The development and validation of scales to measure the presence of a teachable moment following a cardiovascular disease event

Highlights

• •

  Investigating cardiac events as teachable moments is a promising venture.

• •

  Validated measures to conduct research on teachable moments are lacking.

• •

  We developed scales that demonstrate validity and reliability.

• •

  The scales could be employed in research on teachable moments and behavior change.

• •

  Clinicians could use the scales to foster conversation around lifestyle.

Abstract

Better conceptually-driven research is necessary to learn more about 1) the characteristics of life events as teachable moments (TMs) and 2) the potential of life events to evoke lifestyle change intention (LCI). This study aimed to develop and validate two scales for the purposes of TM research in the context of cardiovascular disease (CVD): the CardiacTM and CardiacLCI-scales. After the initial development of items based on a theoretical framework and literature search, six experts rated the content validity of both scales as sufficient. The item list was further adjusted after think-aloud sessions with two CVD patients. The resulting scales were presented online in a cross-sectional survey, which yielded 625 responses of Dutch CVD patients (June 2020). To test construct validity, we conducted Exploratory Factor Analysis (EFA) with Varimax rotation on a random split-half of the sample (n = 300) and evaluated the factor structure with Confirmatory Factor Analysis (CFA) on the holdout sample (n = 325). EFA and CFA on the CardiacTM-scale (α = 0.88) revealed a 28-item six-factor structure explaining 61.0% of the variance, with adequate goodness-of-fit statistics (CFI = 0.87; TLI = 0.85; SRMR = 0.07) and internally reliable factors (Affective impact, Risk CVD, Changed self-concept, CVD group identity, Risk non-communicable disease, Anticipated regret). The CardiacLCI-scale (α = 0.81) revealed an 11-item two-factor structure explaining 51.5% of the variance, with adequate model fit (CFI = 0.92; TLI = 0.90; SRMR = 0.08) and internally reliable factors (Event-related lifestyle change and General healthy lifestyle). The scales may be used to expand knowledge around life events as TMs and to support conversation regarding lifestyle after cardiac and other life events.