Reliability and convergent validity.

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.

本研究旨在验证经文化调适的健康信念模型（Health Belief Model, HBM）问卷，以评估中国女性的乳腺癌筛查相关信念，并评估其结构效度与测量不变性。本研究采用多阶段抽样方法，在中国贵州省对314名年龄介于18至70岁的女性开展横断面调查。原始HBM问卷先经过文化调适与专家内容评审环节。研究通过探索性因子分析与验证性因子分析检验其因子结构，并针对居住环境与年龄亚组开展测量不变性检验。本研究最终确定七因子解，涵盖HBM全部6个核心构念，且将自我效能拆分为两个经验上独立的维度。最终的41条目模型展现出优异的模型拟合度（CFI=0.914，TLI=0.906，RMSEA=0.059，SRMR=0.060），内部一致性良好（ω≥0.88），且在各亚组间实现完全测量不变性。聚合效度与构念间相关关系均符合理论预期。具体而言，自我效能、感知获益与行动线索之间呈现显著正相关，而感知障碍则与感知严重性及风险感知呈负相关。本研究结果为单构念与多构念干预策略均提供了实证依据。经验证的量表为识别中国女性乳腺癌筛查障碍的心理因素提供了一个心理测量学性能优良且契合文化背景的工具，可用于指导基于理论的公共卫生干预方案设计，针对性解决个体信念特征并提升筛查参与率。