Measurement invariance across groups (Age).

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信念，并评价该问卷的结构效度与测量不变性。本研究采用多阶段抽样方法，在中国贵州省招募314名年龄介于18~70岁的女性开展横断面调查。原始HBM问卷完成了文化调适与专家内容评审。通过探索性因素分析与验证性因素分析检验其因素结构，并针对居住环境与年龄亚组开展测量不变性检验。研究最终得到七因素结构，涵盖健康信念模型全部6个核心构念，并将自我效能拆分为两个经验上独立的维度。最终包含41个条目的模型展现出优异的模型拟合效果：比较拟合指数（CFI）=0.914、塔克-刘易斯指数（TLI）=0.906、近似均方根误差（RMSEA）=0.059、标准化均方根残差（SRMR）=0.060，同时具备较高的内部一致性（ω≥0.88），且在各亚组间实现完全测量不变性。会聚效度与各构念间的相关关系均符合理论预期。具体而言，自我效能、感知益处与行动线索之间呈现显著正相关，而感知障碍与感知严重性、风险感知之间呈负相关关系。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。经本研究验证的该量表，可为识别中国女性乳腺癌筛查相关心理障碍提供一个心理测量学性能优良且贴合本土文化的工具。该量表可用于指导以理论为基础的公共卫生干预方案的设计，针对性解决个体的信念特征，进而提升乳腺癌筛查的参与率。