Health anxiety shapes how people interpret health-related uncertainty, seek health information and engage with healthcare services, and in digital health environments these processes are increasingly influenced by online information. Although adapted instruments are available in Turkish, the authors note that studies developing concise scales for assessing health anxiety in general adult samples have remained limited. To address this gap, the research team generated an item pool through a literature review, expert evaluation and pilot testing. The study included 479 adults aged 18 to 65 years, and the dataset was randomly divided into two subsamples so that exploratory and confirmatory factor analyses could be conducted on separate portions of the data.

The psychometric evaluation included content validity assessment, internal consistency analysis, test–retest reliability, convergent and discriminant validity, item response theory (IRT) analyses, differential item functioning (DIF) testing and measurement invariance testing. Criterion-related validity was examined through associations with e-health literacy. Across these analyses, the results were generally consistent with a unidimensional nine-item scale, meaning that the items appear to tap a single underlying dimension of health anxiety rather than several distinct subdomains.

The scale demonstrated high internal consistency, with a Cronbach’s alpha of 0.903, indicating that the nine items measure the construct coherently. Convergent validity was satisfactory, with a composite reliability of 0.91 and an average variance extracted of 0.61. Temporal stability was also good, with an intraclass correlation coefficient of 0.835 for test–retest reliability, suggesting that scores remain reasonably consistent over time.

However, the confirmatory side of the analysis was less definitive. Confirmatory factor analysis provided only preliminary support for the proposed unidimensional structure, and model-fit limitations remained, particularly with respect to the root mean square error of approximation (RMSEA). The authors therefore emphasize that the proposed measurement model should be regarded as provisional. In their conclusion, they state that further refinement and independent replication are needed before the scale can be recommended for broader research or applied use.

As an exploratory criterion-related analysis, the study examined the relationship between health anxiety and e-health literacy. Health anxiety showed a weak negative association with e-health literacy scores (r = −0.142, 95% CI [−0.228, −0.053], p = 0.002). In practical terms, adults with higher health anxiety tended to report slightly lower e-health literacy, although the correlation is small and the cross-sectional design means no causal direction can be inferred. The authors frame this association as exploratory rather than as a definitive test of how health anxiety and online health information behavior interact.

The study’s design combined several complementary analytic procedures. Splitting the sample randomly allows exploratory factor analysis to identify a structure in one half of the data while confirmatory factor analysis tests that structure in the other half. IRT analyses provide item-level information about how each question performs across different levels of health anxiety, while DIF and measurement invariance testing address whether the items function equivalently across subgroups of respondents.

For researchers, the HAS-9 may offer a useful brief option for future studies on health anxiety and related psychological and behavioral processes. The authors position the scale within these limitations: the preliminary psychometric evidence supports its use as a research tool, but the fit limitations observed in the confirmatory analysis and the single-sample nature of the validation mean that independent replication in new samples is an essential next step before broader use can be recommended.

Subject of Research: Development and psychometric validation of a brief health anxiety scale in adults

Article Title: Development and psychometric validation of the health anxiety scale in adults

Article References: Kuşcu Şahin, F. N., & Kuşcu Karatepe, H. (2026). Development and psychometric validation of the health anxiety scale in adults. BMC Psychology. https://doi.org/10.1186/s40359-026-05445-x

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05445-x

Keywords: health anxiety, psychometrics, scale development, e-health literacy, BMC Psychology, confirmatory factor analysis, item response theory, reliability, validity, cross-sectional study, Development, psychometric