Development of Emerging Infectious Diseases Preventive Health Behavior (EID-PHB) Scale and Validation of the Complex Models

Figures & data

Figure 1 Phase of development and validation of the scale.

Table 1 Characteristics of Participants (N = 533)

Characteristics	Categories	EFA (n = 330) n (%)	CFA (n = 203) n (%)
Gender	Male	145 (43.9)	119 (58.6)
	Female	185 (56.1)	84 (41.4)
Age group	19~29	64 (19.4)	43 (21.2)
	30~39	79 (23.9)	25 (12.3)
	40~49	61 (18.5)	42 (20.7)
	50~59	65 (19.7)	45 (22.2)
	60~69	61 (18.5)	48 (23.6)
Marital status	Married	184 (55.8)	114 (56.2)
	Unmarried	128 (38.8)	77 (37.9)
	Divorce/Seperate/Bereave	18 (5.5)	12 (5.9)
Education	Secondary level	60 (18.2)	32 (15.8)
	Tertiary level	228 (69.1)	146 (71.9)
	Postgraduate	42 (12.7)	25 (12.3)
Employment	Employed	224 (67.9)	149 (73.4)
	Unemployed	106 (32.1)	54 (26.6)
Monthly household income	< 2,000,000	55 (16.7)	30 (14.8)
(won)	2,000,000~6,000,000	200 (60.6)	122 (60.1)
	6,000,000 <	75 (22.7)	51 (25.1)
History of chronic diseases	Present	66 (20.0)	49 (24.1)
	Absent	264 (80.0)	154 (75.9)
Perceived health status	Healthy	79 (23.9)	49 (24.1)
	Uncertain	213 (64.5)	132 (65.0)
	Unhealthy	38 (11.5)	22 (10.8)
Infected by EID	Present	167 (50.6)	108 (53.2)
	Absent	163 (49.4)	95 (46.8)
Experience of quarantine	Present	164 (49.7)	108 (53.2)
	Absent	166 (50.3)	95 (46.8)

Abbreviations: EFA, Exploratory Factor Analysis; CFA, Confirmatory Factor Analysis; EID, Emerging Infectious Diseases.

Table 2 Exploratory Factor Analysis (N = 330)

Factors (Indicators)	No	M±SD	Com.	Factor Loading
				F1	F2	F3	F4	F5	F6	F7	F8	F9	F10
Attitude	61	3.86±.084	0.68	0.78	0.03	0.10	0.07	0.11	0.18	0.14	−0.02	−0.01	0.03
	62	4.06±0.71	0.66	0.76	0.02	0.08	0.02	0.09	0.15	0.10	0.09	0.14	0.12
	59	4.28±0.69	0.62	0.72	0.07	0.16	−0.01	0.07	−0.10	0.07	0.10	0.09	0.21
	63	4.14±0.70	0.59	0.67	0.07	0.12	0.02	0.18	−0.01	0.16	0.07	0.17	0.17
	58	4.05±0.73	0.67	0.69	0.11	0.08	0.19	0.16	0.11	0.10	0.06	0.01	0.35
Social distancing	16	3.18±1.09	0.77	0.06	0.83	0.14	0.12	−0.01	0.16	0.02	0.04	0.06	0.05
	17	2.92±1.11	0.71	−0.08	0.82	0.04	0.07	0.13	0.04	0.02	0.01	0.06	0.02
	18	2.93±1.11	0.75	0.06	0.81	0.02	0.09	0.03	0.08	0.22	−0.06	−0.15	0.06
	15	3.38±1.07	0.69	0.09	0.72	0.15	0.20	0.04	0.25	0.12	0.10	0.12	0.07
	9	3.41±0.98	0.56	0.18	0.66	0.03	0.10	0.06	0.16	0.05	0.06	0.19	−0.10
Hand hygiene	25	4.41±0.71	0.71	0.29	0.01	0.77	0.06	0.04	−0.06	0.01	0.09	0.10	−0.04
	26	4.32±0.81	0.70	0.04	0.06	0.76	0.14	0.14	−0.01	0.06	0.10	0.24	0.02
	24	4.15±0.78	0.68	0.14	0.14	0.70	0.03	0.13	0.15	0.28	0.09	0.02	0.14
	23	3.91±0.86	0.63	0.02	0.14	0.54	−0.03	0.29	0.30	0.28	0.18	−0.07	0.16
	27	3.78±0.91	0.56	0.17	0.22	0.48	0.11	0.34	0.28	0.08	0.17	−0.03	−0.09
Wearing masks	5	4.21±1.00	0.84	0.01	0.17	0.05	0.86	0.14	0.09	0.12	−0.06	0.13	0.06
	4	4.26±0.99	0.79	0.01	0.20	0.04	0.86	0.05	0.06	0.07	−0.03	0.02	0.06
	6	4.34±0.89	0.65	0.20	0.12	0.15	0.71	0.09	0.11	0.06	0.19	0.05	−0.11
Environmental management	43	3.30±.1.04	0.69	0.11	0.05	0.08	0.12	0.78	0.19	0.04	0.01	0.04	0.05
	44	3.60±0.93	0.70	0.23	0.11	0.13	0.03	0.76	0.05	0.13	−0.01	0.15	0.02
	42	4.18±0.77	0.57	0.11	0.03	0.19	0.11	0.66	−0.02	0.01	0.23	0.13	0.03
Ventilation	31	3.27±0.95	0.79	0.15	0.27	0.02	0.13	0.04	0.80	0.11	0.14	0.06	0.07
	32	3.26±.1.01	0.79	0.10	0.33	0.07	0.09	0.10	0.78	0.05	0.09	0.09	0.08
	34	3.42±.1.00	0.54	0.06	0.14	0.26	0.07	0.32	0.50	0.00	−0.04	0.29	0.13
Contaminated carriers	19	4.08±0.83	0.74	0.13	0.13	0.14	0.14	0.20	0.03	0.76	0.16	0.07	0.11
	20	4.22±0.72	0.76	0.29	0.17	0.20	0.10	0.02	0.03	0.75	0.06	0.18	0.06
	21	4.12±0.91	0.65	0.41	0.17	0.11	0.09	−0.04	0.26	0.55	0.18	0.17	−0.04
Respiratory etiquette	1	4.11±0.85	0.63	0.06	0.04	0.16	0.05	0.09	0.10	0.05	0.76	0.04	−0.02
	2	4.19±0.86	0.61	0.03	0.04	0.08	−0.03	0.17	0.14	0.09	0.72	−0.03	0.15
	3	4.70±0.53	0.65	0.25	−0.01	0.14	0.11	−0.14	−0.12	0.22	0.60	0.33	0.08
Bloodborne protection	37	4.02±0.98	0.71	0.03	0.17	0.06	−0.11	0.28	0.07	0.21	0.04	0.73	0.02
	38	3.95±0.98	0.49	0.20	0.04	0.06	0.16	0.13	0.23	0.14	−0.02	0.57	0.07
	39	4.46±0.77	0.61	0.18	0.03	0.34	0.32	−0.05	0.01	−0.10	0.26	0.51	0.09
	40	4.34±0.81	0.55	0.37	0.07	0.27	0.28	0.04	0.03	0.05	0.25	0.42	−0.07
Excluded	57	3.98±0.78	0.86	0.38	0.01	0.13	0.01	0.03	0.11	0.07	0.12	0.04	0.81
	56	4.05±0.84	0.84	0.39	0.06	−0.01	0.01	0.06	0.09	0.07	0.07	0.07	0.81
Eigen value				9.5	3.3	2.2	1.9	1.7	1.3	1.3	1.2	1.1	1.0
Explained variance(%)				10.4	9.7	7.7	6.8	6.4	6.0	5.4	5.4	5.1	4.8
Cumulative variance(%)				10.4	20.2	27.9	34.7	41.2	47.1	52.5	57.9	63.0	67.8
Kaiser-Meyer-Olkin: 0.88,				Bartlett’s test of sphericity: χ²=5521.41 (p < 0.001)

Note: The factor’s significant factor loading is highlighted by bold text.

Abbreviations: M, Mean; SD, Standard Deviation; Com, Communality.

Table 3 Confirmatory Factor Analysis of the Models

Factors/ Model	No	β	SE (p)	χ²/degree of freedom	CFI	TLI	RMSEA (90% CI)	SRMR	Cronbach’s a
Six-factor model				1.37	0.91	0.91	0.05 (0.04~0.06)	0.09	0.92
Nine-factor model				1.25	0.94	0.94	0.04 (0.03~0.05)	0.08	0.92
Respiratory etiquette	1	0.58
	2	0.63	0.20 (0.001)
	3	0.67	0.21 (0.001)
Wearing masks	4	0.86
	5	0.90	0.10 (0.001)
	6	0.57	0.09 (0.001)
Social distancing	9	0.51
	15	0.70	0.24 (0.001)
	16	0.80	0.26 (0.001)
	17	0.81	0.26 (0.001)
	18	0.80	0.26 (0.001)
Contaminated carriers	19	0.66
	20	0.72	0.17 (0.001)
	21	0.63	0.16 (0.001)
Hand hygiene	23	0.72
	24	0.77	0.12 (0.001)
	25	0.72	0.12 (0.001)
	26	0.68	0.12 (0.001)
	27	0.74	0.12 (0.001)
Ventilation	31	0.86
	32	0.93	0.09 (0.001)
	34	0.46	0.09 (0.001)
Bloodborne protection	37	0.49
	38	0.64	0.26 (0.001)
	39	0.71	0.27 (0.001)
	40	0.69	0.27 (0.001)
Environmental	42	0.54
Management	43	0.70	0.23 (0.001)
	44	0.81	0.26 (0.001)
Attitude	58	0.84
	59	0.73	0.90 (0.001)
	61	0.74	0.90 (0.001)
	62	0.80	0.90 (0.001)
	63	0.73	0.90 (0.001)

Abbreviations: SE, Standard Error; CFI, Comparative Fit Index; TLI, Tucker Lewis Index; RMSEA, Root Mean Square Error of Approximation; CI, Confidence Interval; SRMR, Standardized Root Mean Residual.

Table 4 Confirmatory Factor Analysis, Convergent & Discriminant Validity of the Six-Factor Model (N = 203)

Factors/ Indicators	No	Items	β	SE (p)	CR	AVE	α*	Correlation r(p) / <√AVE>
								F1	F2	F3	F4	F5	F6
Factor 1 Droplet prevention				(0.001)	0.86	0.51	0.74	<0.71>
Respiratory etiquette	1	I cover my nose and mouth with a tissue, handkerchief, sleeves etc. when coughing or sneezing.	0.58	0.16
	2	I discard the used tissue immediately after coughing or sneezing.	0.63	0.16
	3	I try to turn my head away from others when coughing or sneezing.	0.67
Wearing masks	4	I prepare a mask when going out.	0.86	0.21
	5	I wear a mask when going out in public places.	0.90	0.22
	6	I wear a mask when I have respiratory symptoms.	0.57
Factor 2 Contact prevention				(0.001)	0.93	0.51	0.86	0.50	<0.72>
Social distancing	7	I try not to have physical contacts such as shaking hands or hugging others.	0.51	0.10				(0.001)
	8	I avoid going to crowded places.	0.70	0.10
	9	I refrain from participating social gatherings.	0.80	0.10
	10	I try to refrain from eating out.	0.81	0.10
	11	I try to refrain from traveling within the country or abroad.	0.80
Contaminated carriers	12	I stay home when I have symptoms (fever, cough, rash etc).	0.66	0.17
	13	I would be cautious not to have close contact with others who have symptoms.	0.72	0.18
	14	I would be cautious not to visit the affected areas.	0.63
Hand hygiene	15	I clean my hands (washing hands, using sanitizer) after coughing, sneezing, or nose-blowing.	0.72	0.12
	16	I clean my hands (washing hands, using sanitizer) before having a meal.	0.77	0.12
	17	I wash my hands with water and soap after using restroom.	0.72	0.12
	18	I clean my hands (washing hands, using sanitizer) first, right after entering home.	0.68	0.12
	19	I clean my hands using hand sanitizer when I am not able to wash my hands with water and soap.	0.74
Factor 3 Airborne prevention				(0.001)	0.81	0.61	0.77	0.31	0.60	<0.78>
Ventilation	20	I would be cautious not to enter a place where it is not equipped with ventilation.	0.86	0.32				(0.001)	(0.001)
	21	I leave the place as soon as possible when it is judged hard to be ventilated.	0.93	0.34
	22	I would be cautious controlling temperature and humidity of the indoor.	0.46
Factor 4 Bloodborne prevention				(0.001)	0.73	0.41	0.72	0.46	0.47	0.21	<0.64>
Bloodborne protection	23	I open the window only when the mosquito protective screens are installed.	0.49	0.14				(0.001)	(0.001)	(0.003)
	24	I try to control the pest using the bug catcher (including electronic)/household pest control, etc.	0.64	0.14
	25	I wash in running water when exposed to other’s blood.	0.71	0.14
	26	I try not to be infected when using injection needle (self- injection, blood transfusion, blood donation, blood draw etc.)	0.69
Factor 5 Environmental prevention				(0.001)	0.73	0.48	0.71	0.34	0.45	0.46	0.38	<0.69>
Environmental management	27	I clean my house regularly.	0.54	0.11				(0.001)	(0.001)	(0.001)	(0.001)
	28	I use disinfectants to maintain the hygiene of my home.	0.70	0.12
	29	I clean or disinfect objects or surfaces that are frequently touched.	0.81
Factor 6 Psychological coping				(0.001)	0.88	0.59	0.88	0.49	0.49	0.37	0.51	0.43	<0.77>
Attitude	30	I try to cope with the Emerging Infectious Diseases.	0.84	0.12				(0.001)	(0.001)	(0.001)	(0.001)	(0.001)
	31	I try to be considerate of others to prevent others from getting infected.	0.73	0.12
	32	I try to get information about Emerging Infectious Diseases.	0.74	0.12
	33	I try to comply the preventing behaviors when I acquire information regarding Emerging Infectious Diseases.	0.80	0.12
	34	I comply preventive behaviors with a confidence in medical staff.	0.73
Model fit χ²/degree of freedom = 1.37, CFI= 0.91, TLI= 0.91, RMSEA= 0.05 (0.04~0.06), SRMR= 0.09, Cronbach’s a = 0.92

Note: <√AVE> stands for root AVE, which is used to validate the discriminant validity.

Abbreviations: SE, Standard Error; CR, Construct Reliability; AVE, Average Variance Extracted; α*, Cronbach’s α; CFI, Comparative Fit Index; TLI, Tucker Lewis Index; RMSEA, Root Mean Square Error of Approximation; SRMR, Standardized Root Mean Residual.

Table 5 Model Fit of the Additional Complex Model Scale (N = 203)

Model / Prevention		χ²/degree of Freedom	CFI	TLI	RMSEA (90% CI)	SRMR	AIC	Cronbach’s a
1	Droplet prevention	1.40	0.94	0.93	0.05 (0.04~0.07)	0.08	8162.74	0.89
	Contact prevention
	Airborne prevention
2	Contact prevention	1.32	0.96	0.95	0.05 (0.03~0.06)	0.07	7729.74	0.89
	Environmental prevention
	Psychological coping
Including daily life prevention
3	Droplet prevention	1.29	0.92	0.91	0.04 (0.04~0.05)	0.09	13,766.29	0.92
	Contact prevention
	Airborne prevention
	Bloodborne prevention
	Environmental prevention
	Psychological coping
	Daily life prevention

Abbreviations: CFI, Comparative Fit Index; TLI, Tucker Lewis Index; RMSEA, Root Mean Square Error of Approximation; CI, Confidence Interval; SRMR, Standardized Root Mean Residual; AIC, Akaike Information Criteria.