Perceived Susceptibility to Chronic Disease Among Healthy People: Questionnaire Development, Validity and Reliability Among Young Iraqi Adults

Authors: [Authors as listed in MJPHM]

Affiliations: Baghdad, Iraq; Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Malaysia

Published: 2018  |  Malaysian Journal of Public Health Medicine, 2018; Volume 18 (1): 139-148

Last reviewed: March 2026

Background

Non-communicable diseases (NCDs)—including cardiovascular disease, diabetes mellitus, cancer, and chronic respiratory conditions—represent the leading causes of death and disability worldwide. The global burden of NCDs is particularly pronounced in low- and middle-income countries, where health systems are often ill-equipped to manage the long-term care needs of chronic disease patients. Iraq, having endured decades of conflict and economic disruption, faces a dual burden of infectious and non-communicable diseases, with the latter increasingly dominant in the epidemiological landscape.

Perceived susceptibility—an individual’s belief about their likelihood of developing a particular disease—is a core construct in several health behaviour theories, most notably the Health Belief Model (HBM). According to the HBM, people are more likely to adopt preventive behaviours when they perceive themselves as personally susceptible to a health threat. Understanding and measuring perceived susceptibility is therefore essential for designing effective health promotion interventions targeting chronic disease prevention.

Despite the theoretical importance of perceived susceptibility, validated instruments for measuring this construct among healthy young adults in Arabic-speaking populations were lacking. This study aimed to develop, validate, and assess the reliability of a questionnaire measuring perceived susceptibility to chronic diseases among young Iraqi adults who were free from chronic conditions.

Study Design and Methods

A total of 200 young adults residing in Baghdad, Iraq, participated in this questionnaire development and validation study. Inclusion criteria required participants to be free from any of the chronic diseases under study (cardiovascular disease, diabetes, cancer, and chronic respiratory disease) and to be living in Baghdad. The questionnaire was developed through a multi-stage process: item generation based on literature review and Health Belief Model constructs, expert panel validation for content validity, translation to Arabic, and pretesting among a pilot sample.

The instrument assessed several domains related to chronic disease susceptibility perception: health-related behaviour (general health practices and lifestyle factors), special practices (specific disease prevention activities), information seeking (engagement with health information sources), and perceived probability of diseases (personal risk assessment for specific chronic conditions).

Psychometric evaluation included descriptive statistics, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and internal consistency reliability analysis using Cronbach’s alpha.

Results

Participant Characteristics

The mean age of participants was 30 years, and the majority (71.5%) were male. Participants were recruited from the general community in Baghdad and represented a range of educational backgrounds and occupational categories.

Factor Structure and Validity

Exploratory factor analysis revealed a coherent factor structure, with all retained items demonstrating factor loadings exceeding the 0.4 threshold, indicating adequate item-factor associations. Confirmatory factor analysis supported the proposed factor model with satisfactory goodness-of-fit indices: the Chi-square to degrees of freedom ratio was 1.213 (with 2 degrees of freedom) and the p-value was 0.297 (exceeding the threshold of 0.05), indicating that the model fit the observed data well.

Reliability

Internal consistency reliability analysis demonstrated good reliability across the questionnaire domains. The health-related behaviour, special practice, information seeking, and perceived probability of diseases subscales all achieved acceptable Cronbach’s alpha values, indicating that items within each domain measured a consistent underlying construct.

Discussion

This study successfully developed and validated a questionnaire for assessing perceived susceptibility to chronic diseases among healthy young Iraqi adults. The robust psychometric properties support the instrument’s use in future research and public health practice within Arabic-speaking populations.

The emphasis on young adults is strategically important for chronic disease prevention. By the time NCDs are clinically manifest, considerable organ damage has often already occurred. Understanding how healthy young people perceive their susceptibility to chronic diseases can inform the design of interventions that modify risk perceptions and promote preventive behaviours before disease onset. Young adulthood is also a period when many health-related behaviours (dietary patterns, physical activity habits, tobacco and substance use) become established and persist into later life.

The predominance of male participants (71.5%) reflects cultural factors that may have influenced recruitment in Baghdad. The gender distribution should be considered when interpreting results, as perceived susceptibility to chronic diseases may differ between men and women due to differences in health knowledge, risk exposure, and cultural attitudes toward illness and prevention.

Public Health Implications

The validated questionnaire provides a practical tool for public health researchers and practitioners working with Arabic-speaking populations. It can be used to assess the effectiveness of health education programmes aimed at increasing chronic disease awareness and modifying risk perceptions among young adults. Health ministries in Iraq and other Arabic-speaking countries can utilise this instrument in national health surveys to monitor population-level changes in chronic disease risk perception over time.

Given Iraq’s complex health landscape, where chronic disease risk factors are increasingly prevalent alongside ongoing challenges related to conflict-affected health infrastructure, tools that facilitate early identification of at-risk populations and evaluation of preventive interventions are particularly valuable. Integration of perceived susceptibility assessment into primary healthcare settings could enhance clinical counselling about chronic disease risk factors and motivate behaviour change among young adults.

Limitations

The study was conducted exclusively in Baghdad, and findings may not represent young adults in other Iraqi cities or rural areas, where health literacy levels and access to health information may differ. The predominantly male sample limits the generalisability of findings to female populations. The cross-sectional design does not allow assessment of test-retest reliability over time or the instrument’s sensitivity to change. While CFA results were satisfactory, the relatively small sample size (n = 200) means that model fit statistics should be interpreted with caution. Future studies with larger, more gender-balanced samples from multiple geographic locations would strengthen the evidence base for this instrument.