Miri Cohen1, Faisal Azaiza. 1. Faculty of Social Welfare and Health Sciences, Haifa University, Haifa, Israel. cohenm@research.haifa.ac.il
Abstract
AIMS: To develop and assess an instrument for studying culture-specific barriers to performing examinations for early detection of breast cancer. METHODS: A three-step design: (a) content analysis of five focus groups (n=51); (b) constructing and initial testing of the Arab culture-specific barriers (ACSB) instrument in a pilot study (n=79); (c) testing for validity and reliability of the revised ACSB instrument (n=300, of these 200 Muslim and 100 Christian, mean age 48). Construct validity was examined using factor analysis. Performance of screenings (mammography and clinical and self breast examination) was used to test criterion validity by logistic regression and receiver operating characteristic (ROC) curve; convergent validity was tested by the barriers subscale of the health beliefs questionnaire. Internal consistency reliability was tested by Cronbach's alpha coefficients. RESULTS: Factor analysis revealed five subscales: social barriers, exposure barriers, environmental barriers, uneasiness with own body, and traditional beliefs concerning cancer. The factors accounted for 54.6% of cumulative variance. Twelve items not meeting item-scale criteria were removed, resulting in a 21-item instrument. Convergent validity was confirmed for all subscales except traditional beliefs. ACSB mean score explained between 0.79 (95% CI .72-.86) and 0.85 (95% CI .79-.94) of the area under the ROC curve of the screening procedures. Internal consistency of the subscales ranged from 0.76 to 0.90. CONCLUSIONS: The study showed initial satisfactory reliability of the ACSB. Validity was approved for social barriers, exposure barriers, environmental barriers and uneasiness with own body subscales, and only partially for traditional beliefs. Further examination of the instrument with different populations of Arab women is needed.
AIMS: To develop and assess an instrument for studying culture-specific barriers to performing examinations for early detection of breast cancer. METHODS: A three-step design: (a) content analysis of five focus groups (n=51); (b) constructing and initial testing of the Arab culture-specific barriers (ACSB) instrument in a pilot study (n=79); (c) testing for validity and reliability of the revised ACSB instrument (n=300, of these 200 Muslim and 100 Christian, mean age 48). Construct validity was examined using factor analysis. Performance of screenings (mammography and clinical and self breast examination) was used to test criterion validity by logistic regression and receiver operating characteristic (ROC) curve; convergent validity was tested by the barriers subscale of the health beliefs questionnaire. Internal consistency reliability was tested by Cronbach's alpha coefficients. RESULTS: Factor analysis revealed five subscales: social barriers, exposure barriers, environmental barriers, uneasiness with own body, and traditional beliefs concerning cancer. The factors accounted for 54.6% of cumulative variance. Twelve items not meeting item-scale criteria were removed, resulting in a 21-item instrument. Convergent validity was confirmed for all subscales except traditional beliefs. ACSB mean score explained between 0.79 (95% CI .72-.86) and 0.85 (95% CI .79-.94) of the area under the ROC curve of the screening procedures. Internal consistency of the subscales ranged from 0.76 to 0.90. CONCLUSIONS: The study showed initial satisfactory reliability of the ACSB. Validity was approved for social barriers, exposure barriers, environmental barriers and uneasiness with own body subscales, and only partially for traditional beliefs. Further examination of the instrument with different populations of Arab women is needed.