Development and preliminary psychometric evaluation of the exercise behavioral intention scale for hemodialysis patients

Abstract Exercise is clinically recommended for patients undergoing hemodialysis (HD); however, their physical activity levels remain low. Guided by the theory of planned behavior, this study developed the Exercise Behavioral Intention Scale for Hemodialysis Patients (EBISHP) and conducted an initial psychometric evaluation to assess exercise intention and support individualized interventions. Scale development proceeded in two phases: (1) item generation from literature and patient/nurse input with face and content validity testing, and (2) a multicenter cross-sectional survey in 26 Japanese HD facilities. In addition to the EBISHP, the short version of the International Physical Activity Questionnaire and the Self-Efficacy for Exercise Scale were used to assess physical activity and exercise self-efficacy. The EBISHP items were rated on a five-point Likert scale and analyzed as ordinal data using factor analytic methods. The psychometric evaluation included item analysis, exploratory factor analysis (principal factor, ProMax), confirmatory factor analysis, concurrent and known-groups validity, internal consistency, and test–retest reliability. Data from 273 completed surveys (191 retests) were analyzed. The final 29-item, eight-factor structure showed good model fit (CFI = 0.94, TLI = 0.93, RMSEA = 0.05, SRMR = 0.04). EBISHP correlated moderately with self-efficacy (r = 0.642, p < 0.01) and weakly with physical activity (r = 0.263, p < 0.01). Cronbach’s α was 0.925, and the ICC for the total score was 0.943 (95% CI: 0.924–0.957). The EBISHP showed preliminary evidence of structural validity, concurrent and known-groups validity, and reliability among HD patients. This tool may guide theory-based interventions and future research on behavioral motivation and change.