Abstract
BackgroundInformed choice is of ethical and practical importance in mammography screening. To assess the level to which decisions regarding such screening are informed is thus imperative, but no specific instrument has been available to measure informed choice in the German mammography screening programme. The aims of this study were to develop the Informed Choice in Mammography Screening Questionnaire (IMQ) and to find first evidence for the factor structure, reliability and validity of its different components.MethodsThe IMQ was sent to 17.349 women aged 50 in Westphalia-Lippe, Germany. The instrument has been developed after consideration of (1) the results of qualitative interviews on decision making in the mammography screening programme, (2) relevant literature on other informed choice instruments and (3) a qualitative study on influencing factors. The IMQ comprises 3 scales (attitude, norms, and barriers), 1 index (knowledge) and singular items covering intention to participate and sociodemographic variables. To assess the psychometric properties of the components of the IMQ, confirmatory factor and item response theory analyses were conducted. Additionally, reliability, validity and item statistics were assessed.Results5.847 questionnaires were returned (response rate 33.7%). For attitude, the confirmatory factor analysis supported a one-factor structure. For norms, the model fit was not acceptable. Reliability levels were good with a Cronbach‘s α of.793 for attitude (4 items) and.795 for norms (5 items). For barriers, 9 items were deleted because of low discrimination indices; 6 items remained. The hypothesised assumption-subscale and the importance-subscale were confirmed, but these subscales showed poor reliabilities with Cronbach‘s α=.525 (4 items) and.583 (2 items). For the knowledge index, item response theory analysis showed that 6 out of 7 items were suitable. Hypotheses concerning the correlations between the different components were confirmed, which supported their convergent and divergent validity.ConclusionThe results of this study demonstrated that the IMQ is a multidimensional instrument. Further development of the barriers and norms scales is necessary. The IMQ can be utilised to assess the level of informed choices as well as influencing factors.
Highlights
Informed choice is of ethical and practical importance in mammography screening
Fewer women die of breast cancer when they participate in mammography screening, but there is a lot of uncertainty regarding the size of the effect [3]
Women who had ever had breast cancer (n = 183), who had already participated in the MSP (n = 256), and who had completed the Turkish questionnaire (n = 114) were excluded, since this publication reports the psychometric properties of the German version of the in Mammography Screening Questionnaire (IMQ)
Summary
Informed choice is of ethical and practical importance in mammography screening. To reduce mortality from breast cancer and to improve treatment opportunities, a comprehensive mammography screening program for women aged 50 to 69 years was introduced in Germany in 2002 [2]. Fewer women die of breast cancer when they participate in mammography screening, but there is a lot of uncertainty regarding the size of the effect [3]. In which it is unclear whether the benefits outweigh the harms, it is important that women make informed choices. Women’s knowledge of possible screening outcomes and their likelihood is a prerequisite for informed choice and of practical and ethical importance [7, 8]. Informed choice is still poorly understood, regarding process as well as outcomes [10]
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