Decisional Balance Inventory Research Articles

Validation of the Malay Version of the Decisional Balance Inventory (MDBI) among secondary school-going adolescents.

INTRODUCTIONThe Decisional Balance Inventory is a tool used to measure propensity to maintain or change a habit which takes into consideration the perceived advantages and disadvantages. This study aimed to establish the validity and reliability of a Malay language version of the DBI for assessing inclination for change in smoking behavior among secondary school-going adolescents in Malaysia.METHODSWe administered the MDBI to 669 secondary school students selected through multistage sampling. The sample consisted of 60.1% male (n=398) and 39.9% (n=264) female students, more than two-thirds (69.9%, n=463) of which were from rural areas. The majority of the respondents were aged 13–14 years [13 years, 36.4% (n=241), 14 years, 40.0% (n=265), 16 years, 23.6% (n=156)]. The construct validity of the MDBI was assessed using explanatory (EFA) and confirmatory factor analysis (CFA), and the reliability of the MDBI via Cronbach’s alpha.RESULTSEFA and parallel analysis extracted three factors in the MDBI that accounted for 65.4% of the observed variance, and this was supported by CFA. Internal consistency of the three factors ranged from 0.734 to 0.867, indicating acceptable reliability.CONCLUSIONSThe MDBI has good psychometric properties and is suitable for measuring smoking intention among Malaysian secondary school-going adolescents. However, it should continue to be tested to expand its usefulness and applicability among adolescents in other sociodemographic settings.

MILLENIAL’S BEHAVIOUR AND ATTITUDE TOWARDS NATURAL COSMETICS: A CASE STUDY IN UNIVERSITI MALAYSIA TERENGGANU

Investing in natural cosmetics contributes to the sustainability of natural resources in two ways – the emission of less harmful by-products, and the conservation of ecosystems through sustainable harvesting of resources. Therefore, studying students’ (millennials’) behaviour and attitude towards these products may help improve awareness-raising approaches on their benefits for local market acceptance. A study was conducted in Universiti Malaysia Terengganu (UMT), Malaysia with the aim to understand the current perception and habits of UMT students towards natural cosmetics and their readiness to convert to natural cosmetics. 521 responses were collected through an online survey that focused on three themes: Stage of Change, Decisional Balance Inventory, and Product Knowledge and Perception. The study found that most of the respondents (79%) claim to be using natural cosmetics, while only nine percent are not considering at all. Eighty-six percent of those users practice label reading habits although most respondents could not distinguish natural cosmetics from synthetic ones if solely based on personal knowledge and appearance of product. This proves that product design does influence customers’ purchasing behaviours. Moreover, results indicate that existing natural cosmetic users are quite likely to maintain the habit, while others are still indecisive. Meanwhile, label reading habits are quite likely to be maintained by many respondents. Hence, based on results, businesses should acknowledge that there is a demand in natural cosmetics among Malaysian millennials, and should increase their promotional activities, improve product design and affordability in order to grab consumers’ attention to switch from synthetic to natural cosmetics.

Decisional Balance Inventory (DBI) Adolescent Form for Smoking: Psychometric Properties of the Persian Version

BackgroundOne effective model for studying cigarette smoking cessation is the transtheoretical model (TTM). In order to assess to what degree interventions can make variations in individuals’ behavior, several questionnaires have been developed based on the TTM. This study aims to describe the development of the Persian version of the Decisional Balance Inventory (DBI) for smoking cessation in Iran and to evaluate its psychometric properties.Design and methodsThe forward-backward technique was used to translate the DBI from English into Persian. After linguistic validation and a pilot test among 30 male smoking young adults, a cross-sectional study was performed, and psychometric properties of the Persian version of the DBI were assessed. Using a convenience sampling method, 120 male smokers between 16 and 24 years of age were recruited from three factories in Nowshahr, Iran. In order to assess the reliability of the DBI, internal consistency and test–retest methods were performed. Additionally, face and content validity were assessed, and the construct validity of the DBI was calculated by performing both exploratory and confirmatory factor analysis. Data were analyzed using SPSS and AMOS.ResultsThe mean age of the sample (n = 120) was 20.19 (SD = 2.13) years. The mean scores for the content validity index (CVI) and the content validity ratio (CVR) were .94 and .89, respectively. The results of exploratory factor analysis (EFA) showed a three-factor solution for the DBI that accounted for 55.4% of observed variance. The results achieved from the confirmatory factor analysis (CFA) displayed that the data fit the model: the relative chi-square (×2/df) = 1.733 (p < .001) and the root mean square error of approximation (RMSEA) = .07 (90% CI = .05–.105). All comparative indices of the model including GFI, AGFI, CFI, NNFI, and NFI were more than .80 (.87, .83, .91, .89, and .81, respectively). The Cronbach’s alpha ranged from .78 to .83, indicating an acceptable reliability. Furthermore, the intraclass correlation coefficient (ICC) ranged from .72 to .89, confirming a satisfactory result.ConclusionsThe results from the present study indicate that the Persian version of the DBI has good psychometric properties and is suitable to measure smoking behaviors among Iranian adolescent and young adult smokers. Consequently, the instrument could be used in planning cigarette smoking cessation interventions among Iranian adolescents and young adults.

Assessing demographic differences in decisional balance for smoking prevention and temptations to try smoking among adolescent subgroups.

INTRODUCTIONCigarette smoking initiation remains prevalent in adolescence. Effective prevention methods are needed to dissuade this behavior. Demographic factors are identified as important risk factors in the developmental nature of smoking in adolescence. The current study investigates potential demographic differences for two new trans-theoretical model measures, the Decisional Balance Inventory (pros and cons) for Smoking Prevention and the Temptations to Try Smoking Scale.METHODSA sample of 6th grade Rhode Island students from 20 middle schools (N = 4151) who were participating in a longitudinal and computer-delivered intervention for substance abuse prevention was assessed on these measures at baseline. Three MANOVA tests were conducted to assess the impact of race (White vs. Non-White), ethnicity (Hispanic vs. Non-Hispanic) and gender (male vs female).RESULTSSignificant effects for race and ethnicity were found for Decisional Balance and Temptations to Try Smoking. For race, Whites reported lesser pros (p <.0001) and Non-Whites reported higher cons (p <.0001) and temptations to try smoking (p <.0001). Differences for ethnicity showed that Hispanics were higher on pros (p <.0001) and temptations to try smoking (p <.0001) than Non-Hispanics. Non-Hispanics reported higher cons (p <.0001). Gender differences were noted only for temptations to try smoking, and showed females were higher on this construct than males (p <.0001). The effect sizes were .01 or below.CONCLUSIONSThe results did not demonstrate a strong association between these demographics and constructs, suggesting that tailored prevention methods based solely on these factors may not dissuade smoking in this group.

Validation of decisional balance inventory test in Italian: assessment of motivation in weight loss

The decisional balance inventory (DBI) test is a valuable tool to assess motivation to change; we consider its application in enhancing motivation of losing weight. Our aim is the translation, cultural adaption and validation in Italian of this test originally designed and drafted in English. The questionnaire has been translated according to an &lt;em&gt;English&lt;/em&gt; → &lt;em&gt;Italian&lt;/em&gt; → &lt;em&gt;Italian&lt;/em&gt; → &lt;em&gt;English&lt;/em&gt; algorithm with reconciliation of the differences. Pilot study and retests were performed on 47 cases [body mass index (BMI) ≥30 kg/m&lt;sup&gt;2&lt;/sup&gt;] and 15 controls (BMI value between 18.5 and 25 kg/m&lt;sup&gt;2&lt;/sup&gt;). The internal consistency of the Italian version of DBI test, was satisfied (Cronbach α 0.87 on patients); test-retest shows a good concordance in pilot [Lin’s concordance correlation coefficient (CCC) 0.79; 95% confidence interval (CI) 0.68-0.90] and in patient sample (Lin’s CCC 0.83; 95% CI: 0.67 0.99).Our study demonstrated the trans-cultural adaptation and validation of DBI test in Italian.

Assessing motivation and readiness to change for weight management and control: an in-depth evaluation of three sets of instruments.

It is highly recommended to promptly assess motivation and readiness to change (RTC) in individuals who wish to achieve significant lifestyle behavior changes in order to improve their health, overall quality of life, and well-being. In particular, motivation should be assessed for those who face the difficult task to maintain weight, which implies a double challenge: weight loss initially and its management subsequently. In fact, weight-control may be as problematic as smoking or drugs-taking cessation, since they all share the commonality of being highly refractory to change. This paper will examine three well-established tools following the Transtheoretical Model, specifically assessing RTC in weight management: the University of Rhode Island Change Assessment Scale, the S-Weight and the P-Weight and the Decisional Balance Inventory. Though their strengths and weaknesses may appear to be rather homogeneous and similar, the S-Weight and P-Weight are more efficient in assessing RTC in weight management and control. Assessing motivation and RTC may be a crucial step in promptly identifying psychological obstacles or resistance toward weight-management in overweight or obese hospitalized individuals, and it may contribute to provide a more effective weight-control treatment intervention.

The beliefs about pros and cons of drinking and intention to change among hazardous and moderate alcohol users: a population-based cross-sectional study.

Background: Fundamental to supporting hazardous alcohol users are the rationales for reducing alcohol intake highlighted by the users themselves. This study analyses the relative importance of beliefs about pros and cons of drinking in relation to having an intention to reduce intake among both hazardous and moderate alcohol users. Methods: Intention to change was assessed in a representative sample of Stockholm’s population (n = 4278, response rate 56.5%). Alcohol use was assessed using the Alcohol Use Disorders Identification Test measure. A decisional balance inventory was used to examine various beliefs about the pros and cons of drinking, which covered affect changes, social gains and losses, and possible adverse effects. Independent correlations were determined by logistic regression using a backward exclusion procedure (P > 0.05). Results: Higher ratings of importance were generally related to intent, whether or not the contrast was with having no intent or already having made a reduction. This was especially true for hazardous users. Only two beliefs were independently correlated with change among hazardous users: ‘Drinking could get me addicted’ and ‘Drinking makes me more relaxed/less tense’ (pseudo-R2 < 0.1). Among moderate users, there was no uniform pattern in the relationships. Conclusions: Unexpectedly, hazardous users with an intent to change rated pro arguments as more important than those with no intent to change. Of the investigated pros and cons, only a few were independently related to intention to change drinking behaviour. These arguments provide interesting topics in consultations. Little support was found for any rational decision making behind the intention to reduce alcohol intake.

Stages of Change, Self-efficacy and Stress Management Perceptions in First Year Undergraduate Students

The study explored first year undergraduate students’ intention to change behavior in an attempt to manage stressful academic situations (passing the exams, semester’s grades and organization of their studies) and the effect of the self-efficacy, the pros, cons of stress management and the pros of stress on moving between stages. Gender differences were explored. The validity and reliability of the Decision Balance Inventory were also investigated. The study was held through questionnaires. All scales had acceptable levels of internal consistency (60 < α < 79) and the sample consisted of 209 first-year undergraduate students. The results of the exploratory factor analysis supported the factorial validity and the reliability of the Decisional Balance Inventory. Most of the students reported themselves in the earlier stages of change. The results indicated an interplay of self-efficacy with the pros, cons of stress management and the pros of stress, mainly at the stages of precontemplation and preparation. There were few gender differences. Females reported a less positive perception of the pros of stress management than males when closer to adopt a behavior of stress management. The findings are discussed in relation to recent literature.

Prevention of alcohol use in middle school students: Psychometric assessment of the decisional balance inventory

A measurement model should be equivalent across the different subgroups of a target population. The Decisional Balance Inventory for the Prevention of Alcohol Use is a 2-factor correlated model with 3 items for Pros of alcohol use and 3 items for Cons. The measure is part of a tailored intervention for middle school students. This study evaluated the important psychometric assumptions of factorial invariance and scale reliability with a large sample of sixth grade students (N = 3565) from 20 schools. A measure is factorially invariant when the model is the same across subgroups. Three levels of invariance were assessed, from least restrictive to most restrictive: 1) Configural Invariance (unconstrained nonzero factor loadings); 2) Pattern Identity Invariance (equal factor loadings); and 3) Strong Factorial Invariance (equal factor loadings and measurement errors). Structural equation modeling was used to assess invariance over two levels of gender (male and female), race (white and black), ethnicity (Hispanic and non-Hispanic), and school size (large, indicating > 200 students per grade, or small). The strongest level of invariance, Strong Factorial Invariance, was a good fit for the model across all of the subgroups: gender (CFI: 0.94), race (CFI: 0.96), ethnicity (CFI: 0.93), and school size (CFI: 0.97). Coefficient alpha was 0.61 for the Pros and 0.67 for Cons. Together, invariance and reliability provide strong empirical support for the validity of the measure.

Motivation for blood donation among African Americans: developing measures for stage of change, decisional balance, and self-efficacy constructs

Despite a specific need for transfused blood among African Americans due to higher rates of sickle cell disease, African Americans donate blood significantly less frequently than their White counterparts. This study describes the development and validation of culturally adapted measures of the transtheoretical model (TTM) constructs of Stage of Change, Decisional Balance, and Self-efficacy applied to blood donation in an African American sample. Exploratory and confirmatory analyses produced one pros and two cons scales for the Decisional Balance Inventory, and one scale for the Situational Self-efficacy Measure. Expected patterns for the Decisional Balance and Self-efficacy Scales by Stage of Change were found, but only the pros and one cons scale varied significantly. Results provide support for use of the TTM applied to blood donation and have important implications for development of effective assessment and intervention tools to increase blood donation among the African American population.

Quality of life (QoL) and motivation for treatment: A female issue?

The Quality of Life (QoL) of overweight and obese subjects is a widely discussed topic. From numerous studies, it emerges that obese persons suffer significant damage as result of their overweight in terms of QoL with regard to their physical and psychosocial well-being, with greater incidence associated with the degree of obesity. Our study aims at evaluating the usefulness of specific psychometric tests on the "obese population" that may be effective for the overall evaluation of the patient and in identifying specific subgroups on the basis of psychometric characteristics relating to QoL and of motivation for treatment. The study was carried out on a sample of 150 obese subjects who approached the Section of Human Nutrition of the University of Pavia requesting treatment for weight loss. The persons in the selected sample were subjected to a specialized examination during which, as well as collecting all the anamnestic information on each individual patient, they were also asked to fill out the obesity-specific ORWELL 97 (Obesity Related Well- Being) questionnaire and the DBI (Decisional Balance Inventory) questionnaire. An analysis of the results indicates that the female group is strongly characterized by a lower QoL, as well as by a clearly larger number of failed dieting attempts and by a strong motivation to undergo treatment. The evaluation of QoL and motivation for treatment in overweight and obese individuals appears to be an effective tool for better identification of the subjects and for planning the most appropriate diagnostic approach.

Factorial invariance and internal consistency for the decisional balance inventory—short form

A crucial assumption for a measure is that it is factorially invariant; that is, the measurement model is the same in different subgroups and across different occasions. The invariance of the short form of the decisional balance inventory was investigated using data from a representative sample of smokers ( N=4144). Separate analyses evaluated the invariance across two levels of gender (male and female), four levels of education (grade school, high school, college, and graduate school), two levels of race (white and black), four levels of age (18–25, 26–35, 36–50, and 50+), and across four assessment occasions. The results indicated that the decisional balance inventory demonstrated strong factorial invariance across the four demographic variables and across assessments.

Stage of change, decisional balance, and temptations for smoking: measurement and validation in a large, school-based population of adolescents.

Developing interventions for reducing adolescent smoking rates based on the Transtheoretical Model (TTM) requires the development of quality measures of the key constructs of the model. The goal of this investigation was to evaluate the psychometric properties of measures of Stage of Change, Decisional Balance and Situational Temptation for both smokers and nonsmokers and to test if the predicted relationships between these constructs were confirmed in a large (N=2808) sample of adolescents. A correlated three factor model (Social Pros, Coping Pros and Cons) provided an excellent fit to the 12-item Decisional Balance inventory for both smokers (CFI=0.957) and nonsmokers (CFI=0.963). A hierarchical four factor model (negative affect, positive social, habit strength and weight control) provided an excellent fit to the eight-item Situational Temptations inventory for smokers (CFI=0.969). A hierarchical five-factor model (same four as smokers plus Curiosity) provided an excellent fit to the 10-item Situational Temptations inventory for nonsmokers (CFI=0.943). The relationships between both the Decisional Balance and temptation scales and the Stages of Change were verified for both smokers and nonsmokers. The measures for adolescents are similar to but not the same as the measures of these constructs for adults.

Decisional balance and stage of change for adolescent drinking

The Transtheoretical Model of Change has been proven very effective in explaining both the acquisition and cessation of many health related behaviors. In this study, this model was applied to the domain of immoderate alcohol use among adolescents (usually drinking three or more drinks per occasion). Measures for two constructs of the model were developed: Stage of Change and Decisional Balance. A total of 853 tenth and eleventh graders who attend vocational training programs were administered a 37-item decisional balance questionnaire and a 5-item staging measure. A short (16-item) psychometrically sound Decisional Balance Inventory was developed based on an exploratory factor analysis that identified two factors, the Pros and Cons of Alcohol Use. The factor structure was confirmed using structural modeling techniques on a hold-out sample. Based on a combination of model fit and parsimony considerations, an uncorrelated model was selected (IFI2 = .909). Students were classified into one of nine stages of acquisition or cessation. External validity was established by the significant and meaningful differences between the stages of change on the pros and cons of alcohol use. Implications of this research are discussed.