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Development and validation of the Health Belief Model questionnaire to promote smoking cessation for nasopharyngeal cancer prevention: a cross-sectional study

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Oct 18, 2021 version files 41.52 KB
Jul 11, 2022 version files 41.49 KB
Jul 21, 2022 version files 40.61 KB

Abstract

Objective: Nasopharyngeal cancer (NPC) risk factors caused by lifestyle choices are substantial yet avoidable. Using the Health Belief Model as a conceptual framework, this study develops and validates a questionnaire to predict smokers' intentions to quit in Sarawak, Malaysia (HBM).

Design: A cross sectional study.

Setting: Urban and suburban areas in Sarawak, Malaysia.

Participants: Following a thorough literature study, the preliminary items for the instrument were created. Prior to beginning the content validity by a panel of 10 experts, the instrument was translated into the Malay language utilising the forward-backwards approach. 10 smokers carried out face validity in both quantitative and qualitative ways. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to assess the instrument's concept validity. Phase 1 of the EFA involved 100 smokers, whereas phase 2 of the CFA involved 171 smokers. Cronbach's alpha coefficients were used to measure internal consistency and assess reliability.

Results: The factor loading of each item remained within the acceptable threshold in the exploratory stage. The final revised CFA yielded the following model fit indices that suitably fitted the seven-factor model: Chi Square: 641.705; df= 500; P< 0.001; CFI = 0.953; TLI: 0.948; RMSEA= 0.041. With the exception of one pairwise construct, satisfactory convergent validity and divergent validity were demonstrated. Phases 1 and 2 both have Cronbach's alpha values over 0.7, suggesting acceptable internal reliability.

Conclusions: The study confirmed the validity and reliability of the instrument in predicting smokers' tendency to adopt healthy behaviour of smoking cessation to lower risk of developing cancer. The instrument consists of 34 items, dividing into two sections: 6 HBM components and health behavioural intention. The instrument is regarded as innovation and can be applicable in other smoking-related malignancies in different susceptible populations and geographical locations.