Cancer Screening Belief Scale
Objective: To develop and validate a culturally sensitive scale measuring cancer screening beliefs for Chinese; and to examine the validity and reliability of the scores of the new instrument (CSBS-C).
Methods: A modified instrument measuring cancer screening beliefs in general was developed, adapting from the previous Cervical Smear Belief Inventory (CSBI) developed by Hou and Luh (2005) among Chinese women, and tested among a Chinese worksite population in Taiwan. Items consisted in the CSBS-C were carefully reworded from Hou’s previously validated CSBI to reflect statements that would apply to cancer screening beliefs in general. Participants were asked to complete the self-administered screening belief items at baseline and one month follow-up (follow-up rate = 81%). Structural equation modeling (SEM) was used to assess the stability of the scores of the three-factor scale measured over time. Confirmatory factor analysis (CFA) was then used to validate these hypothesized theoretical constructs (factors). Results: SEM analysis revealed that the standardized coefficients of the three factors measured over time ranged from .30 to .75, indicating reasonable stabilities, and all three models revealed acceptable model fits (RMSEA=.06 ~ .09; GFI=.90~.99; IFI=.92~.99; TLI=.89~.97; and CFI=.92~.99). The final version of the CSBS-C, validated by CFA, consisted of 17 items that were clustered into three subscales: pros (eight items), cons (six items), and perceived cancer risks (three items); with all items loaded consistently and significantly with their corresponding factors (p<.001). Internal consistency ranged from 0.72 to 0.90.
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Conclusion: Evidence showed that psychometric properties of the CSBS-C demonstrated satisfactory reliability and validity. The instrument with its side-by-side English-Chinese comparison provides researchers and practitioners a valuable tool to reach Chinese population in a culturally sensitive and linguistically appropriate way.
Introduction
Cancers is the number one cause of death among Asian Americans (Kagawa-Singer & Pourat, 2000) as well as in many countries in Asia such as Taiwan. Although cancer statistics data in the U.S. show that in general, Asians tend to have lower incidences or mortalities comparing with other racial/ethnic groups, recent studies involving cancer mortality data find that death rates for Asians are often understated. Similarly, the U. S. Cancer Statistics Working Group comments that incidence data for Asians may be underestimated, although those data are generally reliable for whites and blacks. One major reason suspected is possibly due to racial misclassification or differences in cancer registry operations (U. S. Cancer Statistics Working Group, 2003).
Although cancer screenings for cervical, breast, and colorectal cancers have been proven to be effective to detect cancers early and significantly reduce cancer mortality, Asians is the group least likely to receive cancer screenings of any kind (U. S. Cancer Statistics Working Group, 2003). According to American Cancer Society’s most recent report based on nation-wide surveillance surveys, only 59% of the Asians reported a mammography within the past 2 years, comparing to 70% among Whites (American Cancer Society, 2006). Only 68% of Asians reported a cervical smear test within the past three years, as compared to 80%, 82%, and 75% for White, African American, and Hispanic or Latina women, respectively. Disparities in colorectal cancer screening rates were observed across racial or ethnic groups, with Asians still ranked at the bottom. Only 14% of the Asian overall had a fecal occult blood test (FOBT) in the past year, and 25% had an endoscopy in the past 5 years (American Cancer Society, 2006). These low cancer screening rates may lead to cancers being identified at more advanced stages, less effective treatments, and higher cancer mortalities.