Development of a Breast Cancer Awareness Scale for Thai Women: Moving towards a Validated Measure

Risk perception of non-communicable diseases: A systematic review on its assessment and associated factors

BACKGROUND

The burden of non-communicable diseases (NCDs) is increasing. Risk perception of NCDs is an important factor towards the uptake of preventive health interventions. There are various questionnaires assessing risk perception of NCDs, but no internationally standardized questionnaire has been available. Identification of factors associated with risk perception of NCDs may facilitate the development of targeted interventions. This systematic review aims to identify available questionnaire assessing risk perception of NCDs and the factors associated with risk perception of NCDs.

METHODS

The reporting of this systematic review is in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We carried out a literature search through three databases (Scopus, PubMed, Web of Science) and targeted original article published in English between 2012 and 2021. Quality appraisal of the eligible articles was conducted using the Mixed Methods Appraisal Tool. Findings were synthesized using content analysis.

RESULTS

A total of 86 studies were included. We found a variety of questionnaires assessing risk perception of NCDs, with many differences in their development, domains, items and validity. We also identified several personal, sociopsychological and structural factors associated with risk perception of NCDs.

LIMITATIONS

Most of the included studies were of cross-sectional design, and therefore the quality of evidence was considered low and exhibit a high risk of bias. The role of publication bias within this systematic review should be acknowledged as we did not include grey literature. Additionally, language bias must be considered as we only included English-language publications.

CONCLUSION

Further development and testing of available questionnaire is warranted to ensure their robustness and validity in measuring risk perception of NCDs. All the identified factors deserve further exploration in longitudinal and experimental studies.

Breast Self-examination Among AKHA Women (Hill Tribe Group) in Chiang Rai, Thailand

The mortality rate of breast cancer has increased in worldwide and reported first rank of women cancer in Thailand. One an urgent concern of prevention and education on early detection is Breast Self-examination (BSE). This study aims to report the percentage of BSE and examine the associated factors with BSE among Akha women, the largest ethnic group in northern part of Thailand. A study was conducted with 296 Akha women by survey quantitative data. Descriptive statistic and Binary regression were used for analysis. The majority of the participants were 45-59 years old (51.70%), and illiterate (68.90%). The percentage of good BSE founded 19.60%. The participants who received breast information showed zero-point one three time more likely to report good BSE compared to those non receiving (OR 0.13; 95% CI 0.03-0.53). Factor of susceptibility, benefit of BSE, barrier of BSE, and BSE confident were association with BSE practice. Based on findings, we recommend implementing a new practical program such as BSE media in Akha Language to promote BSE in this ethnic group.

Development and validation of the MARA scale in Spanish to assess knowledge and perceived risks and barriers relating to breast cancer prevention

Objective

The aim of this study was to develop a measurement instrument for assessing knowledge of breast cancer and perceived risk of developing the disease (MARA).

Methods

641 women with a mean age of 36.19 years (SD = 7.49) participated in the study. Data collection took place during 2019 and included sociodemographic data, data on history of cancer and breast cancer, perceived risk, and feelings of concern about developing breast cancer. Internal consistency, test–retest reliability, convergent validity, and structural validity were tested.

Results

The questionnaire items comprise 4 subscales: risk factors (9 items), signs and symptoms (9 items), perceived risk (6 items), barriers (7 items). A factor analysis revealed that the first two subscales had two dimensions each, whereas the other two subscales had one dimension each. Each subscale was shown to have adequate reliability (α = 0.74–0.92) and temporal stability (r = 0.201–0.906), as well as strong evidence of validity in relation to a questionnaire on breast cancer knowledge (r = 0.131–0.434). In addition, the subscales were shown to have high discriminatory power in terms of the presence or absence of a history of cancer or breast cancer, perceived risk, and feelings of concern.

Conclusion

The MARA questionnaire represents a valid, reliable tool for assessing Spanish women’s knowledge, risks, perceptions, and barriers regarding breast cancer.

Factors associated with breast cancer awareness and breast self-examination in Fiji and Kashmir India - a cross-sectional study

BACKGROUND

In low-income countries breast cancer awareness (BCA) is essential to reduce the proportion of advanced stage presentations of breast cancer. There is a lack of studies using multivariable techniques to explore factors related to BCA in low-income countries. The objective of this study was to identify to what extent women in Fiji and Kashmir, India have BCA and practice breast self-examination (BSE) as well as factors associated with BCA and BSE.

METHODS

A survey of women aged ≥18 years was conducted in Fiji and Kashmir, India to assess BCA and rates of BSE. Comparison between Fiji and Kashmir was done using student's t-test for continuous data and chi-square for binary data. Factors associated with BCA and BSE were analysed using a multivariable logistic regression for Fiji and Kashmir separately.

RESULTS

Data were collected from 399 and 1982 women in Kashmir and Fiji, respectively. Of 1968 women in Fiji 57% were deemed to have an acceptable BCA compared to only 7.3% of 395 women in Kashmir. Having some education was associated with having BCA with an odds ratio of 4.7 (1.7-13) in Fiji and 10 (1.7-59) in Kashmir. Of 1976 women in Fiji 40% had tertiary education while 40% of 392 women in Kashmir had no education at all. The marital status was similar in both samples (n = 1973 and 395) with 68-69% being married and 21-26% being single. The lack of female doctors or nurses with whom to discuss issues, was perceived as a problem in both countries.

CONCLUSIONS

The key finding is an association between having any level of education and BCA. This correlation was much stronger than for a family history of breast cancer and BCA. Hence, general education to illiterate women may reduce the proportion of women in low-income countries presenting with advanced-stage breast cancer.

Construction and Validation of Breast Cancer Awareness Scale in Iranian Women

Introduction: Application of a single valid and reliable questionnaire in future studies in the area of Iranian women’s awareness of breast cancer provides the health policymakers with a comprehensive view over the issue. In designing the current questionnaires in Iran, the prior researchers neither explained about the design procedure, nor calculated the validity and reliability of the questionnaire completely. In this regard, researchers decided to design a standard questionnaire to examine women’s awareness about the symptoms and risk factors of the breast cancer.

Methods: This methodological study was conducted on 250 women in Yazd. Data were collected by a researcher-made questionnaire. The reliability was determined using the Cronbach’s alpha and test-retest method. Factor analysis was used to determine the construct validity in SPSS version 21.

Results: The face validity of the questionnaire was evaluated by the target population. The results of the impact score indicated that all questions had a score equal or greater than 1.5. The qualitative content validity of the questionnaire was evaluated by the expert panel. Content validity ratio (CVR) and content validity index (CVI) obtained close to one for questionnaire. Construct validity was confirmed by performing factor analysis and dimensions of the questionnaire were determined. Cronbach’s alpha coefficient for all dimensions was higher than 0.8. Also, intraclass correlation coefficient (ICC) for all dimensions was close to one and was between 0.84-0.95.

Conclusion: Validity and reliability of designed questionnaire in this study for Iranian women are acceptable and suitable.

Awareness of Breast Cancer Risk Factors, Symptoms and Breast Self-Examination Among Omani Female Teachers: A cross-sectional study

OBJECTIVES

This study aimed to assess knowledge of breast cancer (BC) risk factors, warning signs and symptoms and breast self-examination (BSE) practice among Omani female teachers in Al-Dhahira Governorate.

METHODS

A cross-sectional sample of female teachers aged 20-50 years was collected from January to December 2018 from three wilayats (provinces) in Al-Dhahira-Ibri, Dhank and Yunqal. A questionnaire that included the Breast Cancer Awareness Scale and demographic characteristics was administered. Data were analysed using descriptive statistics, regression analysis and Pearson's Chi-square test.

RESULTS

A total of 478 female teachers were included in the study (response rate: 72.4%). The majority of participants (60.5%) had good overall knowledge about BC while 19.9% of participants had excellent overall knowledge. Only 9% of participants demonstrating excellent knowledge of BC risk factors. More than half of the participants (56.1%) reported excellent knowledge in screening methods. Unfortunately, only 57% of the female teachers indicated practising BSE. Knowledge of BC symptoms was closely divided between excellent and good levels (45.8 and 42.5%, respectively). BSE practice was significantly (P <0.05) correlated with overall knowledge of BC and its symptoms and screening methods, but not with knowledge of BC risk factors.

CONCLUSION

This study revealed unsatisfactory overall knowledge of BC risk factors, symptoms, screening methods and BSE practice among female Omani teachers in Al-Dhahira Governorate. These findings constitute a challenge to healthcare providers to continue developing awareness of BC and providing health information to the public.

Factors Associated with Breast Cancer Awareness in Thai Women

Background:

Breast cancer is the most common cancer in women worldwide. In south-east Asia, both the incidence and mortality rates of breast cancer are on the rise, and the latter is likely due to the limited access to large-scale community screening program in these resource-limited countries. Breast cancer awareness is an important tool which may, through increasing breast self-examination and the seeking of clinical examination, reduce breast cancer mortality. Investigating factors associated with breast cancer awareness of women is likely to help identify those at risk, and provide insights into developing effective health promotion interventions.

Objective:

To investigate factors associated with breast cancer awareness in Thai women.

Methods:

A cross-sectional sample of Thai women aged 20-64 years was collected during August to October, 2015 from two provinces of southern Thailand (Surat Thani and Songkla). A questionnaire including the Breast Cancer Awareness Scale along with demographic characteristics was administered and Proportional Odds Logistic regression was then used to investigate factors associated with breast cancer awareness.

Results:

In total, 660 Thai women participated in this study. Factors most often associated with the various breast cancer awareness domains were age and rurality. While rural women had poorer knowledge of breast cancer signs and symptoms, they also had lower levels of perceived barriers and considerably better breast cancer awareness behaviors.

Conclusion:

Despite lower knowledge of breast cancer risk factors and no evidence of better knowledge of signs and symptoms, we found rural Thai women had considerably better breast cancer awareness behavior. This may be due to these women’s lower levels of perceived barriers to breast cancer screening services. Indeed this suggests, at least in Thai women, that interventions aimed at lowering perceived barriers rather than enhancing disease knowledge may be more successful in engaging women with breast cancer screening services and increasing breast self-examination.

Awareness Level about Breast Cancer Risk Factors, Barriers, Attitude and Breast Cancer Screening among Indonesian Women

Background: Globally, breast cancer is the second most common cancer in women and is a leading cause of mortality in Indonesia. Raising awareness of breast cancer is particularly important to help at risk women seek medical treatment for this disease. This study aimed to comprehensively investigate the Indonesian women’s level of knowledge about breast cancer risk factors, barriers, attitude and breast cancer screening. Methods: This population-based cross-sectional study administered the breast cancer awareness Indonesian scale (BCAS-I) to 856 Indonesian women. Samples were selected in rural and urban combinations from three provinces by stratified random sampling. The ordinal logistic model was used to investigate the clustering effect of the participant’s characteristics in this study. Results: Of the women, 62% lived in rural areas and 38% lived in urban areas. Living in an urban area was significantly associated with a lower knowledge of the risk factors. However, living in an urban area was significantly associated with better attitudes and healthier behaviours related to breast cancer awareness. Women with higher education levels had 70% worse attitudes toward breast cancer awareness. Women living South of Sumatera, women living in Yogyakarta, and unmarried women were 5.03, 3.84, and 1.56 times as likely to have higher perceived barriers, respectively. Conclusion: Urban women had a poorer level of knowledge of breast cancer risk factors compared to women living in more rural areas. The result of this study may reflect inadequate breast cancer awareness campaigns or a lack of breast cancer awareness campaigns. These findings suggest that additional education programs aiming to increase awareness and educate the public are needed.

Hong Kong female’s breast cancer awareness measure: Cross-sectional survey

BACKGROUND

In women worldwide, breast cancer is the most common cancer. Breast cancer accounted for 26.6% of all new cancers in females diagnosed in 2015 in Hong Kong.

AIM

To examine women’s awareness, perception, knowledge, and screening practice of breast cancer in Hong Kong.

METHODS

We carried out a population-based survey using random telephone interviews to women aged 18 or above using the United Kingdom Cancer Research Breast Cancer Awareness Measure (United Kingdom CAM). The data was analysed using proportions, chi-square test (χ²-test) and adjusted odds ratios (ORs).

RESULTS

A total of 1000 participants completed the CAM questionnaire from 1,731 responses (response rate = 57.8%) from September to October 2017. One in five and one in four respondents recalled ≥ 3 early warning signs and ≥ 2 risk factors of breast cancer respectively. The majority (62.6%) reported they were not confident that they would notice a change in their breasts. Among the respondents, 16.8% would have regular mammography at least every two years. In general, 4 in 10 women had tried practices on preventing breast cancer. Respondents with better result in recalling breast cancer signs and symptoms were more likely to seek immediate medical help when noticed a change in their breasts (χ²-test P = 0.038), and more likely had tried prevention practice (χ²-test P < 0.001). Respondents received higher education (secondary school or above) had higher breast cancer awareness (OR = 2.83, CI: 1.61-4.97), more frequent screening (OR = 2.64, CI: 1.63-4.26) and more had tried prevention practices (OR = 2.80, CI: 1.96-4.02) when compared to those with lower education. Those in age groups 31-45 and 46-60 had higher percentages in performing breast self-exam and mammography when compared to the 18-30 and 61 or above age groups.

CONCLUSION

Population-wide public health initiatives should emphasize on prevention and early detection of breast cancer in women, with targeted strategy for those with low education level and advance in age.

Awareness of breast cancer screening and risk factors among Saudi females at family medicine department in security forces hospital, Riyadh

Objectives:

To describe the level of knowledge about breast cancer screening and breast cancer risk factors according to sociodemographic characteristics and to know the most common source of their knowledge among the females participating in this study.

Patients and Methods:

A cross-sectional descriptive study conducted through distributing validated pretested Arabic questionnaire. The sample are Saudi adult females age 18–55 years attending the Family Medicine Department at Security Forces Hospital for healthcare services or accompanying patients.

Results:

Of 384 participants, 57% were aware that lump or thickening in the breast could be a sign of breast cancer and 68% knew bleeding or discharge from nipple as a warning sign of breast cancer. Fortunately, 291 women (75.8%) have a good knowledge about breast cancer risk factors, and only 93 women (24.4%) have poor knowledge. Regarding knowledge about the screening of breast cancer, 60.9% knew breast self-examination and clinical breast examination (CBE) are the methods of early detection of breast cancer. About 53.1% of women have heard about CBE.

Conclusion:

All the participants showed sufficient knowledge about the risk factors and symptoms of breast cancer but insufficient knowledge about screening methods. These findings are encouraging for public awareness about how to screen themselves and guidance to health authorities for developing effective breast healthcare programs in the entire Kingdom for the all-female population.

Transcultural adaptation and validation of the Persian version of the breast cancer awareness measure (BCAM) questionnaire

BACKGROUND/OBJECTIVE

Enhancing awareness level about breast cancer is a pivotal strategy for reducing breast cancer burden. There is no fully validated Persian instrument for evaluating breast cancer awareness. This study aimed at investigating the validity and reliability of the Persian version of the Breast Cancer Awareness Measure (BCAM) questionnaire.

METHODS

This methodological cross-sectional study was conducted among 1078 Persian language women (including 965 general women and 113 medical/clinical experts), which selected from different parts of Isfahan city using multistage cluster random sampling method. Translation of BCAM questionnaire was performed using forward-backward method. Internal consistency was evaluated through Cronbach's α and test-retest reliability using unweighted kappa statistic and intraclass correlation (ICC) coefficient. Construct validity was investigated using both exploratory and confirmatory factor analyses as well as Latent class analysis (LCA), and discriminant validity using ROC curve. Convergent validity was assessed using phi and eta correlation coefficients. Ceiling and floor effects, SE of measurement (SEM), and smallest detectable change (SDC) were also determined.

RESULTS

Persian version of BCAM showed excellent test-retest reliability (ICC = 0.841) and internal consistency (Cronbach's alpha = 0.882). Most of the computed kappa coefficients were in the range moderate to very good (0.47-0.81). Medical/clinical experts had higher levels of breast cancer awareness than general women, indicating good discriminant validity (Area under the curve [AUC]) of 0.822 (95% CI: 0.781, 0.864). Construct validity evaluation by exploratory factor analysis (EFA) led to extraction of two factors from 11 items ("breast shape changes" and "breast pain and lump"), and the confirmatory factor analysis (CFA) confirmed the adequacy of extracted construct from EFA. Latent class analysis for evaluating of construct validity led to extracting three classes from participants (high [12.83%], moderate [60.97%], and low [26.2%]) in terms of awareness levels about early warning signs of breast cancer. All item-scale correlation coefficients exceeded the set value of 0.40, indicating satisfactory convergent validity. No ceiling and floor effects were detected. SEM and SDC were found to be 0.85 and 2.36, respectively.

CONCLUSIONS

The Persian version of BCAM is a reliable and valid instrument for monitoring levels of breast cancer awareness in general women population, also it can be used for evaluating the impacts of interventions attempting to raise breast cancer awareness.

Assessing Breast Cancer Awareness in Thai Women: Validation of the Breast Cancer Awareness Scale (B-CAS)

Background:

Raising breast cancer awareness is a well-established first line strategy to reduce breast cancer mortality. A properly validated instrument is needed to gain a better understanding of breast cancer awareness.

Objective:

The objective of this study was to develop and validate an instrument to assess breast cancer awareness in Thai women.

Methods:

In this study, we develop and evaluate the validity of the Breast Cancer Awareness Scale (B-CAS). Construct validity was evaluated by using exploratory factor analysis and confirmatory factor analysis, and criterion validity was investigated using ROC curves to examine the associations between B-CAS subscales and breast self-examination. Internal consistency and test-retest reliability were also investigated. This validation process employed two independent samples of Thai women aged 20-64 years collected from communities in southern Thailand.

Results:

In total, 660 Thai women (mean age 41 years) participated in this study. Confirmatory factor analysis demonstrated the construct validity of B-CAS (CFI =0.91; NNFI=0.90; GFI=0.95; AGFI= 0.95; RMSEA=0.044, 95%CI 0.041 to 0.047; P< 0.05). Several of the B-CAS subscales demonstrated strong utility in discriminating between women who do and do not regularly conduct breast self-examination. B-CAS also demonstrated strong internal consistency (Cronbach’s α=0.86) and test-retest reliability. The final version of B-CAS contains 35 items across five domains: knowledge of risk factors, knowledge of signs and symptoms, attitude to breast cancer prevention, barriers of breast screening, and health behaviour related to breast cancer awareness.

Conclusion:

The breast cancer awareness scale (B-CAS) was shown to have good psychometric properties in Thai women, and is likely to prove useful in studying the epidemiology of breast cancer awareness in Thai women, and evaluating breast cancer prevention programs for raising awareness.

Validation of an Indonesian Version of the Breast Cancer Awareness Scale (BCAS-I)

Background: Raising breast cancer awareness is a key strategy to reduce associated mortality. While a paucity of adequately validated instruments for breast cancer awareness is applicable across cultures, even outside the health care setting such instruments have been developed. Objective: This study investigated the validity and psychometric properties of a breast cancer awareness scale in Indonesia (BCAS-I). Methods: This cross-sectional study was carried out among Indonesian women conveniently selected within three provinces (Yogyakarta, South of Sumatera and East Nusa Tenggara) located in rural-urban areas using stratified random sampling. First, we translated all questionnaires from English to the local language and then back-translated. The third step was to perform psychometric testing of the adapted instrument by establishing internal consistency (Cronbach’s alpha score 0.79) and construct validity by confirmatory factor analysis (CFA). Results: In the 856 participants who responded (responded rate = 98.28%), the age ranged from 18 to 80 years old (mean = 30, SD = 11). The BCAS-I was shown to have good internal consistency, and CFA demonstrated the model fit data adequately (χ2 = 922.267, df = 515, p <0.001, comparative fit index = 0.965, Tucker-Lewis Index = 0.96, goodness-of-fit index = 0.97, adjusted goodness-of-fit index = 0.97, root-mean-square error of approximation = 0.03 95% confidence interval: 0.027, 0.034). The final version of BCAS-I consists of 33 items across 5 domains that cover most key aspects of breast cancer awareness for this population. Conclusion: The BCAS-I demonstrated good psychometric properties and was found to be valid to provide a measurement of breast cancer awareness in Asian women in general and Indonesian women in particular.

Knowledge about Risk Factors for Breast Cancer and Having a Close Relative with Cancer Affect the Frequency of Breast Self-Examination Performance

BACKGROUND

Breast cancer incidence and mortality rates are increasing in North-Eastern Brazil and the patients with the disease often presented at advanced stages. The present study was focused on identifying variables that affect women's frequency of breast self- examination (BSE) performance.

MATERIALS AND METHODS

Data on BSE, socio-economic parameters and risk factors for breast cancer were obtained from 417 women from a community in North-Eastern Brazil by a self-informant method. To identify independent variables that affect frequency of BSE, nominal logistic regression analysis was performed.

RESULTS

Of 417 women, 330 (79.3%) reported performing BSE. Compared to high-income women, BSE performance by low-income women every month was 7.69 (OD=0.130; CI 95%: 0.044- 0.0386; p=0.000) times lower. Women who did not live in a stable union performed BSE each month 2.73 (OD=0.366; CI 95%: 0.171-0.782; p=0.010) less often than those living in a stable union. BSE performance every month and every six months or every year by women with poor knowledge about risk factors for breast cancer was 3.195 (OD=0.313; CI 95%: 0.141- 0.695; p=0.004) times and 2.028 (OD=0.493; CI 95%: 0.248- 0.979; p=0.043) times lower, compared to women with good knowledge. Participants who had a close relative with cancer performed BSE every month and every six months or every year 2.132 (OD=0.469; CI 95%: 0.220-0.997; p=0.049) times and 2.337 (OD=0.428; CI 95%: 0.219-0.836; p=0.013) times less often, compared to those women without close relatives with cancer.

CONCLUSIONS

The results of this study indicated that income, marital status, knowledge about risk factors and having a close relative with breast cancer, affect the frequency of BSE performance. Information about risk factors in public health campaigns could additionally strengthen avoidance behaviour and also motivate BSE performance.