Open Access Open Badges Research article

Development and validation of a health belief model based instrument for measuring factors influencing exercise behaviors to prevent osteoporosis in pre-menopausal women (HOPE)

Atoosa Soleymanian1, Shamsaddin Niknami1*, Ebrahim Hajizadeh2, Davoud Shojaeizadeh3 and Ali Montazeri4

Author Affiliations

1 Department of Health Education, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

2 Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

3 Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Science, Tehran, Iran

4 Mental Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran

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BMC Musculoskeletal Disorders 2014, 15:61  doi:10.1186/1471-2474-15-61

Published: 1 March 2014



The health belief model (HBM) is the most commonly used conceptual framework for evaluating osteoporosis health belief and behaviors. The purpose of this study was to develop and evaluate the psychometric properties of a health belief model based questionnaire for exercise behavior for preventing osteoporosis among women aged 30 years and over.


This was a cross sectional study of a convenience sample of women aged 30 years and over in Tehran, Iran using a theory-based instrument (HOPE). The instrument contained 39 items covering issues relate to osteoporosis prevention behavior. In this methodological study, exploratory and confirmatory factor analyses were used for psychometric evaluation. The Cronbach’s alpha coefficient and Intraclass Correlation Coefficient (ICC) was used to evaluate the reliability of the scale.


In all 240 women participated in the study. The mean age of participant was 39.2 ± 7.8 years. The initial analysis extracted nine factors for the questionnaire that jointly accounted for 66.5% of variance observed. Confirmatory factor analysis showed that the data obtained was fit with Health Belief Model (HBM) and self-regulation construct (X2 = 1132.80, df = 629, P < 0.0001, CFI = 0.94, GFI = 0.91, RMSEA = 0.05 and SRMR = 0.06). The Cronbach’s alpha coefficient for the subscales ranged from 0.72 to 0.90 and Intraclass Correlation Coefficient (ICC) ranged from 0.71 to 0.98; well above acceptable thresholds.


The HOPE was found to be appropriate instrument for measuring health belief and self-regulation for prevention of osteoporosis.