Chinese Compensatory Health Beliefs Scale

Authors

Purpose

The primary objective of the CHBs-C is to provide a culturally accurate measurement tool for assessing how Chinese individuals rationalize unhealthy behaviors through the promise of future healthy actions. Western scales, while foundational, often include items that do not resonate in a Chinese context—such as skipping meals or drinking coffee—which are viewed differently due to distinct cultural dietary traditions and lifestyle norms.

For researchers and clinicians, this scale is essential for unpacking modern behavioral trends in China, such as the paradoxical 'punk health maintenance' lifestyle where young Adults deliberately mix indulgent behaviors with superficial health practices. By accurately measuring these specific compensatory beliefs, public health campaigns can be better tailored to address the actual cognitive rationalizations that derail healthy lifestyles in this demographic, moving beyond generic advice to target the underlying psychological trade-offs.

Construct

Compensatory Health Beliefs operate on the principle of cognitive dissonance reduction. When an individual experiences a conflict between their immediate desires (e.g., eating a high-calorie dessert) and their long-term health goals (e.g., weight management), they experience psychological discomfort. To alleviate this tension without sacrificing the immediate reward, they activate a compensatory belief, convincing themselves that a subsequent healthy behavior will neutralize the negative impact of the indulgence.

In the Chinese cultural context, this construct materialized into three distinct dimensions. The first encompasses intertwined habits related to exercise, eating, and sleeping, reflecting a holistic view of daily routines where dietary intake and physical activity are deeply interconnected. The second dimension captures beliefs surrounding substance use, specifically drinking and smoking, highlighting how individuals rationalize these specific physiological risks. The final dimension focuses on stress, measuring the belief that indulging in unhealthy behaviors is an acceptable and effective method for mitigating psychological pressure.

Validity

The validation process for the CHBs-C involved a multifaceted approach to ensure the instrument accurately captured the intended psychological constructs. Confirmatory factor analysis was utilized to verify the structural integrity of the scale, demonstrating that the culturally adapted three-factor model provided a good fit for the data. Discriminant validity was successfully established, as the square root of the average variance extracted for the factors exceeded their correlations with one another, proving that the subscales measure distinct aspects of compensatory beliefs.

However, the scale demonstrated some limitations regarding general convergent and predictive validity. The average variance extracted (AVE) values fell below the optimal threshold of 0.50, and while the composite reliability (CR) for the first two factors exceeded 0.70, the third factor fell short. This suggests that the items within the factors share a modest amount of variance with the underlying construct. While broad predictive validity was limited, researchers found meaningful significant correlations at the subscale level when examining specific Health Behaviors, indicating that the tool is most effective when analyzing targeted, nuanced interactions rather than broad behavioral predictions.

Reliability

To establish the dependability of the CHBs-C, researchers evaluated both its internal consistency and its temporal stability. Internal consistency was assessed using McDonald's omega, a robust metric that does not assume tau-equivalence among items, which confirmed that the items within the scale reliably measure the same underlying concepts at an acceptable level.

Furthermore, the temporal stability of the instrument was verified through a two-week test-retest reliability protocol evaluated via Spearman correlation analysis. The strong correlations observed between the two administration points indicate that Compensatory Health Beliefs, as measured by this scale, are relatively stable cognitive traits rather than fleeting states. This high test-retest reliability ensures that researchers can confidently use the CHBs-C in longitudinal studies to track belief changes over time or to evaluate the long-term efficacy of public health interventions.

Factor Analysis

The structural foundation of the CHBs-C was established through a sequential application of exploratory and confirmatory factor analyses. Initially, principal axis factoring was employed on the item pool, which successfully reduced the scale to 14 items that mapped onto a novel three-factor structure. This structure diverged significantly from the original four-factor Western model, merging diet, exercise, and sleep into a single comprehensive factor while maintaining distinct factors for substance use and stress.

To rigorously test this newly discovered structure, researchers applied confirmatory factor analysis using the diagonally weighted least squares (DWLS) estimation method. DWLS was specifically selected for its superior performance and robustness when handling ordinal data and non-normal distributions, which are common in self-report psychological measures. The resulting fit indices confirmed that this culturally adapted three-factor model accurately represents the latent structure of Compensatory Health Beliefs within the Chinese population.

Subscales

Instrument

Figures

Chinese Compensatory Health Beliefs Scale Items

Sample

The study utilized three distinct samples recruited via the Credamo online platform. Sample 1 (n = 476; 44.1% female) was used for exploratory factor analysis. Sample 2 (n = 308; 57.8% female) completed the survey twice over a two-week period for confirmatory factor analysis and reliability testing. Sample 3 (n = 274; 45.6% female) was recruited to assess predictive validity. The majority of participants across all samples were between 21 and 40 years old.