Health-promoting lifestyle among individuals at high risk of colorectal cancer: a scale development and validation study

Health-promoting lifestyle plays a crucial role in reducing colorectal cancer risk among high-risk populations. To our knowledge, no validated health-promoting lifestyle instrument specifically designed for individuals at high risk of colorectal cancer before diagnosis has been widely reported. This study aimed to develop and validate a Health-Promoting Lifestyle Scale for individuals at high risk of colorectal cancer (HPLS-HRCRC). Based on the Health-Promoting Lifestyle Profile-II (HPLP-II), an initial item pool was generated through literature review and semi-structured interviews. The scale was refined via two rounds of expert consultation ( N = 7 experts) and cognitive interviews ( N = 22 high-risk individuals). A cross-sectional survey was conducted with 233 participants for item analysis and exploratory factor analysis (EFA), and 284 participants for confirmatory factor analysis (CFA), reliability testing, and convergent and discriminant validity. Principal axis factoring with Promax oblique rotation was used for EFA, and the HPLP-II served as a reference measure for convergent validity. The final HPLS-HRCRC consisted of 34 items across six dimensions: health responsibility, nutrition, physical activity, stress management, interpersonal relations, and spiritual growth. EFA explained 64.953% of the total variance, and CFA showed acceptable to moderate model fit (χ²/df = 2.309, RMSEA = 0.072, SRMR = 0.068, CFI = 0.883, TLI = 0.874, GFI = 0.863, NFI = 0.876). Composite reliability values ranged from 0.748 to 0.908, and average variance extracted values ranged from 0.416 to 0.713. Average variance extracted met the recommended threshold for three of the six dimensions. Discriminant validity was only partially supported according to the Fornell–Larcker criterion. The HPLS-HRCRC showed a moderate positive correlation with the HPLP-II ( r = 0.518, P < 0.001). The scale demonstrated high internal consistency (Cronbach’s α = 0.934) and good test–retest agreement over a two-week interval (ICC = 0.909, 95% CI: 0.812–0.955). The HPLS-HRCRC showed acceptable reliability and preliminary evidence of structural and convergent validity in this sample, although discriminant validity among some dimensions requires further examination. Further validation in other regions and populations is recommended.