Development and psychometric evaluation of a cognitive function health questionnaire for older adults with subjective cognitive decline or mild cognitive impairment

Abstract Disease perceptions and attitudes play an important role in cognitive health awareness among older adults with cognitive impairment or dementia risk. In particular, the specific health behavioural and psychological symptoms of cognitive dysfunction are different from other chronic diseases. However, there is no tool for evaluating the behavioural consciousness and cognitive health beliefs of older participants at risk of dementia during their early stage of cognitive impairment. This study aimed to develop a cognitive health belief questionnaire to explore the behavioural and cognitive health beliefs of older adults with subjective cognitive decline or mild cognitive impairment and to evaluate its psychometric properties. An instrument-development and cross-sectional validation study was conducted at five community health centers in five districts of Fuzhou, China. The study was conducted in two steps: (1) instrument development and (2) psychometric tests. After item generation and the evaluation of content validity and face validity in six subscales, a total of 35 preliminary items were tested. For the psychometric tests, item analysis using the corrected item-to-total correlations and construct validity with exploratory and confirmatory factor analysis were performed. Other questions were asked to report the frequency of cognitive rehabilitation training, social activities frequency and memory clinical visits in this study. Associations between CFHQ components and cognitive health behaviors, including cognitive rehabilitation training, social activities, and memory clinic visits, were examined using multiple logistic regression.Reliability was evaluated using Cronbach’s α and the intraclass correlation coefficient. A total of 429 community-dwelling older adults with subjective cognitive decline or mild cognitive impairment (mean age = 69.28 ± 8.87 years, female = 57.8%, live with family = 71.8%) participated in the study. The exploratory factor analysis (EFA) identified a six-factor structure with 31 items retained from the original 35-item pool, aligned with the extended Health Belief Model (HBM): Perceived Susceptibility (SUS 1–2), Perceived Benefits (BEN 3–8), Cues to Action (CUE 10–14), Perceived Severity (SEV 15–19), Perceived Barriers (BAR 22–26), and Self-efficacy (EFF 28–35). The CFA conducted in the independent second subsample showed acceptable model fit (RMR = 0.059, CFI = 0.969, NFI = 0.923, RMSEA = 0.038, GFI = 0.911, and TLI = 0.966). The questionnaire demonstrated good internal consistency and test–retest reliability (Cronbach’s α = 0.921; ICC = 0.851). Several CFHQ components were significantly associated with cognitive health behaviors, specifically cognitive training, social activities, and memory clinic visits. The CFHQ showed preliminary evidence of acceptable validity and reliability for assessing cognitive health beliefs and related behavioral tendencies among older adults with memory complaints or MCI. The findings suggest that the CFHQ may be useful as a supplementary self-reported measure to support cognitive health education, patient engagement assessment, and non-pharmacological intervention planning. Further longitudinal and interventional studies are needed to determine its utility in risk identification, clinical decision-making, and broader healthcare settings.