{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T20:42:48Z","timestamp":1793047368387,"version":"4.5.0"},"reference-count":41,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2022,9,14]],"date-time":"2022-09-14T00:00:00Z","timestamp":1663113600000},"content-version":"unspecified","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,7,8]]},"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Lifestyle-induced nasopharyngeal carcinoma is a serious but preventable risk factor. This study serves to develop and validate a questionnaire that aims to predict the health behavioural intention on smoking cessation in Sarawak, Malaysia using the Health Belief Model (HBM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Urban and suburban areas in Sarawak, Malaysia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>The preliminary items of the instrument were developed after extensive literature review. The instrument was translated into the Malay language using the forward-backwards method before commencing with the content validity by a panel of 10 experts. Face validity was done both quantitatively and qualitatively by 10 smokers. The construct validity of the instrument was evaluated through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). A total of 100 smokers participated in phase 1 for EFA, while 171 smokers participated in phase 2 for CFA. Internal consistency was measured using Cronbach\u2019s alpha coefficients to evaluate the reliability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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 indices: \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      =641.705; df=500; p&lt;0.001; comparative fit index=0.953; Tucker-Lewis Index=0.948; root mean square error of approximation=0.041. Satisfactory convergent validity and divergent validity were shown, with the exception of one pairwise construct. The internal reliability of these scales was above the desirable threshold, with Cronbach\u2019s alpha coefficients ranging from 0.705 to 0.864 and 0.838 to 0.889 in phases 1 and 2, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The study substantiated the instrument to be valid and reliable for predicting smokers\u2019 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 cessation-related cancers in different at-risk populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-057552","type":"journal-article","created":{"date-parts":[[2022,9,14]],"date-time":"2022-09-14T11:55:19Z","timestamp":1663156519000},"page":"e057552","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Development and validation of the health belief model questionnaire to promote smoking cessation for nasopharyngeal cancer prevention: a cross-sectional study"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7473-343X","authenticated-orcid":false,"given":"Martin Tze Wah","family":"Kueh","sequence":"first","affiliation":[{"name":"Department of Public Health Medicine, RCSI & UCD Malaysia Campus, Georgetown, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0248-6046","authenticated-orcid":false,"given":"Fairuz Fadzilah","family":"Rahim","sequence":"additional","affiliation":[{"name":"Department of Public Health Medicine, RCSI & UCD Malaysia Campus, Georgetown, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1520-8480","authenticated-orcid":false,"given":"Abdul","family":"Rashid","sequence":"additional","affiliation":[{"name":"Department of Public Health Medicine, RCSI & UCD Malaysia Campus, Georgetown, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,9,14]]},"reference":[{"key":"2025121512570268000_12.9.e057552.1","unstructured":"Institute for Health Metrics and Evaluation (IHME) . Findings from the Global Burden of Disease Study 2017. In: IHME. Seattle, WA, 2018. http:\/\/www.healthdata.org\/policy-report\/findings-global-burden-disease-study-2017"},{"key":"2025121512570268000_12.9.e057552.2","unstructured":"World Health Organization . Who report on cancer: setting priorities, investing wisely and providing care for all, 2020. Available: https:\/\/apps.who.int\/iris\/handle\/10665\/330745"},{"key":"2025121512570268000_12.9.e057552.3","first-page":"1085","article-title":"[SMOKING AND HEALTH. ON THE REPORT OF THE ADVISORY COMMITTEE TO THE SURGEON GENERAL OF THE PUBLIC HEALTH SERVICE]","volume":"89","author":"Wellmann","year":"1964","journal-title":"Dtsch Med Wochenschr"},{"key":"2025121512570268000_12.9.e057552.4","doi-asserted-by":"publisher","DOI":"10.1093\/ntr\/ntq216"},{"key":"2025121512570268000_12.9.e057552.5","doi-asserted-by":"publisher","DOI":"10.1158\/0008-5472.CAN-10-1087"},{"key":"2025121512570268000_12.9.e057552.6","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"2025121512570268000_12.9.e057552.7","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdw027"},{"key":"2025121512570268000_12.9.e057552.8","doi-asserted-by":"publisher","DOI":"10.1038\/s41416-020-01038-6"},{"key":"2025121512570268000_12.9.e057552.9","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1016\/j.ijrobp.2015.11.047","article-title":"Global pattern of nasopharyngeal cancer: correlation of outcome with access to radiation therapy","volume":"94","author":"Lam","year":"2016","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"2025121512570268000_12.9.e057552.10","unstructured":"Azizah A , Hashimah B , Nirmal K , Siti Zubaidah A , Puteri N , Nabihah A . Malaysian National Cancer Registry Report 2012-2016 [Internet]. Malaysia National Cancer Institute; 2019. https:\/\/www.moh.gov.my\/moh\/resources\/Penerbitan\/Laporan\/Umum\/2012-2016%20(MNCRR)\/MNCR_2012-2016_FINAL_(PUBLISHED_2019).pdf"},{"key":"2025121512570268000_12.9.e057552.11","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1158\/1055-9965.482.13.3","article-title":"High incidence of nasopharyngeal carcinoma in native people of Sarawak, Borneo island","volume":"13","author":"Devi","year":"2004","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"2025121512570268000_12.9.e057552.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2014.02.006"},{"key":"2025121512570268000_12.9.e057552.13","doi-asserted-by":"crossref","DOI":"10.3892\/ol.2021.12775","article-title":"Nasopharyngeal carcinoma among the Bidayuh of Sarawak, Malaysia: history and risk factors","volume":"22","author":"Linton","year":"2021","journal-title":"Oncol Lett"},{"key":"2025121512570268000_12.9.e057552.14","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1186\/s13014-014-0246-y","article-title":"The impact of smoking on the clinical outcome of locoregionally advanced nasopharyngeal carcinoma after chemoradiotherapy","volume":"9","author":"Guo","year":"2014","journal-title":"Radiat Oncol"},{"key":"2025121512570268000_12.9.e057552.15","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kws479"},{"key":"2025121512570268000_12.9.e057552.16","unstructured":"Institute for Public Health . National health and morbidity survey 2015 (NHMS 2015) Ministry of Health Malaysia Kuala Lumpur; 2015. https:\/\/www.moh.gov.my\/moh\/resources\/nhmsreport2015vol2.pdf"},{"key":"2025121512570268000_12.9.e057552.17","first-page":"1","article-title":"Factors associated with tobacco use among the adult population in Sarawak, Malaysia: a cross sectional study","volume":"12","author":"Rahman","year":"2015","journal-title":"Epidemiol Biostat Public Health"},{"key":"2025121512570268000_12.9.e057552.18","unstructured":"Champion VL , Skinner CS . The health belief model. In: Health behavior and health education: theory, research, and practice. 4th ed. San Francisco, CA, US: Jossey-Bass, 2008: 45\u201365."},{"key":"2025121512570268000_12.9.e057552.19","doi-asserted-by":"publisher","DOI":"10.1177\/109019817400200404"},{"key":"2025121512570268000_12.9.e057552.20","doi-asserted-by":"crossref","DOI":"10.1186\/1750-9378-6-S2-S10","article-title":"Prostate cancer health and cultural beliefs of black men: the Florida prostate cancer disparity project","volume":"6","author":"Odedina","year":"2011","journal-title":"Infect Agent Cancer"},{"key":"2025121512570268000_12.9.e057552.21","doi-asserted-by":"crossref","DOI":"10.1186\/s12885-019-6171-6","article-title":"Predictors of cervical cancer screening practice among HIV positive women attending adult anti-retroviral treatment clinics in Bishoftu town, Ethiopia: the application of a health belief model","volume":"19","author":"Solomon","year":"2019","journal-title":"BMC Cancer"},{"key":"2025121512570268000_12.9.e057552.22","doi-asserted-by":"crossref","DOI":"10.1186\/1472-6874-9-37","article-title":"Prediction of breast self-examination in a sample of Iranian women: an application of the health belief model","volume":"9","author":"Tavafian","year":"2009","journal-title":"BMC Womens Health"},{"key":"2025121512570268000_12.9.e057552.23","unstructured":"LaMorte. WW . The health belief model: behavioral change models, 2019. Available: http:\/\/sphweb.bumc.bu.edu\/otlt\/MPH-Modules\/SB\/BehavioralChangeTheories\/BehavioralChangeTheories2.html"},{"key":"2025121512570268000_12.9.e057552.24","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200012150-00014"},{"key":"2025121512570268000_12.9.e057552.25","doi-asserted-by":"publisher","DOI":"10.1111\/j.1744-6570.1975.tb01393.x"},{"key":"2025121512570268000_12.9.e057552.26","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1136\/jech.2008.082511","article-title":"A dictionary of epidemiology","volume":"63","author":"Ferreira Antunes","year":"2009","journal-title":"J Epidemiol Community Health"},{"key":"2025121512570268000_12.9.e057552.27","doi-asserted-by":"crossref","first-page":"149","DOI":"10.3389\/fpubh.2018.00149","article-title":"Best practices for developing and validating scales for health, social, and behavioral research: a primer","volume":"6","author":"Boateng","year":"2018","journal-title":"Front Public Health"},{"key":"2025121512570268000_12.9.e057552.28","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.02.00216902"},{"key":"2025121512570268000_12.9.e057552.29","unstructured":"Suhr DD . Exploratory or confirmatory factor analysis? 2006. Available: https:\/\/support.sas.com\/resources\/papers\/proceedings\/proceedings\/sugi31\/200-31.pdf"},{"key":"2025121512570268000_12.9.e057552.30","unstructured":"Kueh M , Rahim FF , Rashid A . Data from: development and validation of the health behavioural intention on smoking cessation to prevent nasopharyngeal cancer in Sarawak, Malaysia based on the health belief model: a cross-sectional study. Dryad Digital Repository 2021.doi:10.5061\/dryad.4tmpg4fbb"},{"key":"2025121512570268000_12.9.e057552.31","unstructured":"Munro BH . Statistical methods for health care research. lippincott williams & wilkins, 2005."},{"key":"2025121512570268000_12.9.e057552.32","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-020-08851-x","article-title":"Development and validation of the oral health behavior questionnaire for adolescents based on the health belief model (OHBQAHBM)","volume":"20","author":"Xiang","year":"2020","journal-title":"BMC Public Health"},{"key":"2025121512570268000_12.9.e057552.33","unstructured":"Brown TA . Confirmatory factor analysis for applied research. New York, NY, US: The Guilford Press, 2006."},{"key":"2025121512570268000_12.9.e057552.34","doi-asserted-by":"publisher","DOI":"10.2307\/3151312"},{"key":"2025121512570268000_12.9.e057552.35","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.21.2.78"},{"key":"2025121512570268000_12.9.e057552.36","unstructured":"Cohen RJ , Swerdlik ME , Phillips SM . Psychological testing and assessment: an introduction to tests and measurement. Mayfield Publishing Co, 1996."},{"key":"2025121512570268000_12.9.e057552.37","doi-asserted-by":"crossref","DOI":"10.1016\/j.yebeh.2020.107169","article-title":"Designing and psychometric evaluation of disease-related fear scale (D-RFS) in adults with epilepsy: a sequential exploratory mixed methods design","volume":"110","author":"Shamsalinia","year":"2020","journal-title":"Epilepsy Behav"},{"key":"2025121512570268000_12.9.e057552.38","doi-asserted-by":"publisher","DOI":"10.3200\/JOER.99.6.323-338"},{"key":"2025121512570268000_12.9.e057552.39","unstructured":"Kline P . The Handbook of psychological testing. Psychology Press, 2000."},{"key":"2025121512570268000_12.9.e057552.40","unstructured":"Kline P . An easy guide to factor analysis. 1st ed. London, 1994: 208."},{"key":"2025121512570268000_12.9.e057552.41","doi-asserted-by":"publisher","DOI":"10.1037\/\/0033-2909.103.3.411"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-057552","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T20:57:09Z","timestamp":1765832229000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-057552"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9]]},"references-count":41,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9,14]]},"published-print":{"date-parts":[[2022,9]]}},"alternative-id":["10.1136\/bmjopen-2021-057552"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-057552","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9]]}}}