Development and Validation of the Healthy Lifestyle Scale (HLS) for Regions with Icy Winters and Dry Summers

The present study aimed to develop and validate the Healthy Lifestyle Scale (HLS), a culturally and environmentally specific instrument designed to assess health-promoting behaviors in populations residing in climatically extreme and geographically isolated regions such as Jammu, Kashmir, and Ladakh. These areas experience long, cold winters, frequent snowfall, and dry summers, which pose significant challenges to maintain a healthy lifestyle. Existing lifestyle assessment tools are often developed for temperate urban contexts and fail to account for behaviors influenced by seasonal adaptation, isolation, limited access to fresh food, and restricted mobility. The HLS was constructed through a mixed-method approach involving literature review, expert consultation, and pilot testing, followed by rigorous psychometric evaluation to address this gap. A sample of 517 participants from the target regions completed the initial scale. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) supported a nine-factor model encompassing physical activity, healthy diet, stress management, hydration, substance use avoidance, preventive health, personal hygiene, environmental responsibility, and social well-being. The model demonstrated good fit indices (CFI = 0.93, IFI = 0.92, CMIN/DF = 3.645); all standardized factor loadings exceeded 0.50. The scale exhibited high test-retest reliability (r = 0.855, p < 0.001), indicating strong temporal stability. Expert review ensured content and criterion validity were confirmed via significant correlations with established health behavior instruments such as the HPLP-II, CSI, PEBS, DAST, and SSQ (r = 0.64 to 0.82, p < 0.001). Regression analysis supported predictive validity, with HLS scores significantly predicting real-world behaviors across multiple domains (β = 0.39 to 0.56, p < 0.001). The relevance of this scale is further reinforced by existing studies emphasizing region-specific interventions to promote health behavior, such as a health literacy initiative in Northern Thailand and research highlighting the role of healthy lifestyles in reducing anxiety during the COVID-19 pandemic. These findings underscore the importance of culturally responsive tools in guiding public health interventions. The HLS emerges as a reliable, valid, and practical tool for researchers, health professionals, and policymakers working in underserved or ecologically sensitive environments. Its future use may extend to other regions with similar challenges, supporting global efforts in personalized health promotion and sustainable lifestyle interventions.