Adapting Champion's Breast Cancer Fear Scale to colorectal cancer: psychometric testing in a sample of older Chinese adults

Development and reliability and validity test of the Fear of Cancer Scale (FOCS)

OBJECTIVE

To develop a Fear of Cancer Scale (FOCS) for non-cancer populations.

METHODS

FOCS was developed by classical measurement theory. A total of 15 college students were invited to conduct semi-structured interviews. Seven experts were invited for expert consultation. A total of 2012 Chinese college students who had completed the electronic questionnaire on WJX.cn platform was included. The reliability and validity of FOCS were verified. Multiple linear regression analysis was adopted to explore the influencing factors of cancer fear among college students and further verify the validity of FOCS.

RESULTS

There were 17 items in the FOCS, including two subscales - direct fear (8 items), and indirect fear (9 items). FOCS had good validity and reliability. Multiple linear regression showed that GAD-7 score, CSDS score, negative coping score, positive coping score, guardian's highest education, gender, life satisfaction, nationality and major were the influencing factors of cancer fear (p < .05).

CONCLUSIONS

The 17-item FOCS was a reliable and valid measure to examine the level of cancer fear in non-cancer populations.

Development and psychometric evaluation of the Aversion to Bowel Cancer Screening Scale

OBJECTIVE

Avoidance of colorectal cancer (CRC) screening is well documented with emotional barriers deterring screening intention and uptake. However, the assessment of such aversion is limited by the available instruments focusing on siloed emotions or screening procedures, limiting relevance to the complete process of decision-making in the CRC context.

METHODS

To address this gap, psychometric properties of the newly developed Aversion to Bowel Cancer Screening Scale (ABCSS) were assessed using data from 640 CRC screening eligible asymptomatic community members. Item review and piloting reduced 179 items to the initial 29-item scale. Using a holdout sample technique, exploratory and confirmatory factor analysis, reliability and validity checks were conducted.

RESULTS

A three-factor model (Fecal Occult Blood Test [FOBT] Aversion, Colonoscopy Aversion and Health Conscientiousness) with 21 items was identified. Analyses of the 21-item ABCSS indicated excellent reliabilities for the scale and subscales (α = .91 to .95). Correlations with relevant existing measures, intention and behaviour indicated good construct validity.

CONCLUSION

The ABCSS is a valid measure of aversion to CRC screening for asymptomatic community members facing the decision to undertake CRC screening. This instrument may provide a more comprehensive understanding of the decision-making process for CRC screening.

Psychometric Evaluation of a Fear of COVID-19 Scale in China: Cross-sectional Study

BACKGROUND

At the very beginning of the COVID-19 pandemic, information about fear of COVID-19 was very limited in Chinese populations, and there was no standardized and validated scale to measure the fear associated with the pandemic.

OBJECTIVE

This cross-sectional study aimed to adapt and validate a fear scale to determine the levels of fear of COVID-19 among the general population in mainland China and Hong Kong.

METHODS

A web-based questionnaire platform was developed for data collection; the study instruments were an adapted version of the 8-item Breast Cancer Fear Scale ("Fear Scale") and the 4-item Patient Health Questionnaire. The internal construct validity, convergent validity, known group validity, and reliability of the adapted Fear Scale were assessed, and descriptive statistics were used to summarize the participants' fear levels.

RESULTS

A total of 2822 study participants aged 18 years or older were included in the analysis. The reliability of the adapted scale was satisfactory, with a Cronbach α coefficient of .93. The item-total correlations corrected for overlap were >0.4, confirming their internal construct validity. Regarding convergent validity, a small-to-moderate correlation between the Fear Scale and the 4-item Patient Health Questionnaire scores was found. Regarding known group validity, we found that the study participants who were recruited from Hong Kong had a higher level of fear than the study participants from mainland China. Older adults had a higher level of fear compared with younger adults. Furthermore, having hypertension, liver disease, heart disease, cancer, anxiety, and insomnia were associated with a higher fear level. The descriptive analysis found that more than 40% of the study participants reported that the thought of COVID-19 scared them. About one-third of the study participants reported that when they thought about COVID-19, they felt nervous, uneasy, and depressed.

CONCLUSIONS

The psychometric properties of the adapted Fear Scale are acceptable to measure the fear of COVID-19 among Chinese people. Our study stresses the need for more psychosocial support and care to help this population cope with their fears during the pandemic.

Fear of breast cancer among young Spanish women: Factor structure and psychometric properties of the Champion breast cancer fear scale

Heightened fear of breast cancer (FBC) has been linked to increased distress following breast cancer diagnosis and to avoidance of mammography screening. To our knowledge, however, no studies have examined the nature of FBC exclusively among young females, even though they are overrepresented in media stories of breast cancer. Given that no instruments are available to assess FBC in the Spanish language, we sought to 1) evaluate the psychometric properties and factor structure of the Champion Breast Cancer Fear Scale (CBCFS), and 2) offer preliminary data on the nature of FBC among young women. Participants (N = 442, mean age = 21.17, range 17-35) completed the translated CBCFS (CBCFS-es) and the Spanish version of the Short Health Anxiety Inventory. The CBCFS-es demonstrated good concurrent validity, internal consistency, and test-retest reliability. Confirmatory factor analysis showed adequate fit to a one-factor solution. The majority of participants reported considerably high levels of FBC, as 25.34% and 59.73% of them scored above the moderate- and high-FBC cut-offs, respectively. Moreover, FBC could not be explained by general concerns regarding health and illness, given that levels of health anxiety were low. Implications for health education, research, and clinical practice are discussed.

Cancer-Related Information Seeking and Scanning Behaviors among Older Chinese Adults: Examining the Roles of Fatalistic Beliefs and Fear

Effective communication in health information plays an important role in health promotion and cancer prevention. Cancer-related information acquisition can happen via active and purposeful seeking, but may also happen less purposely via the routine use of media and interactions with other people (called scanning). We examined seeking and scanning behaviors regarding cancer prevention in older Chinese adults, identified commonly used sources of information of such behaviors, and examined their associations with fatalistic beliefs and cancer fear. A convenience sample of 224 community-dwelling adults aged ≥60 were recruited between May and July in 2013 in Hong Kong. Results suggested that cancer information scanning (79.5%) was more common than information seeking (30.4%) among our participants. Health professional was the most popular source for both scanning (78.7%) and seeking (58.8%) behaviors regarding cancer information. Fatalistic beliefs was significantly and negatively associated with seeking behaviors (OR = 0.50) but not scanning behaviors, and cancer fear showed no relationship with either behavior. This study shows that the cancer information seeking and scanning behaviors were still suboptimal in this age group and adds to the knowledge regarding the associations between fatalistic beliefs and fear with cancer information seeking and scanning behaviors among older Chinese adults.

Exploring Chinese Women's Perception of Cervical Cancer Risk as It Impacts Screening Behavior: A Qualitative Study

BACKGROUND

Chinese women rarely undergo regular cervical screening. Women's decisions about cervical screening may be influenced by their perception of the risk of cervical cancer. Therefore, understanding how women perceive the risk of cervical cancer, how personal risk factors are interpreted, and the influence of cultural issues on cervical screening behavior is important.

OBJECTIVE

The aim of this study is to understand cervical cancer risk perception and the role of personal risk factors as they influence screening behavior among Chinese women.

METHOD

An exploratory qualitative research design was used. We conducted semistructured, in-depth interviews of 27 women in Changsha, a medium-size city in Hunan province, China.

RESULTS

Participants identified that cervical cancer had serious consequences, but they distanced themselves psychologically from the disease because they felt that "cervical cancer is a shameful and deadly disease." Although women identified some of the risk factors for the disease, they had little specific knowledge of human papillomavirus infection, its association with cervical cancer, and the importance of cervical screening.

CONCLUSION

This study contributes new knowledge to the understanding of cervical screening behavior within a specific social and cultural context. Better efforts should be made to educate Chinese women on the risk of cervical cancer and emphasize that effective cancer treatments are available and that there is a good chance of survival.

IMPLICATIONS FOR PRACTICE

Nurses working with Chinese women should ensure that the information they provide is culturally sensitive, particularly by acknowledging the normative beliefs of this population group.

Effects of Promotional Materials on Attitudes and Fear towards Colorectal Cancer Screening among Chinese Older Adults: An Experimental Study

Colorectal cancer (CRC) screening is a cost-effective prevention and control strategy. However, the promotion of CRC screening for older adults may be difficult because reading CRC prevention information may evoke embarrassment, fear, and anxiety towards the screening procedure and cancer diagnosis. This study aims to (1) examine the effects of three promotional materials for CRC screening on the attitudes toward CRC screening tests (screening interest, screening effectiveness, and trust in the screening results) and cancer fear, and (2) to explore the interaction effect of cancer fear with screening effectiveness and trust in the screening results on screening interest of the three screening tests (fecal occult blood test (FOBT), flexible sigmoidoscopy, and colonoscopy) among Chinese older adults. A total of 114 community-dwelling older adults were asked to look at the corresponding promotional materials (pamphlet, cartoon, and video) of one of the three study groups. The pamphlet and video represent convention strategies and the cartoon represents an innovative strategy. No significant difference was observed in the screening interest and cancer fear across groups. FOBT was the most preferred screening modality. The video group has a large proportion agreed screening effectiveness of flexible sigmoidoscopy than pamphlet and cartoon groups and trusted in the screening results for FOBT and flexible sigmoidoscopy than the pamphlet group. Logistic regression results showed that the effect of trust in the screening results on screening interest for colonoscopy was greater among participants with higher cancer fear than those with lower cancer fear level. In conclusion, the three promotional groups had produced similar results in their attitudes toward CRC screening and cancer fear. The use of cartoons may be a comparable approach with conventional methods in the promotion of CRC screening. Additional components that can arouse fear and boost response efficacy simultaneously might also be useful for the effective promotion of colonoscopy among Chinese older adults.

Determinants of participation in colorectal cancer screening among community-dwelling Chinese older people: Testing a comprehensive model using a descriptive correlational study

PURPOSE

The prevalence of colorectal cancer (CRC) among older people is high. Screening for CRC presents a cost-effective secondary prevention and control strategy which results in a significant reduction in mortality. This study aims to describe the prevalence of CRC screening and examine its risk factors among Chinese community-dwelling older people guided by a comprehensive model combining Health Belief Model and Extended Parallel Processing Model.

METHODS

A descriptive correlational study was conducted. A convenience sample of 240 community-dwelling adults aged ≥60 was recruited in May-July in 2012 in Hong Kong. Participants were asked to complete a questionnaire which collected information on demographic variables, CRC-related psychosocial variables and whether they had a CRC screening in the past 10 years.

RESULTS

Among the participants, 25.4% reported having a CRC screening test. Results of logistic regression analyses indicated that participants with a higher level in cue to action, and lower perceived knowledge barriers and severity-fear were significantly associated with participation in CRC screening. But there were no significant associations between fatalism and cancer fear with screening.

CONCLUSIONS

The prevalence of CRC screening was low in Hong Kong Chinese community-dwelling elders. A number of modifiable factors associated with CRC screening were identified which provides specific targets for interventions. This study also adds to the knowledge regarding the associations between fatalism and fear with CRC screening behaviors among Chinese older people.