Measurement of the knowledge, beliefs, attitudes, and practices of Arab American adults towards cancer screening and early detection: Instrument development and theory testing

Purpose. The aims of this study are to develop and examine the psychometric properties of a 48-item The Cancer Knowledge, Attitudes, & Beliefs Scale (C-KABS), to evaluate the Cancer Screening Action Model (C-SAM), and to generate knowledge regarding the attributes of cancer screening behaviors among Arab American Adults. A comprehensive review of the literature revealed lack of baseline information on the Arab American cancer screening behavior and an instrument to measure it. Five experts reviewed the instrument and a content validity index was obtained.; Sample & design. Adult Arab American participants (n = 174) were recruited at two community sites, and completed two instruments to measure their cancer screening behaviors (C-KABS, and Champion's Health Belief Model Scales), and two other instruments to evaluate their acculturation patterns (Strength of Cultural Affiliation Scale, and the Arabic-Speaking Patients' Acculturation Scale). C-KABS was completed at three times (test, bilingual, and retest) to determine the validity and reliability of the Arabic & English versions of the measure.; Results. Total alpha of the final instrument, after deleting 8 items, was (0.71). Factor analysis revealed six subscales of the C-KABS: perceived benefits, perceived barriers, cancer screening-related self-efficacy, cancer risk-related knowledge, cancer-related cultural beliefs, and cancer screening behaviors. Alpha for subscales ranged from 0.57 to .76; number of items per subscale ranged from 3 to 12. English to Arabic versions reliability was .92; test-retest reliability was .80, and structural equation modeling using AMOS 4.0 showed that the modified C-SAM had a good fit. Fit indices for the structural model were: Chi Square/df = 2.4, NFI = .98, IFI = .99, CFI = .99, and RMSEA = .09. Attributes of cancer screening were also examined. Personal risk appraisal had significant negative correlations with income and education (−.31, & −.2 respectively). Barriers had a significant negative correlation with cancer screening behavior (−.21). Although cultural values and beliefs did not correlate significantly with screening behavior, they were significant predictors of personal risk appraisal (.69, and .13, respectively). Self efficacy had the strongest correlation to screening behavior (.56). Cancer screening practices were evaluated according to American Cancer Society's 2003 guidelines. Surprisingly, 44% of the sample never did any testing for cancer, and only 22% did all required testing up-to-date.; Conclusion. The results suggest a valid and reliable measure and support for the C-SAM model. Descriptive and correlational statistics have shown an urgent need for cancer awareness programs in the Arab American community.