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Background  Several stroke impairment scales are currently available for stroke patients but none of them provide information regarding the pre-stroke behavioral intentions of high-risk stroke patients and their relatives. This study’s objective was to generate and validate a new written tool, the Stroke Pre-hospital Delay Behavior Intention (SPDBI) scale. It is suitable for use with high-risk stroke patients and their relatives to predict the likelihood of pre-hospital delay.    Methods  From a review of related studies, we formulated a prototype scale. We interviewed ten stroke patients in a semi-structured iterative process that included interviews with experts, high-risk patients, and their family members. Then, we pretested and filtered items. We next used a large sample size and factor analysis to determine the scale’s structure. Finally, we checked the reliability and validity of the scale.    Results  We identified five sub-domains (stroke warning signs, non-treatment justification, symptom attributions, habitual response style, and emergency system use). The SPDBI demonstrated good internal consistency and test-retest reliability (Cronbach’s α =0.808; Intraclass Correlation Coefficient [ICC] =0.797).    Conclusions  This SPDBI scale is a reliable, and valid measure of the likeliness of pre-hospital delay in high-risk stroke patients and their family members. It may provide scientific assessment for targeted health education intervention.    Electronic supplementary material  The online version of this article (doi:10.1186/s12955-014-0170-8) contains supplementary material, which is available to authorized users.

Instrument development and validation of the stroke pre-hospital delay behavior intention scale in a Chinese urban population