Purpose: Screening for hepatocellular carcinoma (HCC) as an effective instrument to reduce the burden
of late diagnoses remains underutilized in China, much of the Asian countries, and in a sense all over the
world. Modifiable psychosocial factors should be identified to improve screening utilization and reduce
the burden of late diagnoses. However, valid psychosocial measures are unavailable. This study aimed to
translate, culturally adapt, and validate the preventive health model (PHM) instrument for measuring
psychosocial factors of HCC screening among patients with hepatitis B.
Methods: This study was conducted from June 2020 to April 2021 in three rigorous phases: (1) committee-
based translation from English to Chinese; (2) cognitive interviews (n ¼ 33) and Delphi expert
consultations (n ¼ 7) for cultural adaptation; and (3) a cross-sectional study (n ¼ 305) for validation.
Results: In phase I, two items were reworded, and two retranslated for semantic equivalence. In phase II,
issues related to comprehension, sensitive wording, wording clarity, question relevance, and cultural
sensitivity were addressed by including pictures, rewording five items, and developing seven items. In
phase III, exploratory and confirmatory factor analyses suggested a five-factor 20-item solution: it
explained 76.9% of the variance; had adequate factor loading (.60e.91), convergent and discriminant
validity; satisfactory model fit indices; and reliability (Cronbach's a, .86.91). Known-group analysis
showed that patients with optimal HCC screening behavior had significantly higher scores on each
subscale than those not having such.
Conclusion: The Chinese PHM instrument is culturally sensitive, reliable, and valid to measure the
psychosocial factors of HCC screening. It can help nurses and researchers to tailor strategies to improve
clinical HCC screening practices in high-risk HCC regions.