Cross-cultural adaptation and psychometric evaluation of the Health Behavior Motivation scale(HBMS) for coronary heart disease patients in China

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The current study aimed to cross-culturally adapt and validate the Health Behavior Motivation scale for coronary heart disease patients in China. Methods A convenience sample of 400 patients with coronary heart disease (CHD) was recruited from cardiovascular wards at two tertiary care hospitals in Shenyang, China, during the study period spanning August to October 2024. Statistical analyses were conducted using AMOS 24.0 and SPSS 25.0 software. The scale's reliability was evaluated through three established methods: test-retest reliability, split-half reliability, and internal consistency assessment. Validity verification encompassed examinations of both structural validity and content validity. Results The HBMS had a Cronbach's α coefficient of 0.886, and the range of Cronbach's α coefficient values for each dimension was 0.835–0.965. The scale's test–retest reliability was 0.810, and its split-half reliability was 0.625. Five common factors with a cumulative variance contribution of 71.962% were retrieved from the exploratory factor analysis. In confirmatory factor analysis, the indicators were reported as follows: χ 2 / df = 1.818, TLI = 0.914, CFI = 0.922, IFI = 0.923, and RMSAE = 0.064 and the results of the model fit metrics were within the reference range. Conclusion The HBMS is suitable for health behavior motivation measurement with acceptable validity and reliability, the HBMS can be applied in CHD patients in China. Cross-cultural adaptation Coronary heart disease Health behavior motivation scale Reliability Validity Figures Figure 1 Figure 2 Introduction In recent years, along with social and economic development and changes in residents' lifestyles, the epidemiological impact of Coronary heart disease (CHD) has been progressively rising across China, and the clinically verified CHD patient cohort has reached 11.39 million[ 1 ], and identifying it as the second leading cause of mortality nationwide[ 2 ], it has become a major public health challenge. CHD patients typically demonstrate a high prevalence of multimorbidity, with cerebrovascular disorders, peripheral artery disease, and heart failure constituting common clinical comorbidities[ 3 ]. Clinical evidence substantiates that such comorbidities profoundly impair functional capacity, diminish quality of life, and exacerbate premature mortality risk, while concurrently imposing substantial healthcare expenditures[ 4 , 5 ]. Given these detrimental effects, optimising the management of these comorbidities has been shown to mitigate adverse outcomes in patients with CHD. The key to optimal improvement of adverse outcomes contingent upon sustained patient adherence to multidimensional health behaviors, including nutritional modification, regular exercise, pharmacotherapy adherence and smoking cessation[ 6 – 8 ]. Strong evidence suggests that strict adherence to multidimensional health behaviours in patients with CHD significantly reduces risk: 47% risk decrement in major adverse cardiovascular outcomes, 57% risk decrement in cardiovascular mortality, and 58% risk decrement in all-cause mortality[ 9 , 10 ]. Despite the well-established critical role of health behavior modification in CHD management, how to enable patients to sustain long-term adherence to health-promoting behaviors remains a pressing challenge[ 11 ]. Changing behavior is challenging, and motivation is crucial for adopting healthy behaviors. The level of motivation for individual health behaviors represents a critical psychological variable in predicting the sustainability of health behaviors and adherence to medical recommendations[ 12 ]. As a central variable in maintaining healthy behaviours, the scientific assessment of motivation levels has a direct impact on the persistence of healthy behaviours. However, some studies have shown that traditional assessment tools measure only a single dimension of motivation, a measure that makes it difficult to analyse differences in the degree of internalisation of motivation types[ 13 ]. Self-determination theory(SDT) breaks with the traditional division of motivation by treating motivation as a continuum and revealing the gradual internalisation of extrinsic motivation into intrinsic motivation[ 14 ]. This theory provides an analytical framework for motivational assessment, but the question of how to translate the continuum model into a quantifiable assessment tool remains an ongoing issue to be addressed. The Health Behavior Motivation Scale (HBMS) was developed by Professor Poraj-Weder and coworkers[ 15 ]in 2021 based on the SDT, in healthy adults, which has good psychometric qualities. It has five dimensions and 30 items, aiming to measure the motivation of healthy adults to promote healthy behaviors. The scale is grounded in the conceptual foundations of SDT and explains the dual-channel mechanism of intrinsic motivation (e.g., interest satisfaction) and extrinsic motivation (e.g., external rewards), thereby elucidating the process of motivational change in adopting and maintaining health-related behaviours[ 16 , 17 ]. Compared with traditional health behavior motivation assessment tools, this scale demonstrates significant advantages in the comprehensiveness of evaluation dimensions and the depth of motivational mechanism analysis, with a specific focus on elucidating the multilevel determinants underlying individuals' engagement in health-promoting behaviors. However, its cross-cultural validation in CHD populations remains lacking, and empirical evidence supporting its psychometric properties remains scarce. This study aims to validate the psychological properties of the Health Behavior Motivation Scale (HBMS) for Chinese patients with CHD, conducting cross-cultural adaptation and assessing reliability and validity to inform targeted health promotion interventions for this population. Methods Participants and Research Procedures Convenience sampling was used to select patients with CHD who were hospitalized in the cardiovascular medicine departments of two tertiary care hospitals in Shenyang City, Liaoning Province, and who met the criteria for natriuresis from August to October 2024. The team members underwent a systematic training before the start of the study to use a uniform guide and improve presentation skills. Inclusion criteria for study participants were as follows: age ≥ 18 years; meet the relevant criteria for the diagnosis of CHD; ability to hear, read, write, and communicate properly. Exclusion criteria were the following: patients with severe hepatic, renal, or other organ insufficiency or with major chronic diseases (e.g., malignant tumors); patients with mental illness; patients who have been enrolled in other studies similar to this one during the same time period; patients whose conditions are aggravated by activities or who are unable to move due to their conditions, e.g., cardiac function class IV, joint diseases, severe asthma, hemiplegia due to stroke, and unfavorable limb movement; recent major stressful events (e.g., bereavement, divorce). According to the principle of sample size selection for factor analysis, the sample size was 5–10 times the number of scale items[ 18 ], taking into account 20 percent of invalid questionnaires, the final sample size was determined to be 188—375; therefore, 400 questionnaires were distributed in this study. Measurement tools General information questionnaire Based on relevant literature and consulting experts, the researchers developed a questionnaire that includes demographics such as gender, age, educational background, marital status, course of coronary heart disease, type of occupation, and per capita monthly household income. Health Behavior Motivation Scale (HBMS) The HBMS was developed by Polish scholar Poraj-Weder et al.[ 15 ] in 2021 to measure motivation in healthy adults to adopt healthy behaviors. The HBMS has five dimensions of intrinsic regulation (6 items), integrated and identified regulation (6 items), intrinsic regulation (6 items), extrinsic regulation (6 items), and non-regulation (amotivation) (6 items), with a total of 30 items. A 5-point Likert scale was used, with entries scored 1, 2, 3, 4, and 5 corresponding to "completely disagree, mostly disagree, neither agree nor disagree, mostly agree, and completely agree," respectively. Cronbach's α coefficient was used to assess internal consistency; it ranged from 0.91 to 0.94, indicating good internal consistency. Scores ranged from 30 to 150, with higher scores indicating that individuals are more positively motivated to engage in health behaviors. Process Translation of HBMS Prior to translating the scale, we secured permission from the original scale's authors. The scale was sinicized and cross-culturally adapted in strict accordance with the Brislin translation model and the principles of cross-cultural adaptation[ 19 , 20 ]. Two translators, one was academic English pedagogy practitioner and the other a PhD candidate specializing in nursing with an English proficiency, independently rendered the scale into Chinese. Then, the researcher organized members of the research team to collate the two versions to form the Chinese version of the HBMS A. The Chinese version of the HBMS A was independently back-translated by a professional with a grade 8 English major who works as a translator, and a Doctor of Nursing fluent in English. Members of the research team analyzed the HBMS back-translated version 1. Cross-cultural adaptation of the HBMS A cross-cultural evaluation team was formed with six experts selected among tertiary hospital practitioners and university teachers with more than 10 years of clinical nursing or university teaching experience. One doctoral, three master's, and two bachelor's degree holders were mailed questionnaires on expert correspondence. Experts assessed the meaning and presentation of each entry. They used the Likert 4 scale to assess the relevance of the scale content and calculate the scale-level CVI (S-CVI) and the validity of the item-level CVI (I-CVI). After the expert group's analysis, discussion, and modification, an HBMS containing 30 items and five dimensions was finally constructed, with a concise and clear content and in conformity with the language expression habits of China. Data collection The study protocol was approved by the Ethics Review Committee of the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine in August 2024 (No. Y2024262CS(KT)-262-01). August 2024-October 2024, two trained investigators conducted the survey by distributing questionnaires using uniform instructions with the help of the head of the department; before the survey was conducted, they articulated the study's objective, the methodology, and the content of the study to the study participants. All the participants signed an informed consent. A total of 400 questionnaires were distributed. The sample sizes of Sample 1 (for exploratory factor analysis) and Sample 2 (for confirmatory factor analysis) were set at 200 cases each. HBMS was readministered 2 weeks later to quantify the test–retest reliability with the same participants. The number of patients participated the test–retest interview was 30. Data Analysis Statistical analysis was performed using SPSS 25.0, Amos24.0, and Microsoft Excel. Items were analyzed using the Critical Ratio method and the internal consistency test; Cronbach's α coefficient and split-second reliability were used for the reliability test; and the validity was examined in terms of content validity and structural validity. Results General information A total of 400 valid questionnaires were collected for this study. Among the 400 participants, 208 (52%) were female and 192 (48%) were male. Other participants’ demographic characteristics are shown in Table 1 . Table 1 General demography data (n = 400) Variables n % The course of coronary heart disease 10years 69 17% Monthly per capita household income 4,000RMB 44 11% Type of occupation Professional and technical staff 127 32% Office-bearer 39 10% Workers 101 25% Self-employed 28 7% Unemployed 23 6% Peasant 33 8% Others 49 12% Marital status Unmarried 6 2% Married 335 84% Divorcee 23 6% Widowhood 34 9% Others 2 1% Educational level Elementary school and below 49 12% Junior high school 179 45% High school/secondary school 84 21% College 70 18% Bachelor's degree and above 18 5% Genders Males 192 48% Females 208 52% Age 18 ~ 35 4 1% 36 ~ 59 139 34.75% ≥ 60 257 64.25% Items analysis The critical ratio approach was used to analyze the degree of differentiation among the entries in the HBMS. According to the outcomes of the critical ratio approach, each item’s critical ratio (CR) was 4.000 ~ 20.381 (P 3.0. Thus, all 30 items were retained without reduction. Reliability analysis results The Cronbach's α coefficient for the the HBMS scale was 0.886, and the Cronbach's α coefficient for each dimension ranged from 0.835 to 0.965. Moreover, the split-half and test–retest reliability of were 0.625, 0.810. Validity analysis results Content validity Six experts were invited to assess the relevance of each question to the topic in the HBMS. The range for the content validity index of an item (I-CVI) was from 0.83 to1.00, and the content validity index for the entire instrument (S-CVI) was 0.94, indicating that the scale has good content validity. Structural validity All data were divided into two parts: 200 for exploratory factor analysis and 200 for confirmatory factor analysis. Exploratory factor analysis According to the results of the Bartlett spherical test (χ 2 = 5649.578 df = 435, P < 0.001), the KMO value was 0.857; the data satisfied the spherical hypothesis and demonstrated suitability for factor analysis. The results of the screen plot were combined, further supporting the five-factor structural model (Fig. 1 ). Moreover, the results revealed a cumulative explanatory variation of 71.962%. A total of five factors with eigenvalues > 1were extracted (Table 2 ). The factor load value is shown as 0.509—0.965 in Table 3 . Table 2 Initial eigenvalue, percentage of variance and cumulative percentage of variance Factors Initial Eigenvalue Percentage of Variance Cumulative Percentage of Variance Explained 1 7.862 26.206 26.206 2 5.339 17.798 44.004 3 3.626 12.088 56.092 4 2.991 9.971 66.064 5 1.769 5.898 71.962 Table 3 Factor loadings from exploratory factor analysis of the HBMS Scale Factor loading Factor 1 (Introjected regulation) Factor 2 (Intrinsic regulation) Factor 3 (External regulation) Factor 4 (Integrated and identified regulation) Factor 5 [Non regulation (Amotivation)] H13 0.965 H8 0.963 H3 0.961 H18 0.939 H23 0.923 H28 0.891 H16 0.893 H11 0.860 H21 0.851 H1 0.833 H6 0.818 H26 0.755 H9 0.897 H19 0.885 H4 0.882 H14 0.874 H29 0.686 H24 0.582 H12 0.823 H7 0.808 H17 0.773 H27 0.712 H22 0.676 H2 0.552 H10 0.889 H5 0.866 H20 0.798 H25 0.686 H15 0.516 H30 0.509 Confirmatory factor analysis A confirmatory factor analysis was applied to test the modeling of the scale structure, with the five dimensions of the HBMS as latent variables and the 30 questions under the scale as observational variables modeling structural equations (Fig. 2 ). The confirmatory factor analysis results showed that the fit indices met the requirements, indicating that the factor model of the HBMS is well-fitted (Table 4 ). Table 4 Fit indices of validated factor analysis models for the HBMS scale Indices Actual results Reference standard CMIN/DF 1.818 1 ~ 3 RMSEA 0.064 0.9 IFI 0.923 >0.9 TLI 0.914 >0.9 Discussion In this study, we cross-cultural adapted the original HBMS and examined its validity and reliability by administering the scale on a sample of patients with CHD. Our results indicate sufficient validity (content validity, structural validity), satisfactory reliability (internal consistency, split-half and test–retest reliability). The psychometric evaluation of the measurement tool revealed high internal consistency and good correlation between the scale’s items, as well as good discrimination[ 21 ]. The findings of this study revealed that the reliability coefficients (CR) of all items in the HBMS were higher than the standardized values (3.000), and the differences were statistically significant ( P <0.01). This indicates that the individual items of the translated scale are highly recognizable. The results of the items analysis showed that the items performed well in terms of representativeness and variability, and it is therefore recommended that all items be retained. Estimating the degree of consistency of measurements through reliability[ 22 ]. Cronbach's α coefficient was used to assess internal consistency. In this study, the Cronbach's α coefficient or the HBMS was 0.886, and the Cronbach's α coefficient for the dimensions were 0.835—0.965. This indicates that the scale demonstrated strong internal consistency. In addition, the split-half reliabilities and test-retest reliabilities were within the acceptable range, proving that HBMS has high stability. Therefore, the HBMS demonstrated high reliability in patients with CHD. The six experts involved in the content validity appraisal of this study were drawn from diverse academic backgrounds and brought extensive clinical experience and high academic credentials to the evaluation process. They evaluated the content validity of the questionnaire after expert consultation. The results showed that the I-CVI values were 0.83—1.00, and the S-CVI/Ave was 0.94, indicating that the scale's content validity was adequate to effectively measure the level of motivation towards health behaviors in patients with CHD. The results of the exploratory factor analysis showed a KMO>0.6, indicating that it was suitable for factor analysis. Five common factors were extracted from the HBMS, with a cumulative variance contribution rate of 71.962%. There are consistent with previous findings[ 23 ]. The factor loading values of the 30 items were>0.50, which was consistent with the original version of the scale. This indicates that the HBMS has good construct validity and can effectively assess health behavior motivation in patients with CHD. In addition, the validation factor analysis results showed that the scale's factor model conformed to the range of standardized values. This further proved that the structure of the HBMS was reasonable and clear, and the structural validity was excellent. Limitation In this study, the reliability was validated only among CHD patients in two hospitals, and the sample's representativeness may be limited. Therefore, future studies could expand the sample size to cover other chronic diseases and investigate in multiple regions and research organizations to validate further the validity and reliability of the HBMS. Conclusion The cross-cultural adaptation of the HBMS demonstrates strong reliability and validity while maintaining the properties of original scale. Its straightforward and comprehensible measurement process renders it an apt instrument for assessing health behavior motivation among patients with CHD. Furthermore, it offers a foundational reference for the development and evaluation of health behavior promotion initiatives targeting patient population with CHD. This research is in active alignment with the Healthy China Initiative, which strives to foster the nation's well-being, enhance collaborative efforts in chronic disease prevention and management, and collectively advance the goal of establishing a healthier China. Declarations Acknowledgments The authors thank AiMi Academic Services (www.aimieditor.com) for English language editing and review services and the authors are grateful to patients with CHD who participated in this study, and also to the health providers for their strong support in sampling. Author contributions ZZ and LL participated in the conception and design of the study; ZZ and JW analyzed and interpreted the data and wrote the manuscript; YX and YT participated in the formal analysis; SS and YW took part in the investigation and data collection; LL critically reviewed and revised the manuscript and obtained funding. All authors have read and approved the final manuscript. Funding This work was funded by the The China Social Welfare Foundation (HLCXKT- 202 40102) and by a grant from the China Scholarship Council. The funders had no role in the design and conduct of the study, data collection, analysis, and interpretation; writing of the manuscript; or the decision to submit the article for publication. Data Availability The data that support the findings of this study are available from the corresponding author upon reasonable request. Conflicts of Interest None declared. Ethical approval and consent to participate This study was conducted in adherence to the local and international ethical principles including those in the Declaration of Helsinki. The study proposal was approved by the Ethics Review Committee of the affiliated Hospital of Liaoning University of Traditional Chinese Medicine (No. Y2024262CS(KT)-262-01). Written informed consent was obtained from a legally authorised representative for anonymised patient information to be published in this article. Consent for publication The participant has consented to the submission of the case report to the journal. I confirm that the manuscript has been not submitted to any journal and is not published, in press, or submitted elsewhere. Not Applicable Author details 1 School of Nursing, Liaoning University of Traditional Chinese Medicine, Shenyang110847, Liaoning Province, China 2 Department of Cardiology, The Second Affiliated Hospital of Shenyang Medical College, Shenyang110002, Liaoning Province, China 3 Nursing Department, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang110000, Liaoning Province, China References Wang Z, Ma L, Liu M, Fan J, Hu S, Writing Committee of the Report on Cardiovascular Health and Diseases in China. Summary of the 2022 Report on Cardiovascular Health and Diseases in China. Chin Med J. 2023;136(24):2899–908. https://doi.org/10.1097/CM9.0000000000002927 . Global Burden of Disease (GBD) 2025/5/24. 2025, from https://www.healthdata.org/research-analysis/gbd Ski CF, Taylor RS, McGuigan K, Long L, Lambert JD, Richards SH, Thompson DR. 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Traditional Chinese Medicine","correspondingAuthor":true,"prefix":"","firstName":"Lei","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2025-07-02 02:23:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7024356/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7024356/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s40359-026-04078-4","type":"published","date":"2026-02-03T15:59:40+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":88774045,"identity":"f09ab71e-ff51-4a53-9f4e-a57ca6ffec7f","added_by":"auto","created_at":"2025-08-11 09:59:57","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":71858,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eExploratory factor analysis screen plot of the HBMS\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7024356/v1/ced3064514dd9a68ae58f922.jpg"},{"id":88774047,"identity":"e0f740a7-fba5-422e-a803-68a3a285a0d0","added_by":"auto","created_at":"2025-08-11 09:59:57","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":133681,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStandardized five-factor structural model of the HBMS\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7024356/v1/dd751bcc39e72438e01aed51.png"},{"id":102235470,"identity":"7340cc28-f997-4b45-9ee1-85fb492d5909","added_by":"auto","created_at":"2026-02-09 16:16:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1232903,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7024356/v1/b9acafaf-d748-4f7b-8405-d371384ffb01.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Cross-cultural adaptation and psychometric evaluation of the Health Behavior Motivation scale(HBMS) for coronary heart disease patients in China","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn recent years, along with social and economic development and changes in residents' lifestyles, the epidemiological impact of Coronary heart disease (CHD) has been progressively rising across China, and the clinically verified CHD patient cohort has reached 11.39 million[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], and identifying it as the second leading cause of mortality nationwide[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], it has become a major public health challenge. CHD patients typically demonstrate a high prevalence of multimorbidity, with cerebrovascular disorders, peripheral artery disease, and heart failure constituting common clinical comorbidities[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Clinical evidence substantiates that such comorbidities profoundly impair functional capacity, diminish quality of life, and exacerbate premature mortality risk, while concurrently imposing substantial healthcare expenditures[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Given these detrimental effects, optimising the management of these comorbidities has been shown to mitigate adverse outcomes in patients with CHD.\u003c/p\u003e\u003cp\u003eThe key to optimal improvement of adverse outcomes contingent upon sustained patient adherence to multidimensional health behaviors, including nutritional modification, regular exercise, pharmacotherapy adherence and smoking cessation[\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Strong evidence suggests that strict adherence to multidimensional health behaviours in patients with CHD significantly reduces risk: 47% risk decrement in major adverse cardiovascular outcomes, 57% risk decrement in cardiovascular mortality, and 58% risk decrement in all-cause mortality[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Despite the well-established critical role of health behavior modification in CHD management, how to enable patients to sustain long-term adherence to health-promoting behaviors remains a pressing challenge[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eChanging behavior is challenging, and motivation is crucial for adopting healthy behaviors. The level of motivation for individual health behaviors represents a critical psychological variable in predicting the sustainability of health behaviors and adherence to medical recommendations[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. As a central variable in maintaining healthy behaviours, the scientific assessment of motivation levels has a direct impact on the persistence of healthy behaviours. However, some studies have shown that traditional assessment tools measure only a single dimension of motivation, a measure that makes it difficult to analyse differences in the degree of internalisation of motivation types[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Self-determination theory(SDT) breaks with the traditional division of motivation by treating motivation as a continuum and revealing the gradual internalisation of extrinsic motivation into intrinsic motivation[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This theory provides an analytical framework for motivational assessment, but the question of how to translate the continuum model into a quantifiable assessment tool remains an ongoing issue to be addressed.\u003c/p\u003e\u003cp\u003eThe Health Behavior Motivation Scale (HBMS) was developed by Professor Poraj-Weder and coworkers[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]in 2021 based on the SDT, in healthy adults, which has good psychometric qualities. It has five dimensions and 30 items, aiming to measure the motivation of healthy adults to promote healthy behaviors. The scale is grounded in the conceptual foundations of SDT and explains the dual-channel mechanism of intrinsic motivation (e.g., interest satisfaction) and extrinsic motivation (e.g., external rewards), thereby elucidating the process of motivational change in adopting and maintaining health-related behaviours[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Compared with traditional health behavior motivation assessment tools, this scale demonstrates significant advantages in the comprehensiveness of evaluation dimensions and the depth of motivational mechanism analysis, with a specific focus on elucidating the multilevel determinants underlying individuals' engagement in health-promoting behaviors. However, its cross-cultural validation in CHD populations remains lacking, and empirical evidence supporting its psychometric properties remains scarce.\u003c/p\u003e\u003cp\u003eThis study aims to validate the psychological properties of the Health Behavior Motivation Scale (HBMS) for Chinese patients with CHD, conducting cross-cultural adaptation and assessing reliability and validity to inform targeted health promotion interventions for this population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cb\u003eParticipants and Research Procedures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eConvenience sampling was used to select patients with CHD who were hospitalized in the cardiovascular medicine departments of two tertiary care hospitals in Shenyang City, Liaoning Province, and who met the criteria for natriuresis from August to October 2024. The team members underwent a systematic training before the start of the study to use a uniform guide and improve presentation skills. Inclusion criteria for study participants were as follows: age\u0026thinsp;\u0026ge;\u0026thinsp;18 years; meet the relevant criteria for the diagnosis of CHD; ability to hear, read, write, and communicate properly. Exclusion criteria were the following: patients with severe hepatic, renal, or other organ insufficiency or with major chronic diseases (e.g., malignant tumors); patients with mental illness; patients who have been enrolled in other studies similar to this one during the same time period; patients whose conditions are aggravated by activities or who are unable to move due to their conditions, e.g., cardiac function class IV, joint diseases, severe asthma, hemiplegia due to stroke, and unfavorable limb movement; recent major stressful events (e.g., bereavement, divorce). According to the principle of sample size selection for factor analysis, the sample size was 5\u0026ndash;10 times the number of scale items[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], taking into account 20 percent of invalid questionnaires, the final sample size was determined to be 188\u0026mdash;375; therefore, 400 questionnaires were distributed in this study.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMeasurement tools\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eGeneral information questionnaire\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBased on relevant literature and consulting experts, the researchers developed a questionnaire that includes demographics such as gender, age, educational background, marital status, course of coronary heart disease, type of occupation, and per capita monthly household income.\u003c/p\u003e\u003cp\u003e\u003cb\u003eHealth Behavior Motivation Scale (HBMS)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe HBMS was developed by Polish scholar Poraj-Weder et al.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] in 2021 to measure motivation in healthy adults to adopt healthy behaviors. The HBMS has five dimensions of intrinsic regulation (6 items), integrated and identified regulation (6 items), intrinsic regulation (6 items), extrinsic regulation (6 items), and non-regulation (amotivation) (6 items), with a total of 30 items. A 5-point Likert scale was used, with entries scored 1, 2, 3, 4, and 5 corresponding to \"completely disagree, mostly disagree, neither agree nor disagree, mostly agree, and completely agree,\" respectively. Cronbach's α coefficient was used to assess internal consistency; it ranged from 0.91 to 0.94, indicating good internal consistency. Scores ranged from 30 to 150, with higher scores indicating that individuals are more positively motivated to engage in health behaviors.\u003c/p\u003e\u003cp\u003e\u003cb\u003eProcess\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eTranslation of HBMS\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePrior to translating the scale, we secured permission from the original scale's authors. The scale was sinicized and cross-culturally adapted in strict accordance with the Brislin translation model and the principles of cross-cultural adaptation[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Two translators, one was academic English pedagogy practitioner and the other a PhD candidate specializing in nursing with an English proficiency, independently rendered the scale into Chinese. Then, the researcher organized members of the research team to collate the two versions to form the Chinese version of the HBMS A. The Chinese version of the HBMS A was independently back-translated by a professional with a grade 8 English major who works as a translator, and a Doctor of Nursing fluent in English. Members of the research team analyzed the HBMS back-translated version 1.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCross-cultural adaptation of the HBMS\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA cross-cultural evaluation team was formed with six experts selected among tertiary hospital practitioners and university teachers with more than 10 years of clinical nursing or university teaching experience. One doctoral, three master's, and two bachelor's degree holders were mailed questionnaires on expert correspondence. Experts assessed the meaning and presentation of each entry. They used the Likert 4 scale to assess the relevance of the scale content and calculate the scale-level CVI (S-CVI) and the validity of the item-level CVI (I-CVI). After the expert group's analysis, discussion, and modification, an HBMS containing 30 items and five dimensions was finally constructed, with a concise and clear content and in conformity with the language expression habits of China.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData collection\u003c/b\u003e\u003c/p\u003e\u003cp\u003e The study protocol was approved by the Ethics Review Committee of the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine in August 2024 (No. Y2024262CS(KT)-262-01). August 2024-October 2024, two trained investigators conducted the survey by distributing questionnaires using uniform instructions with the help of the head of the department; before the survey was conducted, they articulated the study's objective, the methodology, and the content of the study to the study participants. All the participants signed an informed consent. A total of 400 questionnaires were distributed. The sample sizes of Sample 1 (for exploratory factor analysis) and Sample 2 (for confirmatory factor analysis) were set at 200 cases each. HBMS was readministered 2 weeks later to quantify the test\u0026ndash;retest reliability with the same participants. The number of patients participated the test\u0026ndash;retest interview was 30.\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eStatistical analysis was performed using SPSS 25.0, Amos24.0, and Microsoft Excel. Items were analyzed using the Critical Ratio method and the internal consistency test; Cronbach's α coefficient and split-second reliability were used for the reliability test; and the validity was examined in terms of content validity and structural validity.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eGeneral information\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 400 valid questionnaires were collected for this study. Among the 400 participants, 208 (52%) were female and 192 (48%) were male. Other participants\u0026rsquo; demographic characteristics are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eGeneral demography data (n\u0026thinsp;=\u0026thinsp;400)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eThe course of coronary heart disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;3 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e129\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 months\u0026thinsp;~\u0026thinsp;1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u0026thinsp;~\u0026thinsp;3 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u0026thinsp;~\u0026thinsp;5years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u0026thinsp;~\u0026thinsp;10years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;10years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eMonthly per capita household income\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;2,000 RMB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,000\u0026thinsp;~\u0026thinsp;3,000RMB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e173\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3,000\u0026thinsp;~\u0026thinsp;4,000RMB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e132\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;4,000RMB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003eType of occupation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProfessional and technical staff\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOffice-bearer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWorkers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSelf-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeasant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnmarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e335\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDivorcee\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWidowhood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eEducational level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eElementary school and below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJunior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e179\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh school/secondary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCollege\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBachelor's degree and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGenders\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e208\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e52%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u0026thinsp;~\u0026thinsp;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u0026thinsp;~\u0026thinsp;59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e139\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34.75%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e257\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e64.25%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eItems analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe critical ratio approach was used to analyze the degree of differentiation among the entries in the HBMS. According to the outcomes of the critical ratio approach, each item\u0026rsquo;s critical ratio (CR) was 4.000\u0026thinsp;~\u0026thinsp;20.381 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and all were \u0026gt;\u0026thinsp;3.0. Thus, all 30 items were retained without reduction.\u003c/p\u003e\u003cp\u003e\u003cb\u003eReliability analysis results\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe Cronbach's α coefficient for the the HBMS scale was 0.886, and the Cronbach's α coefficient for each dimension ranged from 0.835 to 0.965. Moreover, the split-half and test\u0026ndash;retest reliability of were 0.625, 0.810.\u003c/p\u003e\u003cp\u003e\u003cb\u003eValidity analysis results\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eContent validity\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSix experts were invited to assess the relevance of each question to the topic in the HBMS. The range for the content validity index of an item (I-CVI) was from 0.83 to1.00, and the content validity index for the entire instrument (S-CVI) was 0.94, indicating that the scale has good content validity.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStructural validity\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAll data were divided into two parts: 200 for exploratory factor analysis and 200 for confirmatory factor analysis.\u003c/p\u003e\u003cp\u003e\u003cb\u003eExploratory factor analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAccording to the results of the Bartlett spherical test (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;5649.578 df\u0026thinsp;=\u0026thinsp;435, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), the KMO value was 0.857; the data satisfied the spherical hypothesis and demonstrated suitability for factor analysis. The results of the screen plot were combined, further supporting the five-factor structural model (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Moreover, the results revealed a cumulative explanatory variation of 71.962%. A total of five factors with eigenvalues\u0026thinsp;\u0026gt;\u0026thinsp;1were extracted (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The factor load value is shown as 0.509\u0026mdash;0.965 in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eInitial eigenvalue, percentage of variance and cumulative percentage of variance\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFactors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInitial Eigenvalue\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage of Variance\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCumulative Percentage of Variance\u003c/p\u003e\u003cp\u003eExplained\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7.862\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26.206\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e26.206\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5.339\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17.798\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e44.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.626\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12.088\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e56.092\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.991\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9.971\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e66.064\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.769\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.898\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e71.962\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFactor loadings from exploratory factor analysis of the HBMS Scale\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFactor\u003c/p\u003e\u003cp\u003eloading\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFactor 1\u003c/p\u003e\u003cp\u003e(Introjected\u003c/p\u003e\u003cp\u003eregulation)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFactor 2\u003c/p\u003e\u003cp\u003e(Intrinsic\u003c/p\u003e\u003cp\u003eregulation)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFactor 3\u003c/p\u003e\u003cp\u003e(External\u003c/p\u003e\u003cp\u003eregulation)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eFactor 4\u003c/p\u003e\u003cp\u003e(Integrated and\u003c/p\u003e\u003cp\u003eidentified\u003c/p\u003e\u003cp\u003eregulation)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eFactor 5 [Non\u003c/p\u003e\u003cp\u003eregulation\u003c/p\u003e\u003cp\u003e(Amotivation)]\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.965\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.963\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.961\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.939\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.923\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.891\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.893\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.860\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.851\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.833\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.818\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.755\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.897\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.885\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.882\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.874\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.686\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.582\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.823\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.808\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.773\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.712\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.676\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.552\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.889\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.866\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.798\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.686\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.516\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.509\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eConfirmatory factor analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA confirmatory factor analysis was applied to test the modeling of the scale structure, with the five dimensions of the HBMS as latent variables and the 30 questions under the scale as observational variables modeling structural equations (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The confirmatory factor analysis results showed that the fit indices met the requirements, indicating that the factor model of the HBMS is well-fitted (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFit indices of validated factor analysis models for the HBMS scale\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndices\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eActual results\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference standard\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCMIN/DF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.818\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u0026thinsp;~\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRMSEA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.064\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;0.08\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCFI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.922\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026gt;0.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIFI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.923\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026gt;0.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTLI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.914\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026gt;0.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we cross-cultural adapted the original HBMS and examined its validity and reliability by administering the scale on a sample of patients with CHD. Our results indicate sufficient validity (content validity, structural validity), satisfactory reliability (internal consistency, split-half and test\u0026ndash;retest reliability).\u003c/p\u003e\u003cp\u003eThe psychometric evaluation of the measurement tool revealed high internal consistency and good correlation between the scale\u0026rsquo;s items, as well as good discrimination[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The findings of this study revealed that the reliability coefficients (CR) of all items in the HBMS were higher than the standardized values (3.000), and the differences were statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.01). This indicates that the individual items of the translated scale are highly recognizable. The results of the items analysis showed that the items performed well in terms of representativeness and variability, and it is therefore recommended that all items be retained.\u003c/p\u003e\u003cp\u003eEstimating the degree of consistency of measurements through reliability[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Cronbach's α coefficient was used to assess internal consistency. In this study, the Cronbach's α coefficient or the HBMS was 0.886, and the Cronbach's α coefficient for the dimensions were 0.835\u0026mdash;0.965. This indicates that the scale demonstrated strong internal consistency. In addition, the split-half reliabilities and test-retest reliabilities were within the acceptable range, proving that HBMS has high stability. Therefore, the HBMS demonstrated high reliability in patients with CHD.\u003c/p\u003e\u003cp\u003eThe six experts involved in the content validity appraisal of this study were drawn from diverse academic backgrounds and brought extensive clinical experience and high academic credentials to the evaluation process. They evaluated the content validity of the questionnaire after expert consultation. The results showed that the I-CVI values were 0.83\u0026mdash;1.00, and the S-CVI/Ave was 0.94, indicating that the scale's content validity was adequate to effectively measure the level of motivation towards health behaviors in patients with CHD. The results of the exploratory factor analysis showed a KMO\u0026gt;0.6, indicating that it was suitable for factor analysis. Five common factors were extracted from the HBMS, with a cumulative variance contribution rate of 71.962%. There are consistent with previous findings[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The factor loading values of the 30 items were\u0026gt;0.50, which was consistent with the original version of the scale. This indicates that the HBMS has good construct validity and can effectively assess health behavior motivation in patients with CHD. In addition, the validation factor analysis results showed that the scale's factor model conformed to the range of standardized values. This further proved that the structure of the HBMS was reasonable and clear, and the structural validity was excellent.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn this study, the reliability was validated only among CHD patients in two hospitals, and the sample's representativeness may be limited. Therefore, future studies could expand the sample size to cover other chronic diseases and investigate in multiple regions and research organizations to validate further the validity and reliability of the HBMS.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe cross-cultural adaptation of the HBMS demonstrates strong reliability and validity while maintaining the properties of original scale. Its straightforward and comprehensible measurement process renders it an apt instrument for assessing health behavior motivation among patients with CHD. Furthermore, it offers a foundational reference for the development and evaluation of health behavior promotion initiatives targeting patient population with CHD. This research is in active alignment with the Healthy China Initiative, which strives to foster the nation's well-being, enhance collaborative efforts in chronic disease prevention and management, and collectively advance the goal of establishing a healthier China.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank AiMi Academic Services (www.aimieditor.com) for English language editing and review services and the authors are grateful to patients with CHD who participated in this study, and also to the health providers for their strong support in sampling.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZZ and LL\u0026nbsp;participated in the conception and design of the study;\u0026nbsp;ZZ\u0026nbsp;and\u0026nbsp;JW\u0026nbsp;analyzed and interpreted the data and wrote the manuscript;\u0026nbsp;YX\u0026nbsp;and\u0026nbsp;YT\u0026nbsp;participated in the formal analysis;\u0026nbsp;SS\u0026nbsp;and\u0026nbsp;YW\u0026nbsp;took part in the investigation and data collection; LL critically reviewed and revised the manuscript and obtained funding. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was funded by the The China Social Welfare Foundation (HLCXKT- 202 40102) and by a grant from the China Scholarship Council. The funders had no role in the design and conduct of the study, data collection, analysis, and interpretation; writing of the manuscript; or the decision to submit the article for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone declared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in adherence to the local and international ethical principles including those in the Declaration of Helsinki. The study proposal was approved by the Ethics Review Committee of the affiliated Hospital of Liaoning University of Traditional Chinese Medicine (No. Y2024262CS(KT)-262-01). Written informed consent was obtained from a legally authorised representative for anonymised patient information to be published in this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participant has consented to the submission of the case report to the journal. I confirm that the manuscript has been not submitted to any journal and is not published, in press, or submitted elsewhere. Not Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eSchool of Nursing, Liaoning University of Traditional Chinese Medicine, Shenyang110847, Liaoning Province, China\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eDepartment of Cardiology, The Second Affiliated Hospital of Shenyang Medical College, Shenyang110002, Liaoning Province, China\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e3\u003c/sup\u003eNursing Department, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang110000, Liaoning Province, China\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWang Z, Ma L, Liu M, Fan J, Hu S, Writing Committee of the Report on Cardiovascular Health and Diseases in China. Summary of the 2022 Report on Cardiovascular Health and Diseases in China. 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Front Psychol. 2024;15:1279816.\u003c/span\u003e \u003cspan\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyg.2024.1279816\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2024.1279816\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cross-cultural adaptation, Coronary heart disease, Health behavior motivation scale, Reliability, Validity","lastPublishedDoi":"10.21203/rs.3.rs-7024356/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7024356/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eHealth Behavior Motivation, a concept originating from psychology, examines the psychological forces underlying health behaviors. The current study aimed to cross-culturally adapt and validate the Health Behavior Motivation scale for coronary heart disease patients in China.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA convenience sample of 400 patients with coronary heart disease (CHD) was recruited from cardiovascular wards at two tertiary care hospitals in Shenyang, China, during the study period spanning August to October 2024. Statistical analyses were conducted using AMOS 24.0 and SPSS 25.0 software. The scale's reliability was evaluated through three established methods: test-retest reliability, split-half reliability, and internal consistency assessment. Validity verification encompassed examinations of both structural validity and content validity.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe HBMS had a Cronbach's α coefficient of 0.886, and the range of Cronbach's α coefficient values for each dimension was 0.835\u0026ndash;0.965. The scale's test\u0026ndash;retest reliability was 0.810, and its split-half reliability was 0.625. Five common factors with a cumulative variance contribution of 71.962% were retrieved from the exploratory factor analysis. In confirmatory factor analysis, the indicators were reported as follows: χ\u003csup\u003e2\u003c/sup\u003e / df\u0026thinsp;=\u0026thinsp;1.818, TLI\u0026thinsp;=\u0026thinsp;0.914, CFI\u0026thinsp;=\u0026thinsp;0.922, IFI\u0026thinsp;=\u0026thinsp;0.923, and RMSAE\u0026thinsp;=\u0026thinsp;0.064 and the results of the model fit metrics were within the reference range.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe HBMS is suitable for health behavior motivation measurement with acceptable validity and reliability, the HBMS can be applied in CHD patients in China.\u003c/p\u003e","manuscriptTitle":"Cross-cultural adaptation and psychometric evaluation of the Health Behavior Motivation scale(HBMS) for coronary heart disease patients in China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-11 09:59:53","doi":"10.21203/rs.3.rs-7024356/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-03T05:58:36+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-19T02:10:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"265512697312178273548076435895973012532","date":"2025-08-14T07:09:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-13T05:40:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"205943004436166340084298819960718143353","date":"2025-08-05T17:44:10+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-05T17:28:49+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-11T10:59:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-11T01:19:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-11T01:18:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2025-07-02T02:19:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ee8c824f-a9a7-4613-99b1-9a7981a09371","owner":[],"postedDate":"August 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-09T16:15:52+00:00","versionOfRecord":{"articleIdentity":"rs-7024356","link":"https://doi.org/10.1186/s40359-026-04078-4","journal":{"identity":"bmc-psychology","isVorOnly":false,"title":"BMC Psychology"},"publishedOn":"2026-02-03 15:59:40","publishedOnDateReadable":"February 3rd, 2026"},"versionCreatedAt":"2025-08-11 09:59:53","video":"","vorDoi":"10.1186/s40359-026-04078-4","vorDoiUrl":"https://doi.org/10.1186/s40359-026-04078-4","workflowStages":[]},"version":"v1","identity":"rs-7024356","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7024356","identity":"rs-7024356","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}