Patients hospitalized for neurosurgical procedures are highly susceptible to venous thromboembolism (VTE). It is crucial to evaluate the prevention beliefs of VTE among neurosurgical inpatients and analyse the influencing factors. This research sought to create an instrument grounded in the Health Belief Model (HBM) to evaluate the beliefs about VTE prevention and the factors influencing these beliefs among neurosurgical inpatients. A questionnaire comprising 28 questions was designed, validated, and distributed offline to 386 neurosurgical inpatients through random sampling. The data analysis was conducted using SPSS 26.0 and Amos 27.0. The measurement model was assessed through reliability, validity, and confirmatory factor analyses. Additionally, multiple linear regression analysis was utilized to identify the factors influencing VTE prevention beliefs. Statistical significance was determined by P values less than 0.05. The questionnaire encompassed six constructs, all of which exhibited strong internal consistency along with solid convergent and discriminant validity. VTE prevention beliefs score among neurosurgical inpatients was 99.56 (SD = 10.11). Among the belief dimensions, the scoring rate of perceived benefits and cues to action ranked highest, while perceived barriers were the lowest. The influencing factors of VTE prevention beliefs were educational attainment (β = 0.343, P < 0.001), receipt of VTE knowledge education from healthcare providers (β = 0.214, P < 0.001), Personal history of VTE (β = 0.175, P < 0.001), surgical history (β = 0.116, P < 0.01), sources of VTE-related information (β = 0.113, P < 0.01) and method of paying medical expenses (β = 0.112, P < 0.05). The questionnaire showed strong reliability and validity, and the results indicating that neurosurgical inpatients hold moderate beliefs about VTE prevention. While they recognize its benefits, barriers to preventive behaviors persist. Addressing these barriers and enhancing self-efficacy through targeted education and interventions is key to improving VTE prevention awareness and actions.