Refining the use of cancer-related cultural constructs with African Americans.

An important step in using culture to increase colorectal cancer screening is the development and use of a reliable and valid measure. Measurement items that work well are defined as those that use clear and simple language, do not result in significant missing data, do not yield unexpected frequencies or patterns of association, and capture an important component of the underlying construct. The authors' work to develop such a measure includes cognitive response testing. This article describes 41 African American participants' reactions to and processing of items that have been used in the public health literature to assess cultural attitudes believed to be relevant to colorectal cancer screening. Participants were asked to verbalize thoughts, feelings, interpretations, and ideas that came to mind while examining or responding to 10 to 11 survey items. The results of cognitive response testing suggest negative reactions to items addressing the fatalism construct, concerns about appearing racist when responding to discrimination and mistrust items, and resistance to phrasing or terminology that conveys negative attitudes or frames of reference. When items were framed in a positive way, participants reported less frustration, confusion, and concern for how they would be perceived by others. The responses of older African Americans in this sample were consistent with research previously completed by Pasick et al.; participants questioned the relevance of items related to cultural constructs to health and cancer preventive behaviors. Recommendations for the assessment and use of cultural constructs and items assessing constructs are provided.