Cancer Screening Belief Scale. Materials and Methods
Development of the Initial Items
The initial item pool of beliefs related to cancer screenings in general were developed based on items published in Hou’s previously validate cancer screening belief inventory specifically developed for cervical smear test among Chinese women (CSBI). Items were reworded carefully from the CSBI to reflect statements that would apply to cancer screening beliefs in general. For example, the term “cervical smear test” was replaced with a general term “cancer screening”, if the statement can apply to cancer screening in general or early detection overall. Items specifically relate to gender or cervical smear test were removed.
Twenty items were drafted in the initial item pool, reflecting three theoretical constructs (factors). These constructs were derived from existing models of health behavior and inherent in the original CSBI (Hou & Luh, 2005). These included perceived pros and cons from the Transtheoretical Model (Prochaska, Norcross, & Diclemente, 1994), and perceived risk (susceptibility) from the Health Belief Model (Rosenstock & Krischt, 1974). Scale items were drafted in English, translated into Chinese, and then back translated. Items on the two English versions were compared for consistencies. The draft was then given to an expert panel (including three cancer researchers, two health care professionals, and three lay Chinese adults) to evaluate the item clarity, relevancy, comprehensiveness, and literacy demand. One item was identified as redundant thus was removed from the initial item pool. Comments and suggestions were used to further refine these belief statements in order to enhance clarity and readability.
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Study Sample and Procedure
The study participants were selected from a convenient sample of worksite population and their family member age 40 years and older. Participants in the study were recruited from a Fecal Occult Blood Test (FOBT) screening trial for colorectal cancers screenings. Each participant was asked to complete a survey with items measuring their beliefs related to cancer screenings in general (the 19-item CSBS-C scale), along with their screening history, knowledge related to colorectal cancers screenings, as well as demographics. A total of ten worksites in one of the major cities in Taiwan participated in the study. The questionnaires were administered by the researchers, with the assistance of managers or supervisors from each participating worksite. Follow-up surveys were administered to all participants, after one month of the initial survey, when the researchers went to the same study sites and collect their stool test result cards. The detailed process on the actual fecal occult blood test trial is documented elsewhere (Hou & Chen, 2004). Data on cancer screening beliefs in general were analyzed in the current study to assess the internal consistencies, stability (test-retest reliability), and structure validity of the three factors which measured in the CSBS-C scale.