The validity and reliability of Champion's Health Belief Model Scale for screening breast cancer behaviours in occupied Palestinian territory: a cross-sectional study

Abstract

BackgroundBreast cancer is the most common cancer in Palestinian women. Breast self-examination and mammography screening are important tools to detect tumours early and improve survival. Champion's Health Belief Model Scale (CHBMS) is a self-report instrument that can help in detecting beliefs and behaviours. This study aimed to assess the validity and reliability of the Arabic version of CHBMS to assess the beliefs and behaviours of Palestinian women in West Bank, occupied Palestinian Territory, towards screening and health education programmes for early detection of breast cancer. MethodsThe English version of the CHBMS questionnaire was translated into Arabic and revised by two bilingual experts. The questionnaire consisted of sociodemographic questions relating to the following eight subscales: susceptibility to breast cancer (three items), seriousness of breast cancer (seven items), benefits of breast self-examination (six items), barriers to performing examinations (nine items), and confidence in performing examinations (ten items), health motivation (seven items), and benefits of (six items) and barriers to (nine items) performing mammography. A qualitative pilot with ten different women was performed to assess the clarity of the translated CHBMS and its appropriateness to the local context. We then did a cross-sectional study in which all attendees to the main Palestinian Ministry of Health screening clinics in the north, middle, and south of West Bank from Oct 1 to Dec 30, 2016, were asked to be interviewed by telephone. Respondents gave verbal consent to participate. Varimax rotation was used to extract factors with 0·40 loading or greater. The items for breast self-examination and the mammography screening scales were considered separately; 42 items related to breast self-examination were loaded on six subscales and the 15 items related to mammography screening were loaded on two subscales. The internal consistency of each subscale was tested using Cronbach's α and no increase of more than 0·1 if any item was deleted. All analyses were done with SPSS version 22. Results444 interviews were completed. The items “if someone developed [breast cancer], she would not live longer than 5 years” and “Doing [breast self-examination] will make me worry” did not meet any subscale loading criterion. The item “I don’t feel I can do [breast self-examination] correctly” loaded on the confidence subscale instead of being categorized as a barrier to breast examination. The five items referring to mammography screening benefits and the eight items referring to mammography screening barriers loaded to their respective two subscales. Internal consistency for each breast self-examination subscale was acceptable to high: benefits (Cronbach's α=0·931), barriers (0·624) and confidence (0·923), susceptibility (0·941), seriousness (0·786) and health motivation (0·595). The internal consistency for the mammography screening benefits and barriers were good (Cronbach's α=0·668 and 0·640, respectively). InterpretationThe study supports the use of CHBMS as a tool with potential to measure beliefs and behaviours related to breast self-examination and mammography screening among Palestinian women. Improved understanding of these factors will lead to development of more effective educational programmes. FundingNone.