Abstract
BackgroundOur study objective was to determine the validity and reliability of the breast module of a cancer awareness measure (BCAM) among adult women in western Kenya.MethodsThe study was conducted between October and November 2012, following three breast cancer screening events. Purposive and systematic random sampling methods were used to identity 48 women for cognitive focus group discussions, and 1061 (594 who attended vs. 467 who did not attend screening events) for surveys, respectively. Face and psychometric validity of the BCAM survey was assessed using cognitive testing, factor analysis of survey data, and correlations. Internal reliability was assessed using Cronbach’s alpha.ResultsAmong survey participants, the overall median age was 34 (IQR: 26–44) years. Compared to those women who did not attend the screening events, women attendees were older (median: 35 vs. 32 years, p = 0.001) more often married (79% vs. 72%, p = 0.006), more educated (52% vs. 46% with more than an elementary level of education, p = 0.001), more unemployed (59% vs. 11%, p = 0.001), more likely to report doing breast self-examination (56% vs. 40%, p = 0.001) and more likely to report having felt a breast lump (16% vs. 7%, p = 0.001). For domain 1 on knowledge of breast cancer symptoms, one factor (three items) with Eigen value of 1.76 emerged for the group that did not attend screening, and 1.50 for the group that attended screening. For both groups two factors (factor 1 “internal influences” and factor 2 “external influences”) emerged among domain 4 on barriers to screening, with varied item loadings and Eigen values. There were no statistically significant differences in the factor scores between attendees and non-attendees. There were significant associations between factor scores and other attributes of the surveyed population, including associations with occupation, transportation type, and training for and practice of breast self-examination. Cronbach’s alpha showed an acceptable internal consistency.ConclusionCertain subpopulations are less likely than others to attend breast screening in Kenya. A survey measure of breast cancer knowledge and perceived barriers to screening shows promise for use in Kenya for characterizing clinical and community population beliefs, but needs adaptation for setting, language and culture.
Highlights
Our study objective was to determine the validity and reliability of the breast module of a cancer awareness measure (BCAM) among adult women in western Kenya
In the context of initial efforts to develop appropriate approaches to breast cancer screening in western Kenya, we felt the need to have a better understanding of the levels of public awareness, perceptions of breast cancer, and screening practices in various communities served by a health care delivery system
The Walther project has focused on cancer prevention activities and their evaluation, especially activities that respond to challenges in the Academic Model Providing Access to Healthcare (AMPATH) service area in western Kenya posed by breast and cervical cancer
Summary
Our study objective was to determine the validity and reliability of the breast module of a cancer awareness measure (BCAM) among adult women in western Kenya. Even though approaches to enhancing early diagnosis and treatment have been advocated [3, 5], the region is faced with a number of challenges to achieving earlier diagnosis and care, including limited funds for health care services, underfunded health care facilities, lack of mammography equipment, and low levels of community awareness of breast cancer [3,4,5,6,7] Taken together, these limitations have had a major adverse impact on efforts to reduce the stage at which breast cancer is diagnosed and treated. If a well-formed and valid survey instrument could be developed to characterize these matters, we believed that educational programs for the public could be focused to fill gaps in knowledge and perhaps stimulate greater volunteerism for screening
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