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Development and validation of the health behavioural intention among at-risk smokers to prevent nasopharyngeal cancer in Sarawak, Malaysia based on the Health Belief Model

Citation

Kueh, Martin; Rahim, Fairuz Fadzilah; Rashid, Abdul (2021), Development and validation of the health behavioural intention among at-risk smokers to prevent nasopharyngeal cancer in Sarawak, Malaysia based on the Health Belief Model, Dryad, Dataset, https://doi.org/10.5061/dryad.4tmpg4fbb

Abstract

Objective: Since lifestyle-induced NPC should not be disregarded, this study serves to develop and validate a questionnaire that aims to predict the health behaviour intentions of at-risk smokers in Sarawak, Malaysia using Health Belief Model (HBM) as the conceptual framework.

Design: Prospective validation cross sectional study.

Setting: Urban and suburban areas in Sarawak, Malaysia.

Participants: The preliminary items of the instrument were developed through a literature review. The instrument was translated into Malay version using forward-backward method before conducting content validity through a panel of 10 experts. Face validity was examined both quantitatively and qualitatively by 10 local smokers. The construct validity of the instrument was evaluated through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). A total of 100 local smokers participated in Phase 1 for EFA, while 171 local smokers participated in Phase 2 for CFA. Internal consistency was measured using Cronbach’s alpha coefficients to evaluate the reliability.

Results: In the exploratory stage, the factor loading of each item remained within the acceptable threshold. The final revised CFA yielded appropriate fit of the seven-factor model with the following model fit indexes: Chi Square: 641.705; df= 500; P< 0.001; CFI = 0.953; TLI: 0.948; RMSEA= 0.041. Satisfactory convergent validity and divergent validity were shown, with the exception of one pairwise construct. Internal reliability of these scales was above the desirable threshold, with Cronbach’s alpha coefficients ranging from 0.705 to 0.864 and 0.838 to 0.889 for Phase 1 and 2, respectively.

Conclusions: The study substantiated the instrument to be valid and reliable for predicting smokers’ health behavioural intention to reduce cancer risk. The instrument is made up of 34 items, categorised into two sections, six HBM constructs and health behavioural intention. The instrument can be utilised for other smoking-related cancers in different at-risk population.

Methods

This is a prospective cross sectional study. Upon face and content validity, subsequent 100 local smokers in Phase 1 and 171 local smokers in Phase 2 participated to evaluate the construct validity of the instrument through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), respectively. Data collection was assisted by 8 trained research assistants. Participants were informed about the study's goal and methods, as well as the benefits and concerns, prior to receiving questionnaires. Participation in this study was completely voluntary, and there was no risk involved. Eligible individuals gave informed permission once the study specifics were disclosed. Convergent validity and discriminant validity were also assessed. Internal consistency was measured using Cronbach’s alpha coefficients.