Development and validation of the behavioral intention scale for participation in traditional Chinese medicine exercises for pulmonary rehabilitation among COPD patients

This study aimed to develop and validate the behavioral intention scale for pulmonary rehabilitation with traditional Chinese medicine in COPD patients (BISPTCM-PR-COPD), based on the extended theory of planned behavior. Following the COSMIN framework, the scale was developed through literature review, semi-structured interviews, and expert consultations. A preliminary item pool was refined using item analysis and content validity evaluation. Psychometric testing was conducted in 2 patient samples. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to determine the factor structure. Reliability was assessed via internal consistency, split-half reliability, and test-retest reliability (ICC). Convergent validity was examined using composite reliability (CR) and average variance extracted (AVE). The final scale contained 26 items across 5 dimensions: basic knowledge, attitudes, subjective norms, perceived behavioral control, and behavioral intention. EFA supported a 5-factor solution, explaining 68.9% of the variance. CFA demonstrated acceptable model fit (χ2/df = 2.259, RMSEA = 0.075, IFI = 0.941, TLI = 0.933, CFI = 0.941, GFI = 0.822). Reliability was strong, with Cronbach α = 0.951, split-half reliability = 0.883, and test-retest ICC = 0.927 (95% CI: 0.86-0.97). Content validity was satisfactory (S-CVI = 0.933). Convergent validity was supported, with CR values between 0.735 and 0.973 and AVE values between 0.362 and 0.901. Notably, the basic knowledge domain showed lower AVE (0.362), suggesting item heterogeneity. The BISPTCM-PR-COPD is a reliable and valid instrument for assessing COPD patients' intentions to participate in TCM-based pulmonary rehabilitation. It can serve as both a research tool and a clinical screening instrument to identify low-scoring domains, thereby guiding targeted education and support strategies and facilitating more effective implementation of TCM pulmonary rehabilitation.