The Development and Validation of the Health Belief Model for Shift Workers (HBM-SW) Scale

Figures & data

Table 1. Psychosocial determinants proposed by health belief model with brief explanation.

Psychosocial Determinant	Explanation
Perceived Threat [PT]	An individual perception of whether they are at risk of a health outcome or disease
Perceived Severity [PS]	An individual’s perception of the seriousness of condition or disease
Perceived Benefits [BF]	An individual’s beliefs about the efficacy of a health behavior to reduce risk
Perceived Barriers [BR]	An individual’s beliefs about the cost of, or obstacles to, engaging in a health behavior
Cues to Action [CA]	Diverse triggers that can activate engagement in the health behavior
Self-efficacy [SE]	The belief that an individual has the capacity to engage in a health behavior
Health Motivation [HM]	An individual’s general motivation to look after their health

Note. Definitions of determinants in table are drawn from existing literature (Conner & Norman, 2005; Glanz et al., 2008).

Table 2. Demographics of sample that completed HBM-SW scale.

Characteristic	n (%)
Age (yrs.)*	34.0 (18.0)
Gender
Male	64 (41.8%)
Female	83 (54.2%)
Non-binary	3 (0.0%)
Missing	3 (0.0%)
Shift arrangements
Rotating shift work – Yes	93 (60.8%)
On call – Yes	29 (19.0%)
Shift work experience (yrs.)*	8.0 (11.0)
Weekly work hours*	38.0 (10.0)
Occupation
Health care	43 (28.1%)
Trades and Services	26 (17.0%)
Emergency Services	19 (12.4%)
Care assistant or Support worker	14 (9.2%)
Retail	9 (5.9%)
Hospitality	7 (4.6%)
Transport	7 (4.6%)
Administration	6 (3.9%)
Cleaner	5 (3.3%)
Technology services	5 (3.3%)
Management	2 (1.3%)
Education	2 (1.3%)
Other	4 (2.6%)
Not reported	4 (2.6%)
Chronic Disease
Chronic disease – Yes	52 (34.0%)
Family/friends with chronic disease – Yes	72 (47.1%)
Behavioral Outcomes
Global PSQI (>5 = poor sleep)*	9.0 (5.0)
Sleep duration (hrs. per night)*	6.5 (2.0)
Fiber (mg per day)*	16.4 (4.1)
Calcium (mg per day)*	955.3 (222.5)
Wholegrain (ounce per day)*	0.7 (0.4)
Sugar (tsp per day)*	15.0 (5.4)
Dairy (cup per day)*	1.5 (0.5)
Vegetables (cup per day)*	1.6 (0.4)
Fruit (cup per day)*	0.9 (0.5)
Sugar sweetened beverages (tsp per day)*	5.6 (3.9)
Occupational Physical Activity (METs per week)*	3168.0 (6755.0)
Leisure time Physical Activity (METs per week)*	396.0 (1980.0)
Sitting time (hrs per week)*	11.0 (15.0)

Note: Data reported as n(%), unless indicated with * where data are reported as median and interquartile range.

Table 3. Final scale items and results of factor anaylsis for Health Belief Model for Shift Workers Scale (HBM-SW).

Item Code. Item	Benefits	Threat	Barriers	Cues to Action	Self-efficacy	Severity	Health Motivation
PT1. Working shift work makes it more likely that I will develop a chronic disease	0.09	0.93	−0.10	0.03	−0.13	−0.05	−0.04
PT2. Working shift work makes it more likely I will develop chronic diseases compared to someone else my age who is not working shifts	0.03	0.86	0.01	0.03	0.04	0.01	−0.04
PT3. As a shift worker, my chances of developing a chronic disease in the next few years a high	−0.12	0.77	0.02	0.07	−0.17	0.06	0.04
PT4. Working shift work increases my chances of developing a chronic disease, compared to if I wasn’t working shift work	0.06	0.86	−0.13	0.07	−0.13	0.10	−0.01
PT5. I am concerned about the negative effects of developing a chronic disease because of working shift work	0.04	0.70	0.13	−0.04	0.00	0.09	0.08
PS1. If I develop a chronic disease because of working shift work, my whole life would change	0.19	0.07	−0.09	−0.11	0.07	0.81	−0.09
PS2. Developing a chronic disease because of working shift work, would impact my relationship with my important family members or friends	−0.09	0.12	0.12	0.00	0.04	0.67	−0.02
PS3. If I had a chronic disease my whole life would change for the worse	0.00	0.00	0.00	0.04	−0.09	0.73	0.02
BR1. My shift work schedule does not leave me enough time to get enough sleep	0.02	0.26	0.67	−0.07	0.12	−0.12	0.10
BR2. My shift work schedule does not leave me enough time purchase and/or prepare a range of nutritious foods	−0.09	−0.13	0.88	0.00	−0.01	0.03	−0.05
BR3. My shift work schedule does not leave me enough time to do regular physical activity	0.11	−0.05	0.86	0.04	−0.01	−0.10	−0.09
BR4. Working shift work makes it difficult for me to get enough sleep	0.05	0.23	0.61	−0.09	0.10	0.04	0.06
BR5. Working shift work makes it difficult for me to eat a range of nutritious foods	−0.02	−0.11	0.74	0.08	−0.22	0.13	0.00
BR6. Working shift work makes it difficult for me to do regular physical activity	0.07	0.00	0.70	0.03	−0.15	0.08	−0.10
BF1. As a shift worker, getting enough sleep will help prevent the development of chronic disease	0.70	0.23	−0.04	0.01	0.13	0.04	−0.03
BF2. As a shift worker, eating a range of nutritious food will help prevent the development of chronic disease	0.84	0.15	0.02	0.07	0.11	−0.17	−0.13
BF3. As a shift worker, doing regular physical activity (such as walking, bike riding or exercise) will help prevent the development of chronic disease	0.83	0.08	−0.01	0.03	0.01	−0.01	−0.02
BF4. As a shift worker, getting enough sleep is good for my health	0.85	−0.09	0.00	−0.01	−0.15	−0.01	0.07
BF5. As a shift worker, eating a range of nutritious food is good for my health	0.85	−0.08	0.03	−0.05	0.06	0.06	0.04
BF6. As a shift worker, doing regular physical activity is good for my health	0.68	−0.16	0.07	0.01	0.04	0.21	0.08
SE1. I am sure I can eat a range of nutritious foods, even when working shift work	0.04	0.09	−0.16	0.01	0.74	0.03	−0.05
SE2. I am sure I can do regular physical activity, even when working shift work	−0.02	−0.12	−0.04	0.00	0.77	0.01	0.09
SE3. When working shift work, if I really want to I can eat a range of nutritious food	0.14	−0.14	0.02	0.06	0.79	−0.11	−0.08
SE4. When working shift work, if I really want to I can do regular physical activity	0.01	−0.28	0.04	0.14	0.70	0.08	0.00
CA1. As a shift worker, I am more likely to get enough sleep if my family or friends encourage me	0.09	−0.06	0.04	0.73	−0.08	−0.06	0.05
CA2. As a shift worker, I am more likely to eat a range of nutritious foods if my family or friends encourage me	0.05	0.02	0.06	0.62	−0.11	−0.19	0.01
CA3. As a shift worker, I am more likely to get do regular physical activity if my family or friends encourage me	0.11	0.07	−0.09	0.63	−0.02	−0.01	−0.12
CA4. As a shift worker, I am more likely to try to get enough sleep after I hear/see a story about sleep on TV, Radio or Social Media	−0.20	0.06	0.05	0.67	0.15	0.05	0.04
CA5. As a shift worker, I am more likely to eat a range of nutritious foods after I hear/see a story about healthy eating on TV, Radio or Social Media	−0.15	0.07	0.06	0.68	0.17	0.05	0.01
CA6. As a shift worker, I am more likely to do regular physical activity after I hear/see a story about physical activity on TV, Radio or Social Media	−0.07	0.07	0.01	0.67	0.17	−0.01	0.03
CA7. As a shift worker, I am more likely to look after my health after health experts remind me	0.10	−0.06	−0.07	0.57	0.01	0.19	0.07
HM1. I prioritize my sleep for my health	0.22	−0.04	−0.04	0.00	−0.02	−0.07	0.55
HM2. I eat a range of nutritious food for my health	−0.11	0.10	0.03	−0.03	0.24	−0.02	0.59
HM3. I do regular physical activity for my health	−0.13	0.09	−0.11	−0.05	0.18	−0.02	0.65
HM4. Maintaining good health is extremely important to me	0.25	0.04	0.03	−0.08	0.00	−0.02	0.55
HM5. I look for new information about my health	−0.05	−0.09	−0.01	0.12	−0.22	0.04	0.60
Eigen Values	4.27	4.08	3.63	3.18	3.00	2.01	1.90
Variance Explained	12%	11%	10%	9%	8%	6%	5%

Note: PT: Perceived Threat, PS: Perceived Severity, BR: Barriers, BF: Benefits, SE: Self-efficacy, CA: Cues to Action, HM: Health Motivation. Loading onto factor in denoted by bold font. The authors recommend the scale be presented in a randomized order in limit any order effects.

Table 4. Measures of reliability outcomes presented by subscale.

Subscale	Cronbach’s alpha	Test re-test^a
Perceived Threat [PT]	.93	0.70
Perceived Severity [PS]	.82	0.64
Perceived Barriers [BR]	.90	0.89
Perceived Benefits [BF]	.92	0.69
Self-efficacy [SE]	.82	0.72
Cues to Action [CA]	.85	0.76
Health motivation [HM]	.74	0.75

*Test re-test measured using longitudinal sample (n = 36).

^bIntraclass correlation coefficients were based on two-way mixed effects model.

Table 5. Correlations between HBM-SW subscales and outcome measures.

	Sleep		Diet Quality								Physical activity
HBM-SW Subscale	Sleep quality	Sleep duration	Fiber intake	Calcium intake	Wholegrain intake	Sugar intake	Dairy intake	Vegetable intake	Fruit intake	Sugar beverages	Leisure Time METs
Perceived Threat	0.19*	−0.15	0.06	0.06	0.01	−0.22*	0.06	0.02	0.03	−0.19	0.02
Perceived Severity	0.09	−0.10	0.00	0.04	0.07	0.04	−0.04	−0.07	0.02	0.10	−0.09
Barriers	0.46***	−0.44***	−0.17	−0.01	−0.06	0.09	0.05	−0.23*	−0.03	0.15	−0.10
Benefits	0.21**	−0.14	−0.11	−0.13	−0.15	0.06	−0.13	0.04	0.07	0.07	0.06
Self-efficacy	−0.33***	0.26**	0.10	−0.02	0.20	−0.01	−0.04	0.16	−0.08	−0.07	0.15
Cues to Action	−0.17	0.21**	0.20*	0.10	0.18	0.00	0.00	0.02	−0.05	−0.18	0.07
Health Motivation	−0.15	0.16	0.21*	0.03	0.14	−0.33***	−0.01	0.22*	0.10	−0.44***	0.29**

Notes. *p-value <.05, **p-value ≤.01, ***p-value ≤.001.

Significant outcomes are denoted in bold, with a positive value indicating that as score on the HBSM subscale increases, so does the outcome measure. A negative value indicates that as the score on the HBSM subscale increases, the outcome measure decreases.

Figure 1. Visual representation of significant correlations between HBM-SW psychosocial determinants and health behaviors.

Note. This figure depicts significant correlations only. Left side of zero represents negative relationship: Higher levels of psychosocial determinant are associated with lower levels of health behavior. Right side of zero represents positive relationship: Higher levels of psychosocial determinant are associated with higher levels of health behavior. Beneficial health relationships (i.e., higher levels of positive health behaviors) are denoted with green bars, and poorer health relationships (i.e., higher levels of negative health behaviors) are denoted with red bars. Length of bars indicates strength on relationship (i.e., further from zero equals stronger relationship) *Higher scores of sleep quality indicate poorer sleep quality.

Table 6. Kruskal–Wallis tests between behavioral specific subscales (by low, average, high) and relevant outcomes of interest.

Scale	Category	Score range	n	Median outcome score	Chi-Square	P-value
Sleep outcomes x Sleep subscale
Sleep quality					14.7	<.001
	Low	4–10	47	10.0
	Average	11–13	62	9.0
	High	14–24	44	6.0
Sleep Duration					23.2	<.001
	Low	4–10	47	6.0
	Average	11–13	62	6.3
	High	14–24	44	7.3
Diet quality outcomes x Diet subscale
Fiber					3.1	.22
	Low	3–16	32	15.6
	Average	17–20	30	16.3
	High	21–28	35	16.9
Calcium					1.2	.56
	Low	3–16	32	916.9
	Average	17–20	30	987.5
	High	21–28	35	950.5
Wholegrain					0.1	.95
	Low	3–16	32	0.7
	Average	17–20	30	0.7
	High	21–28	35	0.7
Sugar					3.3	.20
	Low	3–16	32	15.7
	Average	17–20	30	14.9
	High	21–28	35	14.7
Dairy					0.7	.70
	Low	3–16	32	1.4
	Average	17–20	30	1.5
	High	21–28	35	1.5
Vegetables					1.1	.57
	Low	3–16	33	1.6
	Average	17–20	30	1.6
	High	21–28	35	1.7
Fruit					3.9	.14
	Low	3–16	33	0.9
	Average	17–20	30	0.7
	High	21–28	35	1.0
Sweetened beverages					6.9	.032
	Low	3–16	33	6.5
	Average	17–20	30	5.8
	High	21–28	36	4.7
Physical Activity outcomes x Physical activity subscale
Leisure METs					18.7	<.001
	Low	3–15	35	0
	Average	16–19	27	396.0
	High	20–28	39	1039.5

Note. Significant interactions are denoted by bold font.

Conner, M., & Norman, P. (2005). Predicting health behaviour. McGraw-Hill Education. https://books.google.com.au/books?id=YjvuX4Q9s_wC

 Google Scholar

Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2008). Health behavior and health education: Theory, research, and practice (4th ed.). Jossey-Bass.

 Google Scholar