Abstract
BackgroundMeasuring factors influencing time to presentation is important in developing and evaluating interventions to promote timely cancer diagnosis, yet there is a lack of validated, culturally relevant measurement tools. This study aimed to develop and validate the African Women Awareness of CANcer (AWACAN) tool to measure awareness of breast and cervical cancer in Sub-Saharan Africa (SSA).MethodsDevelopment of the AWACAN tool followed 4 steps: 1) Item generation based on existing measures and relevant literature. 2) Refinement of items via assessment of content and face validity using cancer experts’ ratings and think aloud interviews with community participants in Uganda and South Africa. 3) Administration of the tool to community participants, university staff and cancer experts for assessment of validity using test-retest reliability (using Intra-Class Correlation (ICC) and adjusted Kappa coefficients), construct validity (comparing expert and community participant responses using t-tests) and internal reliability (using the Kuder-Richarson (KR-20) coefficient). 4) Translation of the final AWACAN tool into isiXhosa and Acholi.ResultsICC scores indicated good test-retest reliability (≥ 0.7) for all breast cancer knowledge domains and cervical cancer risk factor and lay belief domains. Experts had higher knowledge of breast cancer risk factors (p < 0.001), and cervical cancer risk factors (p = 0.003) and symptoms (p = 0.001) than community participants, but similar knowledge of breast cancer symptoms (p = 0.066). Internal reliability for breast cancer risk factors, lay beliefs and symptom and cervical cancer symptom subscales was good with KR-20 values > 0.7, and lower (0.6) for the cervical cancer risk subscale.ConclusionThe final AWACAN tool includes items on socio-demographic details; breast and cervical cancer symptom awareness, risk factor awareness, lay beliefs, anticipated help-seeking behaviour; and barriers to seeking care. The tools showed evidence of content, face, construct and internal validity and test-retrest reliability and are available for use in SSA in three languages.
Highlights
Breast and cervical cancer are the leading causes of cancer morbidity and mortality in women in Sub-Saharan Africa (SSA)
Research outside SSA has indicated that cancer symptom awareness among the general population can be low [11,12], and that interventions to increase awareness lead to better outcomes
In Malaysia, raising public awareness of symptoms has been associated with earler diagnosis of cervical cancer [13]
Summary
Breast and cervical cancer are the leading causes of cancer morbidity and mortality in women in Sub-Saharan Africa (SSA). A substantial proportion of advanced stage diagnosis of poorly differentiated breast cancer cases could be avoided if patients had presented within one month of detecting symptoms [4]. For both breast and cervical cancer there are often subtle but important symptoms in early stage disease, yet women may misinterpret these symptoms or wait until symptoms (and disease) progress before they seek medical attention [7,8,9,10]. This study aimed to develop and validate the African Women Awareness of CANcer (AWACAN) tool to measure awareness of breast and cervical cancer in Sub-Saharan Africa (SSA)
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