Health risk behaviors in adolescents and emerging adults with congenital heart disease: psychometric properties of the Health Behavior Scale-Congenital Heart Disease

Eur J Cardiovasc Nurs. 2013 Dec;12(6):544-57. doi: 10.1177/1474515113475934. Epub 2013 Jan 29.


Background: To optimize long-term outcomes, patients with congenital heart disease (CHD) should adopt health-promoting behaviors. Studies on health behavior in afflicted patients are scarce and comparability of study results is limited. To enlarge the body of evidence, we have developed the Health Behavior Scale-Congenital Heart Disease (HBS-CHD).

Aims: We examined the psychometric properties of the HBS-CHD by providing evidence for (a) the content validity; (b) validity based on the relationships with other variables; (c) reliability in terms of stability; and (d) responsiveness.

Methods: Ten experts rated the relevance of the HBS-CHD items. The item content validity index (I-CVI) and the averaged scale content validity index (S-CVI/Ave); the modified multi-rater Kappa and proportion of missing values for each question were calculated. Relationships with other variables were evaluated using six hypotheses that were tested in 429 adolescents with CHD. Stability of the instrument was assessed using Heise's method; and responsiveness was tested by calculating the Guyatt's Responsiveness Index (GRI).

Results: Overall, 86.3% of the items had a good to excellent content validity; the S-CVI/Ave (0.81) and multi-rater Kappa (0.78) were adequate. The average proportion of missing values was low (1.2%). Because five out of six hypotheses were confirmed, evidence for the validity of the HBS-CHD based on relationships with other variables was provided. The stability of the instrument could not be confirmed based on our data. The GRI showed good to excellent capacity of the HBS-CHD to detect clinical changes in the health behavior over time.

Conclusion: We found that the HBS-CHD is a valid and responsive questionnaire to assess health behaviors in patients with CHD.

Keywords: Heart defects; adolescence; congenital; health behavior; life style; psychometric properties; reliability; validity.

Publication types

  • Validation Study

MeSH terms

  • Adolescent
  • Age Factors
  • Alcohol Drinking
  • Exercise
  • Female
  • Health Behavior*
  • Heart Defects, Congenital / psychology*
  • Humans
  • Male
  • Oral Hygiene
  • Psychometrics* / methods
  • Reproducibility of Results
  • Risk-Taking*
  • Surveys and Questionnaires