Validity and reliability of the Brain Health Self-Efficacy Scale for the elderly

With the rapid increase in ageing population, China is confronted with the daunting challenge of a growing number of patients with neurocognitive disorders (NCDs). This trend makes the maintenance of self-health and early intervention essential, highlighting the need for a tool that assesses self-efficacy of older adults in maintaining brain health or cognitive function.

This study aimed to design the Brain Health Self-Efficacy Scale (BHSES) to measure elderly individuals' attitudes to NCDs, motivations and future plans for controlling risks. The psychometric properties of BHSES have been validated.

Based on the current literature and relevant models, a 19-item scale was created during the first stage. A total of 660 older adults in the Yinhang community of Shanghai were included. The statistical approaches of item analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), criterion-related validity and reliability test were used to evaluate the quality of BHSES. In addition, the Geriatric Depression Scale (GDS) and the Self-Rating Anxiety Scale (SAS) were used as criteria to test the criterion-related validity.

To test item differentiation, the study adopted item analysis and excluded item 8. Selecting a random half of the sample for EFA, the BHSES was refined to 16 items, which were categorised into the following three dimensions: 'memory belief efficacy', 'self-care efficacy' and 'future planning efficacy'. These were highly consistent with the hypothesis model. Its cumulative variance contribution rate reached 61.14%, with factor loads of all items above 0.5. The three-factor model was confirmed by the remaining data through CFA. All fit indices reached the acceptable level (χ²=3.045, Goodness of Fit Index=0.898, adjusted Goodness of Fit Index=0.863, Comparative Fit Index=0.916, Incremental Fit Index=0.917, Tucker-Lewis Index=0.900, root mean square error of approximation=0.079 and root mean residual=0.068). The GDS and SAS scores revealed significant correlations with the BHSES score, indicating a high criterion-related validity. The overall Cronbach's α coefficient was 0.793, with the α coefficients' distribution of subdimensions ranging from 0.748 to 0.883.

The 16-item, self-compiled BHSES is a reliable and valid measurement. It could help identify older adults with potential risks for developing NCDs or with high suspicion of cognitive impairment onset in recent periods and also offer insight into tracking brain health self-efficacy in association with cognition status.