{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T06:12:47Z","timestamp":1788502367957,"version":"build-2803163510"},"reference-count":20,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"unspecified","delay-in-days":18,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Responsive Research Funding Scheme of Project CORE","award":["NIHR132731"],"award-info":[{"award-number":["NIHR132731"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,8,8]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Existing frameworks on Commercial Determinants of Health (CDoH) largely focus on macro-level corporate practices and policy environments. Individual-level exposure\u2014mediated through targeted marketing, pricing strategies, product availability and placement\u2014remains underexplored, particularly in low- and middle-income countries. The absence of standardised tools to capture these exposures limits the ability to quantify commercial influences on health and weakens evidence-informed public health responses. There is a critical need for a robust, contextually grounded instrument to measure individual-level exposure to CDoH. Developing and validating an individual-level CDoH measurement tool is therefore essential to strengthen research, surveillance and policy action aimed at mitigating health-harming commercial influences. The availability of this tool will allow policymakers and public health practitioners to identify high-risk populations and monitor the effectiveness of regulatory actions addressing harmful commercial practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>\n                      This study will follow standard guidelines for tool (questionnaire) development. The process will include four sequential phases: item generation, refinement, validity testing and construct validation. A literature review with a systematic search strategy and in-depth interviews with purposively sampled adults will inform domain identification and item generation. An e-Delphi process involving experts in CDoH and public health will refine and confirm items followed by content validity. This will be followed by assessment of face validity for clarity and relevance. Construct validity will be assessed through exploratory and confirmatory factor analyses, using fit indices such as Minimum \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      \/df, Goodness of Fit Index, Tucker-Lewis Index, Comparative Fit Index, Root Mean Square Error of Approximation and Standardised Root Mean Square Residual. Reliability will be estimated using Cronbach\u2019s alpha, and convergent and discriminant validity will be examined through correlation analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval has been obtained from the Institutional Ethics Committee, Amrita Institute of Medical Sciences, Kochi (ECASM-AIMS-2025-267). Results will be disseminated through peer-reviewed publications, conferences and policy briefs, and the validated tool will be made accessible for research and public health applications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-118369","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T12:00:39Z","timestamp":1787227239000},"page":"e118369","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Measuring the influence of commercial determinants of health at the individual level: Protocol for tool development and validation"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5587-3453","authenticated-orcid":false,"given":"Venkitachalam","family":"Ramanarayanan","sequence":"first","affiliation":[{"name":"Public Health Dentistry, Amrita Vishwa Vidyapeetham Amrita School of Dentistry, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devika","family":"Krishna","sequence":"additional","affiliation":[{"name":"Public Health Dentistry, Amrita Vishwa Vidyapeetham Amrita School of Dentistry, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9192-7615","authenticated-orcid":false,"given":"Abhishek","family":"Mehta","sequence":"additional","affiliation":[{"name":"Public Health Dentistry, Jamia Millia Islamia Faculty of Dentistry, New Delhi, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2908-022X","authenticated-orcid":false,"given":"Manu Raj","family":"Mathur","sequence":"additional","affiliation":[{"name":"Centre for Dental Public Health and Primary Care, Queen Mary University of London Institute of Dentistry, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"2026090322302285000_16.8.e118369.1","doi-asserted-by":"crossref","first-page":"e895","DOI":"10.1016\/S2214-109X(16)30217-0","article-title":"The commercial determinants of health","volume":"4","author":"Kickbusch","year":"2016","journal-title":"Lancet Glob Health"},{"key":"2026090322302285000_16.8.e118369.2","unstructured":"Commercial determinants of health. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/commercial-determinants-of-health [Accessed 7 Jan 2025]."},{"key":"2026090322302285000_16.8.e118369.3","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1177\/00207640231175047","article-title":"Commercial determinants of mental health","volume":"69","author":"Bhugra","year":"2023","journal-title":"Int J Soc Psychiatry"},{"key":"2026090322302285000_16.8.e118369.4","doi-asserted-by":"publisher","DOI":"10.1111\/add.12118"},{"key":"2026090322302285000_16.8.e118369.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12992-020-00607-x","article-title":"An overview of the commercial determinants of health","volume":"16","author":"Mialon","year":"2020","journal-title":"Global Health"},{"key":"2026090322302285000_16.8.e118369.6","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0300699","article-title":"Characteristics of commercial determinants of health research on corporate activities: A scoping review","volume":"19","author":"Burgess","year":"2024","journal-title":"PLoS One"},{"key":"2026090322302285000_16.8.e118369.7","unstructured":"Bringing the commercial determinants of health out of the shadows: a review of how the commercial determinants are represented in conceptual frameworks | semantic scholar. Available: https:\/\/www.semanticscholar.org\/paper\/Bringing-the-commercial-determinants-of-health-out-Maani-Collin\/17ca06d6ada270c264115ad3f47811df7fe8e550 [Accessed 5 Jan 2025]."},{"key":"2026090322302285000_16.8.e118369.8","doi-asserted-by":"crossref","unstructured":"Abdalla SM , Ofei L , Maani N , et al . Commercial determinants of health in low- and middle-income countries. In: Maani N , Petticrew M , Galea S , eds. The Commercial Determinants of Health. Oxford University Press, 2023.","DOI":"10.1093\/oso\/9780197578742.003.0028"},{"key":"2026090322302285000_16.8.e118369.9","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1177\/00207314211044992","article-title":"Measuring the Commercial Determinants of Health and Disease: A Proposed Framework","volume":"52","author":"Lee","year":"2022","journal-title":"Int J Health Serv"},{"key":"2026090322302285000_16.8.e118369.10","doi-asserted-by":"crossref","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":"2026090322302285000_16.8.e118369.11","first-page":"100","article-title":"Essential elements to elaborate a study with the (e)Delphi method","volume":"32","author":"Romero-Collado","year":"2021","journal-title":"Enfermer\u00eda Intensiva (English Ed)"},{"key":"2026090322302285000_16.8.e118369.12","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.4102\/curationis.v41i1.1934","article-title":"Using e-Delphi to formulate and appraise the guidelines for women\u2019s health concerns at a coal mine: A case study","volume":"41","author":"Msibi","year":"2018","journal-title":"Curationis"},{"key":"2026090322302285000_16.8.e118369.13","unstructured":"Homepage - Welphi. 2021. Available: https:\/\/www.welphi.com\/ [Accessed 3 Jan 2026]."},{"key":"2026090322302285000_16.8.e118369.14","doi-asserted-by":"crossref","first-page":"49","DOI":"10.21315\/eimj2019.11.2.6","article-title":"ABC of content validation and content validity index calculation","volume":"11","author":"Yusoff","year":"2019","journal-title":"Education in Medicine Journal"},{"key":"2026090322302285000_16.8.e118369.15","doi-asserted-by":"crossref","first-page":"816","DOI":"10.4103\/indianjpsychiatry_750_25","article-title":"Item generation and establishing face and content validity of a rating scale: A primer","volume":"67","author":"Gupta","year":"2025","journal-title":"Indian J Psychiatry"},{"key":"2026090322302285000_16.8.e118369.16","doi-asserted-by":"crossref","first-page":"27","DOI":"10.21315\/eimj2018.10.2.4","article-title":"Malay Language Translation and Validation of the Oldenburg Burnout Inventory Measuring Burnout","volume":"10","author":"Mahadi","year":"2018","journal-title":"EIMJ"},{"key":"2026090322302285000_16.8.e118369.17","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2021-007156","article-title":"Recognising the elephant in the room: the commercial determinants of health","volume":"7","author":"de Lacy-Vawdon","year":"2022","journal-title":"BMJ Glob Health"},{"key":"2026090322302285000_16.8.e118369.18","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000032829","article-title":"Use of Delphi in health sciences research: A narrative review","volume":"102","author":"Shang","year":"2023","journal-title":"Medicine (Baltimore)"},{"key":"2026090322302285000_16.8.e118369.19","doi-asserted-by":"crossref","DOI":"10.1186\/s13643-023-02323-0","article-title":"The Commercial Determinants of Health and Evidence Synthesis (CODES): methodological guidance for systematic reviews and other evidence syntheses","volume":"12","author":"Petticrew","year":"2023","journal-title":"Syst Rev"},{"key":"2026090322302285000_16.8.e118369.20","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1007\/s00038-020-01427-x","article-title":"Commercial determinants of health: an ethical exploration","volume":"65","author":"Ndebele","year":"2020","journal-title":"Int J Public Health"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-118369","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:30:31Z","timestamp":1788499831000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-118369"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":20,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,19]]},"published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1136\/bmjopen-2026-118369"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-118369","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]}}}