Measuring and investigating health motivation among college students in China

Lifestyle has a profound impact on people's health. In China, emerging adults, typically college students, experience unhealthy lifestyles such as smoking, drinking, sleep disorders, and sedentary lifestyles, which are common risk factors for chronic diseases. Enhancing health motivation plays a key role in promoting them to want to adopt health-promoting lifestyles. The purpose of this study was to (i) explore and delineate college students' motivations for health-promoting lifestyles; and (ii) develop a measurement scale to measure health motivations. Study participants included college students in China. To achieve the first objective, 93 undergraduate students (59 males and 34 females; mean age 21.2 years) were interviewed in the first stage of the study. Verbatim transcripts were analyzed using a theory-directed approach following the Self-determination Theory (SDT). Participants reported five types of health motivation that broadly fall under SDT: absence of motive, external, introjected, identified, and integrated. Sources of motivation identified included health literacy, the environment, and social relationships. To achieve the second objective, an item pool for the College Students Health Motivation Questionnaire (CSHM-Q) was generated based on content coding results. A panel discussion comprising 7 experts was conducted to examine content validity. To examine the initial reliability and validity of the measurement scale, 283 college students were surveyed. An initial five-domain solution was revealed from an exploratory factor analysis. The five factors explained 66.0% of the total variance. To further confirm the internal structure and validate the questionnaire, 1023 college students were surveyed. Good model fit indices from confirmatory factor analysis suggested that a four-domain solution of the CSHM-Q has a more stable structure and was generally consistent with the theoretical model based on Self-determination Theory. Reliability and validity were further established in Stage 3 of the research. Cronbach's alphas for each domain were all above satisfactory level, ranging from .60 to .86. Test-retest reliability was demonstrated by administering the measurement scale to the same participants at two time points. Intraclass correlation coefficients were all above .8, indicating the CSHM-Q has a good consistency over time. After internal structure was identified, Rasch analysis was performed to examine the unidimensionality and construct validity of each subscale of the measurement scale. Rasch person reliabilities for each domain were all greater than .6, indicating that the item's difficulty placement would be similar when another comparable survey was conducted using the CSHM-Q. Each subscale of CSHM-Q had satisfactory fit values. Unidimensionalities within each subscale were established since all of the fit values were located within the recommended range from .7 to 1.3. Through category functioning analysis, the step calibration advance monotonically. Differential items functioning analysis showed good invariance across different groups, indicating the CSHM-Q can be used for group comparison. Convergent validity was established through examining the relationship between health motivation and exercise motivation. Moderate to high correlations ranging from -.31 to .58 were observed, indicating medium to strong relationship between motivations to practice health-promoting lifestyles and motivations to exercise regularly. However, a weak relationship was observed between health motivation and health-promoting lifestyles; a similar result was also found between exercise motivation and health-promoting lifestyles. These results implied that besides motivation, there might have been other potential determinants or barriers that affect college students' adoption of health-promoting lifestyles. Initial findings from this study show acceptable psychometric properties and CSHM-Q can be a promising instrument in measuring health motivation among college students in China. All rights reserved.