Development and Psychometric Evaluation of a Protection Motivation Theory–Based Scale Assessing the Adherence of Iranian Women Breast Cancer Prevention Behaviors

Abstract

Introduction: Breast cancer is the most common type of cancer that has concerned Iranian women. Early detection is a major determinant of disease prognosis. Thus, participation in prevention behaviors is the only available option for women. The aim of this study was to develop and validate a protection motivation theory (PMT)-based scale for assessing the participation of Iranian women in breast cancer prevention behaviors. Methods: A sequential exploratory mixed methods design was used. In the qualitative phase, 14 semistructured interviews were done with women. After directed qualitative content analysis, primary items were phrased. Validity of the questionnaire was assessed by a panel of experts, calculation of CVR and CVI, and using confirmatory factor analysis. Reliability of the scale was measured using Cronbach's alpha. Then, a cross-sectional study was performed on 420 women. The data were analyzed using SPSS 19 and AMOS 16 software packages. Results: All of the items gained impact scores >1.5 in qualitative and quantitative face validity assessment. In the dimension of content validity, 9 items were deleted. Reliability of the questionnaire was acceptable. The final draft of the questionnaire was prepared in two sections including demographics and PMT constructs comprising 56 items and 8 domains. Factor analysis confirmed the fitness of the model representing the measurement theory. Conclusion: The present study is a pioneer in assessing the applicability of PMT for assessing the participation of Iranian women in breast cancer prevention behaviors. The developed scale has acceptable psychometric properties among Iranian women, and it can be used as a reliable instrument.

Design and Psychometric Evaluation of the Breast Cancer Screening Behavior Scale Based on the Health Action Model (HAM)

“…In addition, factor analysis con rmed the t of the theory of protection motivation for the participation of Iranian women in preventive behaviors against breast cancer. Moreover, perceived sensitivity, perceived severity, and self-e cacy constructs had acceptable factor loadings in determining the participation of Iranian women in breast cancer prevention behaviors, which was in agreement with the present study ndings [14]. Even though these two studies designed and psychometrically evaluated two acceptable tools for investigating breast cancer prevention behaviors, the rst study put much emphasis on lifestyle-related behaviors, mammography screening behaviors, and physician examination, but did not evaluate breast self-examination.…”

“…To design the items of breast cancer screening behaviors and knowledge, 16 items were designed for knowledge and 6 for behaviors with the help of a team of experts consisting of health education and promotion specialists and experts of the non-communicable diseases unit (n = 7). Additionally, qualitative methods such as semi-structured interviews, expert panel's opinions, and studies conducted in this eld [14][15][16][17][18][19][20][21][22] were used to design the constructs of the HAM as well as the factors related to breast cancer screening behaviors. Based on consultation with professors specializing in health education and promotion, a exibility framework was designed to formulate general questions related to each construct of the HAM.…”

Investigating the predictors of breast cancer screening behaviors (breast self-examination, clinical examination or examination by physician /midwife and mammography) based on protection motivation theory (PMT) in women

“…The method of collecting information in this study was to present a questionnaire to the subjects in person and complete it in a report. In this study, two questionnaires were used to collect data: 1) demographic profile questionnaire with 18 options containing questions related to individual characteristics including: age, level of education, marital status, family history of cancer and household income; and 2) researcher-made questionnaire based on the protection motivation theory structure in breast cancer screening behaviors and women’s knowledge in this field with 31 and 18 questions, respectively, due to the lack of a standard questionnaire in this field, it was codified using sources and reference books and the results of other studies [ 20 , 21 ]. Questions related to theoretical structures separately included: 4 questions related to perceived vulnerability, 5 questions related to perceived intensity, 8 questions related to perceived self-efficacy, 7 questions related to perceived response costs, 4 questions related to perceived efficacy of the response and 3 questions about breast cancer screening behaviors (breast self-examination, clinical examination or examination by physician /midwife and mammography) and 18 knowledge questions related to women’s information about breast cancer, its signs and symptoms and screening behaviors available in this regard.…”

The Effectiveness of Educational Intervention based on the Health Action Model (HAM) in Improving Breast Cancer Screening Behaviors

“…The design process was done with the help of an expert team consisting of health education and promotion experts, and specialists of the non-communicable diseases unit in the Kashan Health Department (n = 7) according to the instructions of the Ministry of Health and Medical Education (MOHME) about breast cancer. To design the constructs of the health action model and the factors related to performing breast cancer screening behaviors, qualitative methods such as semi-structured interviews, expert panel opinions, and studies in this eld were utilized [35][36][37][38][39][40][41][42][43]. Therefore, the rst version of the tool was prepared in four sections, 1-Demographic factors (15 items), 2-Knowledge (16 items), 3-Factors related to performing breast cancer screening behaviors or health action model constructs, including the perceived susceptibility (9 items), perceived severity (12 items), perceived barriers (16 items), perceived bene ts (8 items), perceived self-e cacy (12 items), normative system (25 items), skills (including psychomotor skills, social interaction, and self-regulation) (14 items), behavioral intention (4 items), and 4-behavior (6 items).…”