An international measure of awareness and beliefs about cancer: development and testing of the ABC

Abstract

ObjectivesTo develop an internationally validated measure of cancer awareness and beliefs; the awareness and beliefs about cancer (ABC) measure.Design and settingItems modified from existing measures were assessed by a working group in six countries (Australia, Canada, Denmark, Norway, Sweden and the UK). Validation studies were completed in the UK, and cross-sectional surveys of the general population were carried out in the six participating countries.ParticipantsTesting in UK English included cognitive interviewing for face validity (N=10), calculation of content validity indexes (six assessors), and assessment of test–retest reliability (N=97). Conceptual and cultural equivalence of modified (Canadian and Australian) and translated (Danish, Norwegian, Swedish and Canadian French) ABC versions were tested quantitatively for equivalence of meaning (≥4 assessors per country) and in bilingual cognitive interviews (three interviews per translation). Response patterns were assessed in surveys of adults aged 50+ years (N≥2000) in each country.Main outcomesPsychometric properties were evaluated through tests of validity and reliability, conceptual and cultural equivalence and systematic item analysis. Test–retest reliability used weighted-κ and intraclass correlations. Construction and validation of aggregate scores was by factor analysis for (1) beliefs about cancer outcomes, (2) beliefs about barriers to symptomatic presentation, and item summation for (3) awareness of cancer symptoms and (4) awareness of cancer risk factors.ResultsThe English ABC had acceptable test–retest reliability and content validity. International assessments of equivalence identified a small number of items where wording needed adjustment. Survey response patterns showed that items performed well in terms of difficulty and discrimination across countries except for awareness of cancer outcomes in Australia. Aggregate scores had consistent factor structures across countries.ConclusionsThe ABC is a reliable and valid international measure of cancer awareness and beliefs. The methods used to validate and harmonise the ABC may serve as a methodological guide in international survey research.

Cancer Awareness among University Students in Turkey

“…In one study, it was determined that information on cancer is mostly provided by television and that the rate of people who has not been informed by health personnel is very high (Gultekin et al, 2011). According to studies conducted on cancer awareness in the UK, low levels of awareness regarding cancer symptoms lead to late cancer diagnosis (Robb et al, 2009;Simon et al, 2012).…”

Differences in cancer awareness and beliefs between Australia, Canada, Denmark, Norway, Sweden and the UK (the International Cancer Benchmarking Partnership): do they contribute to differences in cancer survival?

“…However, weighting made little difference to the estimates of cancer awareness or beliefs that suggests that under-or overrepresentation of particular groups did not significantly influence the pattern of cancer awareness and beliefs. We calculated aggregate scores for two sets of items (beliefs about cancer outcomes and about barriers to symptomatic presentation), because factor analysis provided strong evidence that responses to each set of items were driven by common underlying factors: broad perceptions about either beliefs about cancer outcomes or barriers to symptomatic presentation (Simon et al, 2012). The mean differences between countries in the aggregate scores are more likely to represent real differences and are more precise (with narrower confidence intervals) than the responses to the individual items.…”

“…The development, validation and structure of the ABC are described in our accompanying paper (Simon et al, 2012). The items in the ABC were informed by theoretical frameworks, such as the Health Belief Model, and drew from other measures previously used in population surveys (Paul et al, 2006;Stubbings et al, 2009;Park and Clery, 2010) but were designed to identify key items that could differ between countries rather than test any one theoretical model.…”

“…We selected this age group because population-level cancer survival largely reflects survival in the over-50s, in whom cancer is the commonest. We measured cancer awareness and beliefs using the newly developed Awareness and Beliefs about Cancer (ABC) measure (Simon et al, 2012). We examined whether the pattern of cancer awareness and beliefs followed the pattern expected from differences in cancer survival and carried out statistical tests of differences between each country and the UK.…”

“…We calculated aggregate scores for beliefs about barriers to symptomatic presentation and beliefs about cancer outcomes, based on results of the factor analysis as described in our linked paper (Simon et al, 2012). Briefly, we generated two new variables, one based on four barrier items: too embarrassed, too busy, worried about wasting the doctor's time, worried about what the doctor might find) and the other based on three belief items ('cancer can often be cured', 'a diagnosis of cancer is a death sentence', 'people with cancer can expect to continue with normal activities and responsibilities').…”