Development and psychometric testing of the Health Beliefs Related to Cardiovascular Disease Scale: Preliminary findings

Aim. This paper is a report of an evaluation of the psychometric properties of the Health Beliefs Related to Cardiovascular Disease Scale designed to measure beliefs related to cardiovascular disease risk and diet and exercise in adults with diabetes. Background. Heart attack and stroke are 2-4 times more common among adults with diabetes than those without diabetes. To reduce this risk for patients with diabetes, understanding beliefs about cardiovascular disease risk and risk-reduction strategies is important. Methods. Item development for the 25-item self-report Likert scale was guided by literature review, expert panel review and focus-group feedback. It consists of four subscales, measuring four constructs of the Health Belief Model: perceived susceptibility and severity of cardiovascular disease and benefits and barriers to diet and exercise. A convenience sample of 178 adults with self-reported type 2 diabetes completed the survey between August 2006 and March 2007; 42 participants completed it again 2-3weeks later to evaluate test-retest reliability. Results. The instrument has more than one dimension, with the best fit identified using a two-factor model specifying the Benefits and Susceptibility subscale items, rather than the four-factor solution as predicted. The Susceptibility and Benefits subscales demonstrated stable factor structure and acceptable reliability (α=0·93 and α=0·82 respectively). The Barriers and Severity items demonstrated unstable factor structure and poor internal consistency (α=0·70 and α=0·61 respectively). Conclusion. Only the Susceptibility and Benefits subscale items can be used in their current form. The Barriers and Severity items need further refinement including revised wording with clearer focus and evaluation with a larger, more diverse sample.