The health resistance (HR) scale: Developing a measure of resistance to health promotion

Abstract

Objective Recent empirical and theoretical research suggests increasing resistance by the general public to health promotion messages and interventions. The aim of this exploratory study was therefore to develop a health resistance (HR) scale capable of measuring the degree of resistance to health promotion within different populations.

Design A preliminary HR scale was generated through consideration of the existing literature, Internet sites and a series of focus groups. The scale was distributed in the form of a questionnaire to 1000 people selected at random from the electoral register of central Manchester. Also included in the questionnaire were previously validated measures of health behaviours, health value and psychological'reactance'. These were included in order to measure associations with the HR scale as evidence of convergent validity. A further sample of students from different faculties at Manchester University were also surveyed in order to provide comparative data on 'health resistance'.

Results Two hundred and four usable questionnaires from the random sample were returned. The preliminary HR scale was Factor Analysed using Varimax Rotation, resulting in a four factor solution accounting for 64 per cent of the variance. The final 'health resistance' scale consisted of 17 items pertaining to four dimensions of health resistance. These included: 1) Scepticism (7 items); 2) Freedom/resistance (5 items); 3) Individual responsibility (2 items); 4) Trust and authority (3 items). Factor scores can be formed separately for each of the four factors and/or a total health resistance score can be calculated. This paper presents comparative data from both the random and student sample pertaining to those scores.

The HR scale showed good test-retest reliability ranging from 0.71 to 0.83 over three weeks, while internal consistency reliability ranged from 0.70 to 0.90. Convergent validity was adequate; the HR scale correlated with the 'health behaviour index' ( r=0.18, p<0.01) and 'psychological reactance scale' (r=0.42, p<0.001 ), but not with 'Health as a value' scale. Conclusion The results of this study support the use of the HR scale as a meaningful measure of health resistance. Test-retest, internal reliability coefficients and convergent validity results were all satisfactory. Further reliability and validity studies conducted with different samples, testing the HR scales' utility and theoretical applicability in different situations, are now required.