Mammography self-efficacy scale and breast cancer fear scale: Psychometric properties of the Arabic versions among Saudi women

Abstract

Background: Breast cancer accounted for 14.2% of all diagnosed cancer cases in 2012 as identified by the Saudi Cancer Registry. Incidence rates of cancer in general and breast cancer, in particular, vary across regions, with the Eastern region and Riyadh exhibiting the highest rates. A recent study reported that breast cancer was responsible for 13.08% of all cancer-related deaths between 2004 and 2013. Early screening for breast cancer is critical for improving health outcomes and reducing mortality. Research has shown that self-efficacy and fear of breast cancer can influence patients’ screening behaviors. Validated measures to assess these constructs among Saudi women are lacking.

Aim: The aim of this study was to translate and assess the psychometric properties of the of the Champion Mammography Self-Efficacy Scale (CMSES) and Champion Breast Cancer Fear Scale (CBCFS) in a sample of Saudi women.

Methods: The CMSES and CBCFS were back-translated into Arabic using an established translation protocol. Six additional items were added to the CMSES based on other relevant research conducted with Muslim women. The study sample consisted of 749 Saudi women aged 18 years and older from the general population (community sample) and female patients who were referred to mammogram centers (patient sample) in three different cities (Najran, Abha, and Jeddah). Reliability was assessed using Cronbach alpha coefficients. Construct validity was evaluated using exploratory and confirmatory factor analytical procedures. This study was approved by the General Directorate of Health Affairs (IRB 2018-001 E).

Results: Participants’ mean (SD) age was 35.8 years (11.9). The vast majority of women (96%) had not reached menopause and reported having a family history of breast cancer (58%). More than half (63%) indicated that they were aware of mammography, 54% reported that they had had at least one mammography in previous two years, and 72% reported that they knew about breast self-examination. The findings from the factor analysis confirmed the unidimensional structure of both scales as reported by the original authors. Additionally, both scales exhibited high internal consistency (Cronbach alpha coefficients) of 0.91 for the modified CMSES-Arabic and 0.94 for the CBCFS-Arabic. The modified CMSES-Arabic and the CBCFS-Arabic have good psychometric properties and are recommended to be used in research with Saudi Arabia.

Implications for Practice: Future research should utilize these measures to better understand how self-efficacy and fear of breast cancer are related to compliance with cancer screening methods among Saudi women and other Arabic-speaking contexts. The scales could also be useful for developing and testing the effectiveness of interventions aimed at improving mammography testing rates.