。确定了一个七因素解决方案，涵盖了所有六个核心HBM构念，自我效能感分为两个在经验上不同的维度。最终的41项模型显示出良好的模型拟合度（CFI = 0.914，TLI = 0.906，RMSEA = 0.059，SRMR = 0.060）、高内部一致性（ω≥0.88）以及在各亚组间的完全不变性。收敛效度和构念间相关性与理论预期一致。特别是，在自我效能感、感知到的益处和行动线索之间观察到强烈的正相关，而感知到的障碍与感知到的严重性和风险感知呈负相关。这些发现为单构念和多构念干预策略提供了实证依据。经过验证的量表为识别中国女性筛查的心理障碍提供了一个心理测量学上合理且基于文化的工具。它可能指导基于理论的公共卫生干预措施的设计，这些措施能够解决个体的信念特征并促进筛查的接受度。
