Validity and Reliability Assessment of the Health Behaviour Inventory (HBI-20) Among Iranian Women

Objective: This study aimed to examine the psychometric properties of the Persian version of the Health Behavior Inventory (HBI-20) among Iranian women by investigating its factor structure, internal consistency, test-retest reliability, and criterion validity. Participants and Methods: A total of 265 Iranian women completed the HBI-20. Construct validity was assessed through both exploratory and confirmatory factor analyses. Internal consistency was measured with Cronbach's alpha, and test-retest reliability was calculated using intraclass correlation coefficients (ICC) along with their 95% confidence intervals. Criterion validity was further evaluated by correlating the HBI-20 dimensions with corresponding scales from the Health-Promoting Lifestyle Profile II (HPLP II). Results: Exploratory factor analysis identified a four-factor model consisting of the Diet, Angerand Stress, Proper Use of Health Care Resources and Preventive Self-Care, and Substance Use dimensions, which together accounted for 52.33% of the total variance. Confirmatory factor analysis supported this four-factor model with acceptable indices (CMIN/DF = 2.391; GFI = 0.959; AGFI = 0.920; CFI = 0.934; RMSEA = 0.073). Reliability analyses demonstrated robust internal consistency with Cronbach's alpha values of 0.704 (Diet), 0.665 (Anger and Stress), 0.793 (Proper Use of Health Care Resources and Preventive Self-Care), and 0.726 (Substance Use), and an overall alpha of 0.902. Test-retest reliability was also strong, with ICC values of 0.840 (95% CI: 0.755-0.898) for Diet, 0.781 (95% CI: 0.669-0.858) for Anger and Stress, 0.853 (95% CI: 0.773-0.906) for Proper Use of Health Care Resources and Preventive Self-Care, and 0.703 (95% CI: 0.561-0.804) for Substance Use. Additionally, correlation analyses with HPLP II dimensions confirmed the criterion validity. Conclusions: The Persian HBI-20 is a psychometrically sound, reliable, and valid tool for assessing health behaviors in Iranian women. Its clear dimensions, high internal consistency and test-retest reliability support its use in health and clinical practice.