Validating a previously untested ‘Intentions and Beliefs around Smoking’ sub-scale for inclusion in the published ‘Attitudes and Beliefs about Cardiovascular Disease (ABCD) Risk Questionnaire’ using a cross-sectional sample
Authors: Bowyer Mark , Hassen Hamid Yimam 
Published: June 2021

ABSTRACTObjectivesTo provide evidence of validity, reliability and generalisability of results obtained using the Attitudes and Beliefs about Cardiovascular Disease (ABCD) Risk Questionnaire with a sample of the English population surveyed within the ‘SPICES’ Horizon 2020 project (Nottingham study site), and to specifically evaluate the psychometric and factor properties of an as-yet untested 5 item sub-scale relating to smoking behaviours.Design and settingCommunity based cross-sectional study in Nottingham, UK.Participants466 English adults fitting inclusion criteria (aged 18+, without known history of CVD, not pregnant, able to provide informed consent) were included in the study.MethodsWe re-validated the published ABCD questionnaire on a sample of the general population in Nottingham to confirm the psychometric properties. Furthermore, we introduced 5 items related to smoking which were dropped in the original study due to inadequate valid samples.Primary and secondary outcome measuresPsychometric and factor performance of untested 5 item ‘smoking behaviours’ sub-scalePsychometric and factorial properties in combination with the remaining 18 items across 3 sub-scalesResultsAnalyses of the data largely confirmed the validity, reliability, and factor structure of the original ABCD Risk Questionnaire. Sufficient participants in our study provided data against an additional five smoking related items to confirm their validity as a sub-scale and to advocate for their inclusion in future applications of the scale. EFA and CFA calculations support some minor changes to the remaining sub-scales which may further improve psychometric performance and therefore generalisability of the instrument.ConclusionsAn amended version of the ABCD Risk Questionnaire would provide public health researchers and practitioners with a brief, easy to use, reliable and valid survey tool. The amended tool may now assist public health practitioners and researchers to quickly survey patient or public intentions and beliefs around three key areas of individually modifiable risk (Physical Activity, Diet, and Smoking).Trial registrationISRCTN68334579 https://doi.org/10.1186/ISRCTN68334579Heart health without a doctor: an implementation study of CVD prevention and behaviour change interventions in community settingsEthical approvalEthical approval for the ‘SPICES’ Nottingham study protocol (incorporating the ABCD Risk Questionnaire) was secured from the Nottingham Trent University College of Business, Law and Social Sciences on the 20th February 2019. Participants were required to provide informed consent (Appendix 4).Article summary (Strengths and Limitations of this study)Large sample (n=466) of English adults from the Nottingham UK populationSufficient case data to validate additional sub-scale related to attitudes and intentions of smokersCriterion validity not exploredFull assessment of the utility of ABCD Risk Questionnaire in health promotion and CVD prevention not explored, further studies may be required to position the tool in clinical and public health practice.Original protocol(Appendix 3)Funding statementThis work was supported by the European Commission Horizon 2020 Non-communicable diseases and the challenge of healthy ageing Grant agreement 733356 ‘SPICES’.Competing interests statementNone declaredPatient and public involvementPatients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.Patient consent for publication(data sharing agreement)Not required (participant information and informed consent attached Appendix 4)Provenance and peer reviewNot commissioned.Data availability statementData are available on reasonable requestAuthor statementMark Bowyer: Design of work, acquisition of data, analysis and interpretation of data, drafting and revising the paper, final approval, accountability for accuracy and integrity.Hamid Hassen: Analysis and interpretation of data, drafting and interpretation of results, accountability for accuracy and integrity.