Development and validation of a multidimensional scale for heat-related health behavior across domains of everyday life

Abstract Heat is an escalating global health risk, yet how populations adapt behaviorally remains poorly understood. We developed and psychometrically evaluated a novel instrument to assess heat-related health behavior (HRHB) across domains of everyday life and along a continuum from reactive to anticipatory responses in a large population-based sample in Germany ( N = 3,351). Factor analyses supported a multidimensional structure capturing both domain-specific (diet, housing, clothing, activity/change of location) and temporal adaptations. HRHB showed good reliability and moderate associations with heat-related health literacy and knowledge, indicating related but distinct constructs. Higher levels of reported behavior were associated with greater symptom burden, consistent with behavior being partly driven by experienced heat strain. HRHB explained additional variance in symptoms beyond sociodemographic and cognitive factors, supporting its incremental validity. These findings identify behavioral adaptation as a distinct and measurable dimension of population-level heat resilience, enabling improved identification of vulnerable groups and more targeted public health interventions.