Development and Validation of the Cancer Prevention Literacy and Behavior Instrument (CPLBI): A Multidimensional Tool...

Cancer education programs require valid instruments to evaluate learners' knowledge, health literacy, behavioral readiness, and educational outcomes. Existing measures generally assess isolated aspects of cancer awareness and provide limited support for comprehensive educational evaluation. This study aimed to develop and validate the Cancer Prevention Literacy and Behavior Instrument (CPLBI) for assessing cancer prevention literacy and behavioral readiness in adult populations. A methodological instrument-development study was conducted using a theory-informed framework. Content validity was established through expert review (n = 10), followed by pilot testing (n = 50). Exploratory factor analysis was performed in 300 participants, and confirmatory factor analysis was conducted in an independent sample of 450 participants. Reliability, construct validity, known-groups validity, and gender measurement invariance were evaluated using established psychometric criteria. The final CPLBI comprised 42 items across seven domains: Risk Knowledge, Warning Signs Recognition, Health Literacy, Cancer Misinformation Identification, Self-Efficacy, Behavioral Intention, and Preventive Health Behavior. Exploratory factor analysis supported the proposed multidimensional structure (KMO = 0.807; Bartlett's χ² = 2866.49, p < .001). Confirmatory factor analysis demonstrated excellent model fit (χ²/df = 1.08, CFI = 0.988, TLI = 0.987, RMSEA = 0.013, SRMR = 0.037). Reliability and construct validity supported the reflective domains, whereas the knowledge domains functioned as complementary educational indices. The CPLBI demonstrated satisfactory psychometric properties and provides a practical instrument for evaluating cancer prevention education, identifying educational needs, assessing learning outcomes, and supporting research and public health initiatives.