The Development and Validation of the Health Belief Model for Shift Workers (HBM-SW) Scale

Meagan E. Crowther, Sally A. Ferguson, Charlotte C. Gupta, Amy C. Reynolds

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Objective: Shift work is associated with circadian misalignment, sleep loss, and suboptimal health behaviors, which may contribute to longer term negative health outcomes. To inform future interventions for shift workers, the present study aimed to develop and evaluate the Health Belief Model for Shift Workers (HBM-SW) scale. 

Methods: The HBM-SW development involved a seven-step process, including a literature review, expert panel analysis, cognitive interviews with shift workers, and a trial with a pilot sample of shift workers (n = 153). Utilizing exploratory factor analysis for factor identification and item reduction, the developed scale loaded on seven factors in line with the theoretical framework of the Health Belief Model: Perceived Threat, Perceived Severity, Perceived Benefits, Perceived Barriers, Cues to Action, Self-efficacy, and Health Motivation. Validation of the scale was conducted utilizing Pittsburgh Sleep Quality Index, International Physical Activity Questionnaire, and Food Frequency Questionnaire. 

Results: The pilot sample had an average age of 34.0 (18.0) years, was majority female (54.2%), with an average of 8.0 (11.0) years shift work experience. The HBM-SW showed good–excellent (α = 0.74–0.93) internal consistency and moderate–good (ICC = 0.64–0.89) test re-test reliability. Using health behavior outcome measures, the HBM-SW scale showed meaningful correlations with sleep quality, sleep duration, diet quality and leisure time physical activity, and acceptable validity and reliability. Further testing should be conducted in a larger sample to facilitate confirmatory factor analysis. 

Conclusions: The developed Health Belief Model for Shift Workers scale is likely beneficial for use in future studies of interventions for shift workers.

Original languageEnglish
Pages (from-to)353-377
Number of pages25
JournalBehavioral Sleep Medicine
Issue number3
Early online date8 Oct 2023
Publication statusPublished - 2024


  • circadian management
  • shift work
  • sleep loss
  • suboptimal health behaviors


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