Cross-regional measurement invariance of the French MosquitoWise survey: A multi-group confirmatory factor analysis

Mosquito-borne diseases (MBDs) transmitted by Aedes albopictus represent an escalating public health challenge in metropolitan France. The MosquitoWise survey (Abourashed et al., 2024) is a 19-item instrument measuring six Health Belief Model (HBM) constructs relevant to MBD prevention: perceived susceptibility (4 items), perceived severity (3 items), self-efficacy (4 items), cues to action (3 items), perceived benefits (3 items), and perceived barriers (2 items). The instrument was originally validated in English (UK), Dutch (Netherlands), and Spanish (Spain), but has not been validated in French. This study reports the first psychometric validation of the French adaptation of the MosquitoWise survey using data from the MoustiKAP-P study, the largest quasi-representative Knowledge, Attitudes, and Practices survey on MBD prevention in metropolitan France (N = 4,009). The primary objective is to establish measurement invariance of the 6-factor MosquitoWise structure across the five UDA5 macro-regions of France using Multi-Group Confirmatory Factor Analysis (MG-CFA) with the WLSMV estimator. The five regions represent a meaningful ecological gradient in Aedes albopictus colonization history, ranging from the south-east (established since 2004) to the nord-west (largely absent as of 2026). Exploring measurement invariance is a prerequisite for valid cross-regional comparison of HBM construct levels and for the broader use of this instrument in French public health research.