A Brief Measure of Decisional Balance for Health Equity Engagement among Health Professionals

Racial health and healthcare inequities are sustained in part by health professionals’ beliefs about the benefits and costs of equity-focused action, yet no validated decisional balance measure exists for this domain. This study introduces and evaluates the Health Equity Decisional Balance (HEDB) scale. Eighty-eight health professionals completed the scale of ten proposed items assessing perceived pros and cons of engaging with health and healthcare equity work, along with a measure of Anti-Racist Efficacy (ARE) (Eschmann et al., 2023). Confirmatory factor analysis and structural equation modeling were used to test the latent structure of the scale and its predictive validity. A two-factor model retaining eights items with correlated pros and cons showed excellent fit (χ²(25)=32.98, RMSEA=.061, CFI=.982). Pros and cons were strongly and inversely related (r=−.90, p<.001), consistent with decisional balance theory. When modeled as latent predictors, pros showed a strong positive association with anti-racist self-efficacy (ARE) (β=.82, p=.037), whereas cons was not significant. Together, the factors accounted for 20% of variance in efficacy. The HEDB scale provides a brief, psychometrically sound measure of health professionals’ readiness-related beliefs about health and healthcare equity work.