Development and Validation of Integrated Behaviour Model (IBM) Instruments Through Confirmatory Factor Analysis (CFA) in Plasmodium knowlesi Malaria Behavioural Change

Hazwani Damanhuri, Emma Mohamad, Mohammad Rezal Hamzah, Sivasangari Genapathy, Neevaarthana Subramaniam

Abstract


Plasmodium knowlesi (P. knowlesi) malaria remains a significant public health challenge in Southeast Asia, particularly in Malaysia. Despite various preventive strategies, the rise in zoonotic malaria cases highlights the need for behaviourally focused interventions. This study aims to develop and validate a reliable instrument based on the Integrated Behaviour Model (IBM) to measure P. knowlesi malaria prevention behaviours among at-risk communities. A cross-sectional study was conducted in Hulu Selangor using a two-phase approach. Phase 1 involved qualitative elicitation interviews to explore attitudes, norms and perceived control toward five prevention behaviours: taking prophylaxis, wearing long sleeves and long pants, using insect repellent, using bed nets and using mosquito coils. These findings informed the development of a structured instrument. In Phase 2, confirmatory factor analysis (CFA) was applied to assess the validity and reliability of the instrument, using responses from 277 respondents. The CFA results showed that the developed instruments have achieved acceptable model fit, although some constructs exhibited reliability and validity concerns particularly attitude, subjective norm, and environmental constraint. The prevention behaviour items that showed the highest model fit among the five prevention behaviour items were wearing long sleeves and long pants and the lowest model fit was using insect repellent. This study provides a validated IBM based tool to assess P. knowlesi malaria prevention behaviours, contributing to more targeted intervention strategies. Future research should expand geographic coverage and use longitudinal methods to assess behavioural change over time.

 

Keywords: Integrated behaviour model (IBM), knowlesi malaria, behavioural change, confirmatory factor analysis (CFA), instrument development and validation.

 

https://doi.org/10.17576/JKMJC-2025-4102-10


Full Text:

PDF

References


Ab Hamid, M. R., Sami, W., & Sidek, M. M. (2017, September). Discriminant validity assessment: Use of Fornell & Larcker criterion versus HTMT criterion. Journal of Physics: Conference Series, 890(1), 012163. https://doi.org/ggssrq

Akello, A. R., Byagamy, J. P., Etajak, S., Okadhi, C. S., & Yeka, A. (2022). Factors influencing consistent use of bed nets for the control of malaria among children under 5 years in Soroti District, North Eastern Uganda. Malaria Journal, 21, 363. https://doi.org/ps9v

Avicor, S. W., Wajidi, M. F. F., & Owusu, E. O. (2017). To coil or not to coil: Application practices, perception and efficacy of mosquito coils in a malaria-endemic community in Ghana. Environmental Science and Pollution Research, 24, 21138–21145. https://doi.org/10.1007/s11356-017-9737-3

Awang, Z., Afthanorhan, A., Mohamad, M., & Asri, M. (2015). An evaluation of measurement model for medical tourism research: the confirmatory factor analysis approach. International Journal of Tourism Policy, 6(1), 29. https://doi.org/ps9w

Awang, P. (2018). Pendekatan mudah SEM (Structural equation modeling). MPWS Rich Resources.

Azlan, A. A., Damanhuri, H., Hamzah, M. R., Pasi, H., & Mohamad, E. (2023). Attitudes toward Plasmodium knowlesi malaria prevention behaviours among at-risk communities and health district officers’ efforts and challenges in promoting these behaviours: An elicitation study in Peninsular Malaysia. Jurnal Komunikasi: Malaysian Journal of Communication, 39(2), 269–292. http://doi.org/10.17576/JKMJC-2023-3902-15

Baistaman J., Awang Z., Afthanorhan A., Zulkifli Abdul Rahim M. (2020). Developing and validating the measurement model for financial literacy construct using confirmatory factor analysis. Humanities & Social Sciences Reviews, 8(2), 413–422. https://doi.org/10.18510/hssr.2020.8247

Barak, M. E. M., Wu, S., Luria, G., Schnyder, L. P., Liu, R., Nguyen, A., & Kaplan, C. D. (2024). Engaging communities in emerging infectious disease mitigation to improve public health and safety. Emerging Infectious Diseases, 30(7), 1390-97. https://doi.org/ps9z

Brattabø, I. V., Bjørknes, R., Breivik, K., & Åstrøm, A. N. (2019). Explaining the intention of dental health personnel to report suspected child maltreatment using a reasoned action approach. BMC Health Services Research, 19, 507. https://doi.org/ps92

Brown R., Chua T.H., Fornace K., Drakeley C., Vythilingam I., Ferguson H.M. (2020). Human exposure to zoonotic malaria vectors in village, farm and forest habitats in Sabah, Malaysian Borneo. PLoS Negl Trop Dis, 14(9), 1–18. https://doi.org/ps93

Cheung, G. W., Cooper-Thomas, H. D., Lau, R. S., & Wang, L. C. (2024). Reporting reliability, convergent and discriminant validity with structural equation modeling: A review and best-practice recommendations. Asia Pacific Journal of Management, 41, 745–783 https://doi.org/10.1007/s10490-023-09871-y

Chua, T. H., Manin, B. O., Vythilingam, I., Fornace, K., & Drakeley, C. J. (2019). Effect of different habitat types on abundance and biting times of Anopheles balabacensis Baisas (Diptera: Culicidae) in Kudat district of Sabah, Malaysia. Parasites and Vectors, 12(1), 1–13. https://doi.org/10.1186/s13071-019-3627-0

Chuma, J., Okungu, V., & Molyneux, C. (2010). Barriers to prompt and effective malaria treatment among the poorest population in Kenya. Malaria Journal, 9, 144. https://doi.org/10.1186/1475-2875-9-144

Chin, A. Z., Maluda, M. C. M., Jelip, J., Jeffree, M. S. B., Culleton, R., & Ahmed, K. (2020). Malaria elimination in Malaysia and the rising threat of Plasmodium knowlesi. Journal of Physiological Anthropology, 39, 1-9.

Cote, C. M., Goel, V., Muhindo, R., Baguma, E., Ntaro, M., Shook-Sa, B. E., ... & Boyce, R. M. (2021). Malaria prevalence and long-lasting insecticidal net use in rural western Uganda: Results of a cross-sectional survey conducted in an area of highly variable malaria transmission intensity. Malaria Journal, 20, 304. https://doi.org/ps94

Dai, M., Wombacher, K., Matig, J. J., & Harrington, N. G. (2017). Using the Integrative Model of Behavioral Prediction to understand college students’ hookup sex beliefs, intentions, and behaviors. Health Communication, 33(9), 1078–1087. https://doi.org/10.1080/10410236.2017.1331306

Damien, B. G., Kesteman, T., Dossou-Yovo, G. A., Dahounto, A., Henry, M. C., Rogier, C., & Remoué, F. (2023). Long-lasting insecticide-treated nets combined or not with indoor residual spraying may not be sufficient to eliminate malaria: A case-control study, Benin, West Africa. Tropical Medicine & Infectious Disease, 8(10), 475. https://doi.org/10.3390/tropicalmed8100475

Field A. (2017). Discovering statistics using IBM SPSS statistics (4th ed.). Sage Publications.

Fishbein, M., Bandura, A., Triandis, H. C., Kanfer, F. H., Becker, M. H., & Middlestadt, S. E. (2001). Factors influencing behavior and behavior change. In Baum, A., Revenson, T. A., & Singer, J. E. (Eds.), Handbook of health psychology (pp. 3–17). Lawrence Erlbaum.

Fornace, K. M., Herman, L. S., Abidin, T. R., Chua, T. H., Daim, S., Lorenzo, P. J., ... & Drakeley, C. J. (2018). Exposure and infection to Plasmodium knowlesi in case study communities in Northern Sabah, Malaysia and Palawan, the Philippines. PLoS Neglected Tropical Diseases, 12(6), e0006432.

Gable, R. K., & Wolf, M. B. (2012). Instrument development in the affective domain: Measuring attitudes and values in corporate and school settings. Science and Business Media.

Gay, L. R. (1980). Educational evaluation & measurement: Competencies for analysis and application. C.E. Merill Publishing Company.

Grigg, M. J., Cox, J., William, T., Jelip, J., Fornace, K. M., Brock, P. M., ... & Drakeley, C. J. (2017). Individual-level factors associated with the risk of acquiring human Plasmodium knowlesi malaria in Malaysia: A case-control study. Lancet Planet Health, 1(3), e97–104. http://dx.doi.org/10.1016/S2542-5196(17)30031-1

Haji-Othman, Y., & Yusuff, M. S. S. (2022). Assessing reliability and validity of attitude construct using partial least squares Structural equation Modeling (PLS-SEM). International Journal of Academic Research in Business and Social Sciences, 7(5), 378-385. https://doi.org/10.6007/ijarbss/v12-i5/13289

Herdiana, H., Cotter, C., Coutrier, F. N., Zarlinda, I., Zelman, B. W., Tirta, Y. K., ... & Hsiang, M. S. (2016). Malaria risk factor assessment using active and passive surveillance data from Aceh Besar, Indonesia, a low endemic, malaria elimination setting with Plasmodium knowlesi, Plasmodium vivax, and Plasmodium falciparum. Malaria Journal, 15(1), 1–15.

Hogarh, J. N., Agyekum, T. P., Bempah, C. K., Owusu-Ansah, E. D. J., Avicor, S. W., Awandare, G. A., Fobil, J. N., & Obiri-Danso, K. (2018). Environmental health risks and benefits of the use of mosquito coils as malaria prevention and control strategy. Malaria Journal, 17, 265. https://doi.org/10.1186/s12936-018-2412-4

Ibrahim M. Y., Noh C. H. C., & Abas M. M. (2017). A measurement model of leadership communication of Coastal Village Leaders in Terengganu, Malaysia. International Journal of Academic Research in Business & Social Sciences, 7(5), 788-789. http://dx.doi.org/10.6007/IJARBSS/v7-i7/3141

Ipa, M., Widawati, M., Laksono, A. D., Kusrini, I., & Dhewantara, P. W. (2020). Variation of preventive practices and its association with malaria infection in eastern Indonesia: Findings from community-based survey. PLoS One, 15(5), e0232909. https://doi.org/10.1371/journal.pone.0232909

Ismail, N. E., Jimam, N. S., Dapar, M. L. P., & Ahmad, S. (2020). Validation and reliability of healthcare workers' knowledge, attitude, and practice instrument for uncomplicated malaria by Rasch Measurement Model. Frontiers in Pharmacology, 10, 1521. https://doi.org/10.3389/fphar.2019.01521

Jimam, N. S., Ahmad, S., & Ismail, N. E. (2019). Psychometric classical theory test and item response theory validation of patients’ knowledge, attitudes and practices of uncomplicated malaria instrument. Journal of Young Pharmacists, 11(2), 186–191.

Jongdeepaisal, M., Ean, M., Heng, C., Buntau, T., Tripura, R., Callery, J. J., Peto, T. J., Conradis-Jansen, F., Von Seidlein, L., Khonputsa, P., Pongsoipetch, K., Soviet, U., Sovannaroth, S., Pell, C., & Maude, R. J. (2021). Acceptability and feasibility of malaria prophylaxis for forest goers: findings from a qualitative study in Cambodia. Malaria Journal, 20, 446. https://doi.org/10.1186/s12936-021-03983-w

Lakerveld, J., Bot, S. D., Chinapaw, M. J., Knol, D. L., De Vet, H. C., & Nijpels, G. (2011). Measuring pathways towards a healthier lifestyle in the Hoorn Prevention Study: The Determinants of Lifestyle Behavior Questionnaire (DLBQ). Patient Education and Counseling, 85(2), e53–e58. https://doi.org/10.1016/j.pec.2011.01.014

Lilje, J., & Mosler, H. (2018). Effects of a behavior change campaign on household drinking water disinfection in the Lake Chad basin using the RANAS approach. The Science of The Total Environment, 619–620, 1599–1607. https://doi.org/gnrdhp

Lee, W. C., Cheong, F. W., Amir, A., Lai, M. Y., Tan, J. H., Phang, W. K., ... & Lau, Y. L. (2022). Plasmodium knowlesi: The game changer for malaria eradication. Malaria Journal, 21(1), 140. https://doi.org/10.1186/s12936-022-04131-8

Makungu, C., Stephen, S., Kumburu, S., Govella, N. J., Dongus, S., Hildon, Z. J., Killeen, G. F., & Jones, C. (2017). Informing new or improved vector control tools for reducing the malaria burden in Tanzania: A qualitative exploration of perceptions of mosquitoes and methods for their control among the residents of Dares Salaam. Malaria Journal, 16, 410. https://doi.org/10.1186/s12936-017-2056-9

Marar, S., Hamza, M. A., Ayyash, M., & Abu-Shaheen, A. (2023). Development and validation of an instrument to assess the knowledge and perceptions of predatory journals. Heliyon, 9(11), e22270. https://doi.org/10.1016/j.heliyon.2023.e22270

Montano, D. E., & Kasprzyk, D. (2008). Theory of reasoned action, theory of planned behavior, and the integrated behavioral model. In B. R. K. Glanz & F. Lewis (Eds.), Health behavior and health education (4th ed., pp. 67–92). San Francisco, CA: JosseyBass.

Mustafa, N. K., Ibrahim, R., Aizuddin, A. N., Aljunid, S. M., & Awang, Z. (2024). Critical success factors and acceptance of the Casemix system implementation within the total hospital information system: Exploratory factor analysis of a pilot study. JMIR Formative Research, 8, e56898. https://doi.org/10.2196/56898

Nalinya S., Musoke D., Deane K. (2022). Malaria prevention interventions beyond long-lasting insecticidal nets and indoor residual spraying in low- and middle-income countries: A scoping review. Malaria Journal, 21, 31. https://doi.org/ps97

Naserrudin, N. A., Monroe, A., Culleton, R., Hod, R., Jeffree, M. S., Ahmed, K., & Hassan, M. R. (2022a). Reimagining zoonotic malaria control in communities exposed to Plasmodium knowlesi infection. Journal of Physiological Anthropology, 41, 14. https://doi.org/10.1186/s40101-022-00288-y

Naserrudin, N. A., Hod, R., Jeffree, M. S., Ahmed, K., & Hassan, M. R. (2022b). The emerging threat of Plasmodium knowlesi Malaria infection: A concept paper on the vulnerable factors in human. International Journal of Environmental Research and Public Health, 19(7), 4419. https://doi.org/10.3390/ijerph19074419

N’Dri, B. P., Heitz-Tokpa, K., Chouaïbou, M., Raso, G., Koffi, A. J., Coulibaly, J. T., ... & Utzinger, J. (2020). Use of insecticides in agriculture and the prevention of vector-borne diseases: Population knowledge, attitudes, practices and beliefs in Elibou, South Côte d’Ivoire. Tropical Medicine and Infectious Disease, 5(1), 36. https://doi.org/ghg44m

Noor, N. M., Aziz, A. A., Mostapa, M. R., & Awang, Z. (2015). Validation of the Malay version of the inventory of functional status after childbirth questionnaire. BioMed Research International, 1, 1–10. https://doi.org/10.1155/2015/972728

Ntuku, H. M., Ruckstuhl, L., Julo-Réminiac, J. E., Umesumbu, S. E., Bokota, A., Tshefu, A. K., & Lengeler, C. (2017). Long-lasting insecticidal net (LLIN) ownership, use and cost of implementation after a mass distribution campaign in Kasaï Occidental Province, Democratic Republic of Congo. Malaria Journal, 16, 1-14. https://doi.org/f9k8w8

Perkins, J. M., Krezanoski, P., Takada, S., Kakuhikire, B., Batwala, V., Tsai, A. C., Christakis, N. A., & Bangsberg, D. R. (2019). Social norms, misperceptions, and mosquito net use: A population-based, cross-sectional study in rural Uganda. Malaria Journal, 18, 189. https://doi.org/10.1186/s12936-019-2798-7

Pope, C. N., Sezgin, E., Lin, S., Morris, N. L., & Zhu, M. (2020). Adolescents’ attitudes and intentions to use a smartphone app to promote safe driving. Transportation Research Interdisciplinary Perspectives, 4, 100090. https://doi.org/10.1016/j.trip.2020.100090

Rahim, M. A. F. A., Munajat, M. B., & Idris, Z. M. (2020). Malaria distribution and performance of malaria diagnostic methods in Malaysia (1980–2019): A systematic review. Malaria Journal, 19, 395. https://doi.org/10.1186/s12936-020-03470-8

Sangoseni, O., Hellman, M., & Hill, C. (2013). Development and validation of a questionnaire to assess the effect of online learning on behaviors, attitudes, and clinical practices of physical therapists in the United States regarding evidence-based clinical practice. The Internet Journal of Allied Health Sciences and Practice, 11(2). https://doi.org/ps98

Schreiber, J. B., Nora, A., Stage, F. K., Barlow, E. A., & King, J. (2006). Reporting structural equation modeling and confirmatory factor analysis results: A review. The Journal of Educational Research, 99(6), 323-338. https://doi.org/10.3200/JOER.99.6.323-338

Scott J. (2020). Proposed integrated control of zoonotic Plasmodium knowlesi in Southeast Asia using themes of one health. Tropical Medicine and Infectious Disease, 5(4), 175.

Shuiabu, A. B., Ishaku, M., Yoriyo, K. P., Abba, E., Bukar, A., & Umar, M. U. (2021). Efficacy of commonly used mosquito coils containing Pyrethrin against Lymphatic Filariasis Vector Culex quinquefasciatus (Say) in Gombe. Asian Journal of Research in Infectious Diseases, 6(1), 32–39. https://doi.org/10.9734/ajrid/2021/v6i130184

Storey, J. D., Babalola, S. O., Ricotta, E. E., Fox, K. A., Toso, M., Lewicky, N., & Koenker, H. (2018). Associations between ideational variables and bed net use in Madagascar, Mali, and Nigeria. BMC Public Health, 18, 484. https://doi.org/gdd7x7

Taber, K. S. (2017). The use of Cronbach’s Alpha when developing and reporting research instruments in science education. Research in Science Education, 48, 1273–1296. https://doi.org/10.1007/s11165-016-9602-2

Vector Borne Disease Section, Disease Control Division, & Ministry of Health Malaysia. (2010, October). National strategic plan for elimination of malaria 2011-2020. https://apmen.org/sites/default/files/all_resources/National%20Strategic%20Plan%20for%20Malaria%20Elimination_Malaysia%20%282010-2020%29.pdf

Wan, C., Shen, G. Q., & Choi, S. (2017). Experiential and instrumental attitudes: Interaction effect of attitude and subjective norm on recycling intention. Journal of Environmental Psychology, 50, 69–79. https://doi.org/10.1016/j.jenvp.2017.02.006

World Health Organization (WHO). (2017). Malaria Policy Advisory Committee meeting report (March 2017). https://www.who.int/publications/i/item/WHO-HTM-GMP-MPAC-2017.8

Yusof, Y., Awang, Z., Jusoff, K., & Ibrahim, Y. (2017). The influence of green practices by non-green hotels on customer satisfaction and loyalty in hotel and tourism industry. International Journal of Green Economics, 11(1). https://doi.org/ps99

Zamzuri, M. A. I. A., Jamhari, M. N., Faisal Ghazi, H., Muhamad Hasani, M. H., Mohd Ali, N. K., Abd. Rashid, M. F., ... & Hassan, M. R. (2021). A unique double tango: Construct validation and reliability analysis of Risk Perception, Attitude and Practice (RPAP) questionnaire on dengue infection. PLoS One, 16(8), e0256636. https://doi.org/ptbb


Refbacks

  • There are currently no refbacks.


e-ISSN: 2289-1528