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Development and Evaluation of The Health

Belief Model Scale in Obesity

Article in TAF preventive medicine bullletin · October 2011

DOI: 10.5455/pmb.20110118022318

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 TAF Preventive Medicine Bulletin, 2011: 10(5)

Araştırma / Research Article TAF Prev Med Bull 2011; 10(5): 533-542

Obezitede Sağlık İnanç Modeli Ölçeği’nin Geliştirilmesi

[Development and Evaluation of the Health Belief Model Scale in Obesity]

1
ÖZET Ozden Dedeli
AMAÇ: Bu çalışmada, obez bireylerin obeziteye yönelik tutum ve inançlarını güvenilir ve geçerli biçimde Cicek Fadıloglu
2
değerlendirebilecek Sağlık İnanç Modeli’ne dayalı bir ölçeğin geliştirilmesi amaçlanmıştır.
YÖNTEM: Çalışmanın örneklemine Temmuz 2008-Mayıs 2010 tarihleri arasında Ege Üniversitesi Tıp 1
Celal Bayar University
Fakültesi Hastanesi ve Celal Bayar Üniversitesi Sağlık Uygulama ve Araştırma Merkezi (Üniversite School of Health, Manısa.
Hastanesi)’nin obezite kliniklerine başvuran 400 obez birey dâhil edilmiştir. Çalışma verileri araştırmacılar 2
Department of Internal
tarafından geliştirilen obez bireylerin sosyodemografik ve obezite ile ilgili özeliklerini ve obezitede sağlık Medicine, Ege University
inançlarını içeren Obezite Soru Formu ve Obezite Sağlık İnanç Modeli Ölçeği (OSİMÖ) kullanılarak yüz School of Nursing, Izmir.
yüze görüşme tekniği ile toplanmıştır. OSİMÖ’nin geçerliliğini test etmek amacıyla ölçek üç hafta içerisinde
yüz yüze görüşme tekniği ile tekrar uygulanmıştır (test-tekrar test). Veriler The Statistical Package for Anahtar Kelimeler:
Social Sciences (SPSS) for Windows 13.0 paket programı kullanılarak analiz edilmiştir. Obezite, Sağlık Davranışı,
BULGULAR: Ölçeğin yapı geçerliliğini belirlemek amacıyla uygulanan faktör analizi sonucunda beş faktör Tutum, İnanç.
grubu ve 32 madde elde edilmiştir. Bu beş faktör ölçeğin alt boyutlarını oluşturmaktadır. Beşli likert
puanlama sistemine sahip olan ölçeğin toplam madde korelasyonları her bir alt boyutu için pozitiftir (> 0.70 Key Words:
p<0.05). Ölçeğin Cronbach alfa katsayısı 0.80 ve test-tekrar test güvenilirliği her bir alt boyutu için >0.60 Obesity, Health Behavior,
p<0.00 olarak belirlenmiştir. Attitude, Belief.
SONUÇ: Çalışma sonuçları, OSİMÖ’nin obez bireylerin obeziteye yönelik tutum ve inançlarını ölçmekte
kullanılabilir geçerli ve güvenilir bir araç olduğunu göstermektedir. Sorumlu yazar/
Corresponding author:
SUMMARY Ozden Dedeli
AIM: The aim of this study was to develop a scale based on the Health Belief Model which can provide a Celal Bayar University
reliable and valid evaluation of obese individuals’ belief and attitudes towards obesity. School of Health, Manısa,
METHOD: The sample of the study that was conducted between July 2008 and May 2010 included 400 Turkey.
obese individuals who presented to the obesity clinics in Ege University Medical Faculty and Celal Bayar ozdendedeli@yahoo.co.uk
University Medical Faculty Hospitals. Obesity questionnaire form and Health Belief Model Scale in Obesity
(HBMSO) developed by the investigators to collect data about sociodemographic and obesity characteristics
of obese individuals as well as the health belief in obesity were completed in face-to-face interviews. The
HBMSO were completed in face-to-face interviews again in the following three weeks to test-retest
reliability of the scale. The analysis of data was The Statistical Package for Social Sciences (SPSS) for
Windows 13.0.
RESULTS: A principal component factor analysis was used to measure the construct validity of the
HBMSO. Five factor groups were obtained as a result of the factor analysis. These five factors formed the
domains of the HBMOS that included 32 items prepared as five point Likert scales. Total item correlation
analysis was positive for all domains (>0.70 p<0.05). HBMSO demonstrated a reasonable level of internal
consistency reliability with a Cronbach’s Alpha Coefficient of 0.80. Test and retest reliability of each
domain of HBMSO was r>0.60 p<0.00.
CONCLUSION: These results show that HBMSO is a reliable and valid scale to measure the attitudes and
beliefs of the obese individuals about obesity.

INTRODUCTION term, globesity, to describe the expanding situation

Obesity is defined as an abnormal increase of fat
in the subcutaneous connective tissue (1). In the other
words, obesity is defined as abnormal or excessive fat
accumulation that presents a risk to health. The
World Health Organization (WHO) identifies obesity
as a worldwide epidemic (2). Statistics from the
United States Centers for Disease Control and
Prevention (CDC) show that 127 millon people in the
United States (US) are overweight; 60 millon people
fit the definition of obese. (3). WHO estimated that
more than one billon people world wide are
overweight. In fact, the organization coined a new
(4). Obesity is a major health problem with an
increasing prevalance both in our country and the
whole world. Obesity effect 22.3% of the Turkish
population and 43.0% of female (5,6). Studies show
that obesity has the highest prevalance between 55
and 59 ages (34.8%) (5). Once considered a problem
only in high income countries, overweight and
obesity are now dramatically on the rise in low- and
middle-income countries, particularly in urban
settings (2). Obesity create negative health
consequences for the overweight and obese face
increased rates of cardiovascular-related ailments,
respiratory problems, some types of cancer,

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TAF Preventive Medicine Bulletin, 2011: 10(5)
complications of pregnancy, bladder control problems
and psychological disorders. Obesity is more likely to
be linked to serious health problems than smoking,
heavy drinking or poverty. Health problems related to
overweight and obesity create substantial economic
burdens for a nation. Overweight and obesity in the
US, for example, account for approximately 9% of all
medical expenditures ($92.6 billion in 2002) (7). In
2000, the cost of obesity in the US was more than $
117 billion. Poor nutrition and physical inactivity
account for more than 300.000 deaths in US each
year. More than 400.000 deaths in 2003 were form
conditions related to obesity (1).
Solutions to overweight and obesity seem simple
– eat a better diet and exercise more. Unfortunately,
most persons in developed countries, where food is
abundant and relatively inexpensive, find these
suggestions difficult to follow. Inadequate nutrition
knowledge, the conveniences of modern society that
reduce the need for physical activity, community
infrastructure that favours powered transportation,
and the politics of food production and retailing are
some of the potential explanations for reduced
motivation and opportunities to eat healthy and
exercise more. One requirement for overcoming these
barriers and designing effective weight management
strategies is to gain a thorough understanding of the
psychosocial processes influencing individuals’ food
beliefs and intake practices. To this end, scholars
have examined the efficacy of psychosocial models
of individual decision making related to determinants,
such as nutrition knowledge, food beliefs, belief and
attitudes towards exercise, knowledge, attitudes
towards obesity, perceived expectations of others and
motivation to health behaviour. Behavior change
models are important in preventing weight gain and
the subsequent loss of excess weight to help the
person meet the goal of living a healthier, longer life.
Studies using social cognitive theory demonstrate that
self-efficacy and outcome expectations significantly
affect food consumption. Investigations of the theory
of planned behaviour show that perceived normative
expectations, particularly related to perceived
expectations of significant others, affect food choice.
Studies using the diffusion of innovations approach
have found that nutrition knowledge and involvement
in food shopping and preparation favourably improve
healthy eating behaviour. Tests of the transtheoretical
model indicate that individuals progress through a
predictable series of psychosocial stages of
knowledge acquisition, contemplation and
preparation prior to action and maintenance of action
in improving their dietary quality. Research using the
health-belief model supports the rationale that
534
perceived consequences and importance of eating a
healthy diet predict nutritional food beliefs and to a
lesser extent dietary quality (8). The Health Belief
Model (HBM) is one of oldest social cognition
models. Hochbaum and his associates from the US
Public Health Service developed the model to explain
individuals’ paticipation in health screenings. The
HBM aims to predict whether individuals choose to
engage in a healthy action in order to reduce or
prevent the chance of disease or premature death. The
HBM addresses the effects of beliefs on health and
the decision process in making behavioral changes.
According to the HBM, there are two main types
beliefs that influence people to take preventetive
action:beliefs related to readiness to take action and
beliefs related modifying factors that facilitate or
inhibit action. The variables that are used to measure
readiness to take action are perceived susceptibility to
the illness (for instance breast cancer) and the
perceived severity of illness. Benefits, i.e. the
perceived advantages of action, and barriers, i.e. the
perceived cost or constraints of the specific action,
are the main modifying variables. A measure of value
for health is often added to the model. The HBM was
showed that Figure 1 (9).
The aim of this study was to develop a scale based
on the Health Belief Model which can provide a
reliable and valid evaluation of obese individuals’
belief and attitudes towards obesity.
Benefits
Barriers
Severity
Behaviour
Susceptibility
Heath Value
Figure 1: The Health Belief Model.
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 TAF Preventive Medicine Bulletin, 2011: 10(5)
MATERIAL and METHOD
The scale was developed in four main phases,
each of which is described as below:
First phase: Item Generation: The goal of this
phase was to establish item relevance, by generating
as many unique items about the experience of obese
individuals belief and attitudes towards obesity based
on HBM. To accomplish this task, we first conducted
an extensive literature review of HBM scale, obesity,
attitudes, and belief. We combined these data with
our experience and based on HBM. A item pool was
prepared by the researchers according to the aim of
study by reviewing relevant literature and by
considering obese individuals’ opinions.
Second phase: Refining Items: The goal of this
phase was to improve and select the items. This draft
of 160-item pool was further refined with a final
check in determining item relevance and content
validity by twelve professionals who was interested
in development of psychometric tool. Forty one items
with content validity ≥0.56 p>0.05 which were
suggested by experts were included in the scale.
Experimental scale is composed of 41 items and it’s a
Likert type scale (e.g., “strongly disagree” and
“strongly agree”; “never” and “always”). Every item
was rated between 1 to 5 points.
Third phase: Pretesting: The goal of this phase
was to determine the experimental scale could be
understand, read, fill time by obese individuals.
Twenty obese individuals (Male:10 and Female:10)
were completed in face-to-face interviews. These
obese individuals were recruited the clarity of
experimental scale and no change was needed after
pre-testing.
Fourth phase: Reliability and Construct
Validity: The goal of this phase were to test the
performance of the items in a participant sample,
identify the underlying components comprising the
scale for construct validity, to determine the scale’s
reliability. The original Turkish version of scale was
applied to a total of 400 participants and all necessary
analysis and evaluation were performed by using
Turkish version.
Study Sample
Study sample included a total of 400 obese
individuals who had including criteria follow as:
-Between 18 to 65 age
-Body Mass Index (BMI) ≥30 kg/m2
-Waist circumference (WC) male > 94 cm; WC
female >80 cm
www.korhek.org
-WC/Hip circumference (HC) male >1.0; WC/HC
female > 0.9 or both of gender > 0.85
-Previously have not received to training and
consulting services related to obesity,
-To have statements in the scale of sense,
-Restrincting activities of daily living do not have
any physical disability,
-After givining information about study with their
own censent to agree to participate in research.
Obese individuals presented to the obesity clinics
in Izmir Ege University Medical Faculty (n=200) and
Manisa Celal Bayar Medical Faculty (n=200)
Hospitals from July 2008- May 2010.
Instruments
Sociodemographic and obesity questionnaire
forms developed by the investigators to collect data
about sociodemographic and obesity characteristics
of obese individuals as well as the experimental scale
were completed in face-to-face interviews. The
experimental scale was completed in face-to-face
interviews again in the following three weeks to test-
retest reliability of the scale.
Data analysis
Statistical analiysis was performed using SPSSv.
13.0 software. Statistical methods were chosen as
recommend in literature (10). Descriptive analyses
have been done to demonstrate the distribution of
participants according to certain variables. Validity:
Content validity was performed by twelve profesional
and researchers, and then after pre-testing. Factor
analysis was done for construct validity. The results
of interim analyses for Factor analyses like Kaiser-
Meyer-Olkin (KMO) test, Bartlett’s Test of
Sphericity, Principal Component Analysis as
Extraction Method and Promax with Kaiser
Normalization as Rotation Method were also
estimated. Kaiser (1974) was reported, a score of
KMO less than 0.50 was unacceptable, 0.50 to 0.60
were deemed poor, 0.60 to 0.70 were judged average,
0.80 to 0.90 were deemed good, and a score of KMO
greater than 0.90 indicated excellent (11). Reliability:
Reliability was established by measuring internal
consistency and test-retest coefficints. The internal
consistency of each subscale within the new scale
was tested using the Cronbach’s alpha value and
Spearman-Brown split-half coefficients. A score of
less than 0.50 was deemed poor internal consistency,
scores ranging from 0.51 to 0.69 were deemed
suspicious, scores ranging from 0.70 to 0.80 were
deemed acceptable, scores ranging from 0.81 to 0.90
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TAF Preventive Medicine Bulletin, 2011: 10(5)

were deemed good, and a score greater than 0.90
indicated excellent internal consistency (12). Test-
retest reliability, which measures the temporal
stability of instrument, was by repeated
administration following 7 to 10 days during which
no change was expected to occur. An interclass
correlation coefficient (ICC) for each subscale was
calculated. The new scale was applied with face-to-
face interviews again in the following three weeks to
test the reliability of the scale. The correlation matrix
based on Pearson’s product-moment correlation eas
used to analysis each of subscale test-retest
correlation, between subscale and item total
correlations. Pearson correlation coefficient score (r)
of 0 to 0.25 were deemed poor, 0.26 to 0.49 were
judged poor, 0.50 to 0.69 were judged average, 0.70
to 0.89 were deemed strong, and scores higher than
0.90 were judged very strong (13). p values less than
0.05 were considered statistically significant.
Ethic consideration
Ethical approval of the Ethics committee and
consent of the obese individuals enrolled in the study
were obtained before the study.
RESULTS
Descriptive characteristics of obese individuals
participated in the study have been presented in Table
1. Mean age of the sample (n=400) was 40.65±11.7
years. Among the obese individuals, 65.5% were
females and 34.5% were males. Most of the obese
individuals were married (70.3%) and it was detected
that high school graduates formed 36.5% of the
sample.
A principal component factor analysis was used to
measure the construct validity. Five factor groups
were obtained as a result of the factor analysis. These
five factors formed the domains of the scale. The
Kaiser-Meyer-Oklin value (0.65) showed that the
correlation between scale items was adequate. The
Barlett Test for Sphericity was x2=3716.842 p<0.00.
While the initial questionnaire included 41 items, the
number of the items was decreased to 32 after the
analysis. Table 2 summarizes results of the Principal
Component Analysis as Extraction Method and
Promax with Kaiser Normalization as Rotation
Method. These five factors could explain
cumulatively 50.56 % of varience. It revealed that
factor loading of items in the instrument varied from -
0.56 to 0.88, and included five factor. In practice any
item with a value factor loading under 0.40, these
items are removed from scale.
Nine items were removed its factor loading <
0.40. The internal reliability and temporal stability of
new scale has been shown Table 3. The overall
Cronbach’s alpha value for the new scale was 0.80.
The Spearman-Brown split-half value was 0.75 for
the first half and 0.80 for the second half. The
Cronbach’s alpha value for the subscale varied from
0.62 to 0.85. Temporal stability testing revealed an
overall ICC values > 0.50 p<0.05. Pearson’s product-
moment correlation eas used to analysis between
subscale score and subscale’s items total points
correlations.

Table 1: Descriptive characteristics of obese individuals.

Descriptive characteristics n % X
2
p

Gender Female 262 65.5

5.3 0.02
Male 138 34.5
Marital status Married 281 70.3
Single 113 28.3 173.2 0.00
Widow 6 1.5
Educational status Master 11 2.8
University 111 27.8
High school 146 36.5
85.1 0.00
Primary school 60 15.0
Literate 22 5.5
Illiterate 5 1.2
Total 400 100

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 TAF Preventive Medicine Bulletin, 2011: 10(5)

Table 2: Total Varience Explained according factor analiysis.

Factor Eingen % of
Factors Items Number
Loading value variance
I follow press about health issues including books, 0.88
magazines, radio, television
I am eager to ask questions about health when I meet health 0.82
professionals
I participate in educational programs and meetings about 0.71
health and life issues.
I am careful about the things I eat and drink every day and I 0.61
Factor 1 9.81 %19.6
try not to skip meals.
I do activities such as exercise, walking, cycling and running 0.60
regularly.
I have a fixed sleep pattern 0.71
I drink 1.5-2 liters of water everyday 0.79
Nothing in my life can be more important that having a good 0.73
health.
Obesity is a disease 0.71
Obesity is an important disease that leads to serious health 0.60
Factor 2 problems. 4.11 % 8.2
Obesity is a treatable disease. 0.63
Obesity is a disease that should be treated 0.84
Being obese is not harmful to health 0.66
I will never be ready for the programs such as diet, exercise 0.51
required to lose weight.
Whatever I do, I will never lose weight or reach the weight I 0.74
aim.
I don’t think it will be helpful for me even if I lose weight. 0.67
Factor 3 I find diet and exercise programs for losing weight boring and 0.79 4.42 % 8.8
I become unhappy.
I feel that I lose the control over my life, when I follow 0.60
doctor’s advice to lose weight
It is very difficult for me to change my eating habits 0.71
It is very difficult for me to increase level of my physical 0.53
activity
Losing weight according to a specific program is my biggest 0.56
hope.
Losing weight during the following six months will be 0.73
beneficial to my health.
I will look better physically, if I lose weight 0.53
I will feel better and happy if I lose weight 0.63
Factor 4 3.62 %7.2
Changing my life style to reach the weight I aim will be good 0.50
for me.
I believe that regular exercising will help to lose weight. 0.55
I believe that dieting will help to lose weight. 0.50
I believe that my social relations will be changed in a positive 0.76
direction if I lose weight
There is a high risk of developing health problems due to 0.63
obesity in any period of my life.
The possibility of developing health problems due to obesity 0.81
frightens me.
Factor 5 3.27 %6.5
Being obese and health problems due to obesity will change 0.74
all my life.
*I do not believe that I will develop health problems due to -0.56
obesity as long as I take good care of myself.
*This item was reverse-score, n:study sample: 400

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TAF Preventive Medicine Bulletin, 2011: 10(5)

Table 3: Internal Reliability and Temporal Stability of Each of Subscale.

Domains Item r** p Cronbach

alpha***
I follow press about health issues including books, magazines, radio,
television.
I am eager to ask questions about health when I meet health
professionals.
I participate in educational programs and meetings about health and
life issues.
Health value I am careful about the things I eat and drink every day and I try not 0.61 0.00 0.63
to skip meals.
I do activities such as exercise, walking, cycling and running
regularly.
I have a fixed sleep pattern
I drink 1.5-2 liters of water everyday
Nothing in my life can be more important that having a good health.
Obesity is a disease
Obesity is an important disease that leads to serious health
Severity problems. 0.79 0.00 0.74
Obesity is a treatable disease.
Obesity is a disease that should be treated
There is a high risk of developing health problems due to obesity in
any period of my life.
The possibility of developing health problems due to obesity
frightens me.
Susceptibility 0.64 0.00 0.62
Being obese and health problems due to obesity will change all my
life.
*I do not believe that I will develop health problems due to obesity as
long as I take good care of myself.
Being obese is not harmful to health
I will never be ready for the programs such as diet, exercise required
to lose weight.
Whatever I do, I will never lose weight or reach the weight I aim.
I don’t think it will be helpful for me even if I lose weight.
Barriers I find diet and exercise programs for losing weight boring and I 0.80 0.00 0.85
become unhappy
I feel that I lose the control over my life, when I follow doctor’s advice
to lose weight
It is very difficult for me to change my eating habits
It is very difficult for me to increase level of my physical activity
Losing weight according to a specific program is my biggest hope.
Losing weight during the following six months will be beneficial to my
health.
I will look better physically, if I lose weight
I will feel better and happy if I lose weight
Benefits 0.68 0.00 0.72
Changing my life style to reach the weight I aim will be good for me.
I believe that regular exercising will help to lose weight.
I believe that dieting will help to lose weight.
I believe that my social relations will be changed in a positive
direction if I lose weight

* This item was reverse-scored, **n:280, ***n:400

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Table 4: Subscale Mean Scores of Health Belief Model Scale in Obesity.

Domains Number of items Distribution range ±Ss

Health value 8 8-40 17.0±3.8
Perceived Severity 4 4-20 16.3±2.7
Perceived Susceptibility 4 4-20 13.9±2.8
Perceived Barriers 8 8-40 25.0±7.3
Perceived Benefits 8 8-40 30.8±4.8

susceptibility domain and severity domain (r=0.50

Perceived Susceptibility p<0.00). The correlation analysis has revealed a
negative direction significant relationship between
barriers domain and benefits domain (r=-0.24
Perceived Severity
p<0.00). The correlation analysis has revealed a
positive direction significant relationship between
health value domain and benefits domain (r=0.66
p<0.00). The correlation analysis has revealed a
Perceived Barriers
positive direction significant relationship between
Health Behavior barriers domain and severity domain (r=-0.22
p<0.00).
Perceived Benefits

DISCUSSION
Health Value

Many overweight or obese patients who fail to

lose weight, or use diet and exercise to lose weight
but then regain it, do so in part for emotional or
psychological reasons or because of a poor
Figure 2: Subscale score of HBMSO were understanding of the need for behavioral change.
correlated to each other. Educating overweight patients about nutrition and
exercise is simply not enough; in many such persons,
behavioral and psychological factors must be
Pearson correlation coefficient score (r) between
addressed or these factors will prevent them from
subscale score and subscale’s items total points were
permanently changing behavior. The behavioral
health value between 0.62 to 0.79, between severity
change required in weight management is
0.80 to 0.93, susceptibility between 0.55 to 0.82,
multifactorial and complex; it involves multiple
benefits between 0.56 to 0.73, barriers 0.60 to 0.89.
changes in exercise, nutrition, and responses to
The new scale involves 32 items with five point
stimuli, and it affects many aspects of a person's daily
Likert type. It was developed to measure the five
life. A patient who indicates being "ready to change"
components of the HBM: health value, perceived
may in fact be at different stages of readiness for each
susceptibility to obesity, perceived severity of
of the different behaviors involved in overall change.
obesity, perceived benefits of preventive behavior,
These multiple stages of readiness are what need to
and barriers to preventive behavior. Each of
be assessed rather than simply the person's general
subscale’s mean scores would be ranged between
willingness to lose weight. In addition to assessing
±Ss:13.9±2.8 and ±Ss:30.8±4.8 points (Table 4).
the patient's stages of readiness, the patient's attitudes
We examined the ability of the HBM values in
and beliefs related to weight should be evaluated. For
this study. The new scale included five factor
example, emotional barriers to some or all aspects of
overlapping the HBM values. Table 5 has been
weight loss may jeopardize success. The HBM is a
shown the HBM values. Each of subscale mean
tool that can be used to determine a patient's general
scores of new scale were correlated to each other
health-related thoughts concerning personal
(Figure 2). The correlation analysis has revealed a
prevention strategies.
positive direction significant relationship between

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TAF Preventive Medicine Bulletin, 2011: 10(5)

Table 5: Subscale Mean Scores of Health Belief Model Scale in Obesity

Component Description
According to the individual health value and in order to individual's been overall healthy
that are required to attitudes and beliefs.
Health value
Individual’s belief that preventive health behaviors will be able assumption to prevent
obesity-related complications and comorbid conditions.
Not accept the results of therapy includes arise. Obesity-related comorbid conditions,
Perceived
health problems and complications, such as social losses include reviews about the
Susceptibility
possible consequences.
Individual’s perception an obesity. Obesity is a major health problem / illness is accepted
Perceived
as the obesity-related health problems / comorbid conditions and the possibility of
Severity
complications are sensitive to the perception.
Perceived Individuals proposed to her, makes it difficult to perform health behaviors or perceptions
Barriers to action about the factors that are preventing.
Behavior will be realized as a result, will reduce the risks associated with obesity-related
Perceived benefits are perceived. Individual is thought to be useful to realize health behaviors such as
Benefits of action healthy eating, weight loss and physical activity. This benefit, complications related to
obesity, health issues / expectations will reduce the likelihood of comorbidity is developed.

In this model, health-related change occurs when
patients have interest in and concern about their
personal health and when they perceive both a
personal vulnerability to a particular health threat and
potential negative consequences if change does not
occur.
A patient whose health beliefs oppose those that
support management of overweight and obesity is
less likely to achieve long-term weight loss and
management. Although obesity has long been
considered a medical condition, growing evidence
suggests that obese patients often also have comorbid
psychopathology, such as destructive eating
behaviors, difficulty with body image, and general
emotional instability related to past attempts at
weight loss. Although primary care providers are the
first to intervene for many health concerns, including
obesity, the complexity of overweight and obesity
often warrants a team approach. Such a strategy may
produce optimal success as various specialists each
reinforce changes in obesity-related behavior.
Behavior change models are important in preventing
weight gain and the subsequent loss of excess weight
to help the person meet the goal of living a healthier,
longer life. The HBM addresses the effects of beliefs
on health and the decision process in making
behavioral changes. The model provides a
comprehensive framework for understanding
psychosocial factors associated with compliance
(14,15).
The model has been used in many areas including
protection of individual health and health related
behaviors (16,17). The Health Belief Model has been
used to health promotion and prevention of
disease/illness, such as breast cancer, servical cancer,
tuberculosis, mental illness, HIV/AIDS, diabetes,
hypertension, coronary arter disease, osteoporosis. In
the international literature there are several scale and
instrument have beeen developed based on the HBM
for the purpose of examining health belief and
attitudes towards illness/disease (18-22). When we
examined the studies have been based on the HBM in
Turkey, Turkish researches have translated from
orginal English version of the HBM scales to Turkish
version than, they studied a reliability and validity
Turkish version (23-27).
The propose of the study was to develop a new
scale that could assess all obese individuals’ belief
and attitudes towards obesity that based on the Health
Belief Model. The new scale was tested on highly
acceptable number of study population. As a result of
study, the name of this new instrument was defined as
Obezitede Saglik Inanc Modeli Olcegi, and its orginal
language is Turkish. The English version Obezitede
Saglik Inanc Modeli Olcegi (OSIMO) was obtained
by combination of translations by 3 Turkish faculties
experienced many years in English. The name of
English version OSIMO was defined as Health Belief
Model Scale in Obesity (HBMSO). The sturucter of
the HBMSO measurement examined by confirmatory
factor analysis demonstrated reasonable model fits
indicating satisfactory construct validitiy. According
to factor analysis scale is composed of five factor and
32 items. HBMSO is with five point Likert type

540 www.korhek.org
 TAF Preventive Medicine Bulletin, 2011: 10(5)
scale. Test-retest reliabilities assessed by structural
equation modeling suggested the scores of the five
factor scale were stable over time (ICC >0.50 p <
0.00). Internal consistency of our instument was high
and it proved to have good construct validity
(Cronbach’s alpha value >0.50 p< 0.00). In addition,
the scores of final 32 items five factor scale revealed
good internal consistencies to assess obese
individual’s belief and attitudes towards obesity. The
validation of the scale confirmed five separate facet
of belief and attitudes towards obesity, defined in the
five subscale. It is important to emphasize that we
aimed not only at the cognitive component of obesity
attitudes but also at the behavioral component
(behaviors of diet, exercise and weight loss).
Although actual behavior can not be assessed using a
questionnaire approach, statements is included in our
subscale. We aimed in the direction that can be
associated with actual behavior. We believe that it is
very important to assess beliefs and attitudes towards
obesity in this way because obese individual’s actual
behavior (diet, eating, weight loss, exercise) is a
potential risk or protective factor for developing
obesity, and thus the most important aspect of obesity
attitudes and beliefs when they are analyzed in the
context of health. Results of this study show that
pyschometric properties of HBMSO demonstrated
satisfactory validity and reliability. It also proved to
be valid and reliable and was judged to be useful as
both a research and clinical tool.
We examined the ability of the HBM values in
this study. The scale is a reliable and valid to measure
the HBM values. HBMSO included five factor
overlapping the HBM values. Moreover, the
significant positive correlation determined between
health value and benefits, and the significant positive
correlation determined between susceptibility and
severity. In addition the significant negative
correlation determined between barriers and benefits,
and the significant negative correlation determined
between barriers and severity. If the perceived
benefits and health beliefs to reduce the impact
perceived barriers the behavior will be realized. With
sensitivity and perception of the seriousness of the
health of individuals has lead to protective behaviors.
Consequences can be understood as an
individual's health beliefs, disease severity perception
and the recommendations useful and found no
relationship beliefs and attitudes of individuals or
disease regulations, active participation of the
affected, they ignore is that the initiatives fail to be
seen. In addition, obese individuals will be more than
sensitive the following situations. Obese individuals:
www.korhek.org
-If they believe that obesity is a major health
problem,
-If they believe that negative consequences of
being obese and important obesity-related health
problems and complications can develop
-If they believe weight loss does not problem and
difficult
-Weight loss specialist in the control of
complications due to obesity and health risks they
believe will help to prevent weight loss and weight
loss programs in their motives will be more about
joining.
Another important point, regarding this scale, it
was developed by Turkish researchers based on the
HBM to measure obese individuals’ belief and
attitudes towards obesity. However, Turkish culture is
a hybrid of Eastern and Western lifestyle, health
behavior, habits and the results of this study suggest
that the HBMSO can be adapted to Western cultures
in future studies.
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