ArticleBMC public health2026
Predicting ART initiation through intertemporal preferences: development and validation of a decision-making preferences scale for ART initiation.
Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundGiven persistent and unpredictable delays in antiretroviral therapy (ART) initiation globally, this study develops a decision preference scale to identify patients at risk of such delays and evaluates its psychometric properties.
methodsGuided by the intertemporal decision-making framework, the scale development followed a triphasic approach. In Phase I, we conceptualized decision-making preferences for ART initiation through theoretical synthesis, systematic literature review, and in-depth qualitative interviews. In Phase II, we generated and optimized the items through group discussions, Delphi expert consultations, and Pilot test. Phase III implemented psychometric evaluations: (1) content validity (Item-Content Validity Index [I-CVI] and Scale-Content Validity Index [S-CVI]); (2) structural validity (Exploratory Factor Analysis [EFA] and Confirmatory Factor Analysis [CFA]); (3) predictive validity (e.g., Odds Ratio [OR], Receiver Operating Characteristic [ROC] curve with Area Under the Curve [AUC]); (4) reliability.
resultsThe scale comprises 16 items across two theoretically derived dimensions: short-term costs and long-term benefits. The content validity is adequate (I-CVIs range from 0.830 to 1.000; S-CVI = 0.949). EFA extracted two factors with a cumulative variance explanation of 66.667%, and CFA shows an excellent model fit. The adjusted scale performed well in predicting ART initiation (OR = 0.745, p < 0.001 logistic regression; AUC = 0.895, p < 0.001 ROC curve analysis). The optimal classification threshold (≥ 2), derived from the Youden index achieved balanced diagnostic accuracy (sensitivity = 81.5%; specificity = 80.9%; precision = 92.0%). Finally, the reliability of the scale is acceptable, with a Cronbach’s α of 0.786 for the total scale, a split-half reliability of 0.908, and a test-retest reliability of 0.837.
conclusionsThe Decision-Making Preferences Scale for ART Initiation is a validated and reliable tool that helps providers systematically identify high-risk patients enabling timely interventions to reduce delays. Future research is warranted to evaluate its external validity in other geographical settings and among broader populations.
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