Transcultural adaptation and validation of the Persian version of the breast cancer awareness measure (BCAM) questionnaire

Abstract

Background/objectiveEnhancing awareness level about breast cancer is a pivotal strategy for reducing breast cancer burden. There is no fully validated Persian instrument for evaluating breast cancer awareness. This study aimed at investigating the validity and reliability of the Persian version of the Breast Cancer Awareness Measure (BCAM) questionnaire.MethodsThis methodological cross‐sectional study was conducted among 1078 Persian language women (including 965 general women and 113 medical/clinical experts), which selected from different parts of Isfahan city using multistage cluster random sampling method. Translation of BCAM questionnaire was performed using forward‐backward method. Internal consistency was evaluated through Cronbach's α and test‐retest reliability using unweighted kappa statistic and intraclass correlation (ICC) coefficient. Construct validity was investigated using both exploratory and confirmatory factor analyses as well as Latent class analysis (LCA), and discriminant validity using ROC curve. Convergent validity was assessed using phi and eta correlation coefficients. Ceiling and floor effects, SE of measurement (SEM), and smallest detectable change (SDC) were also determined.ResultsPersian version of BCAM showed excellent test‐retest reliability (ICC = 0.841) and internal consistency (Cronbach's alpha = 0.882). Most of the computed kappa coefficients were in the range moderate to very good (0.47‐0.81). Medical/clinical experts had higher levels of breast cancer awareness than general women, indicating good discriminant validity (Area under the curve [AUC]) of 0.822 (95% CI: 0.781, 0.864). Construct validity evaluation by exploratory factor analysis (EFA) led to extraction of two factors from 11 items (“breast shape changes” and “breast pain and lump”), and the confirmatory factor analysis (CFA) confirmed the adequacy of extracted construct from EFA. Latent class analysis for evaluating of construct validity led to extracting three classes from participants (high [12.83%], moderate [60.97%], and low [26.2%]) in terms of awareness levels about early warning signs of breast cancer. All item‐scale correlation coefficients exceeded the set value of 0.40, indicating satisfactory convergent validity. No ceiling and floor effects were detected. SEM and SDC were found to be 0.85 and 2.36, respectively.ConclusionsThe Persian version of BCAM is a reliable and valid instrument for monitoring levels of breast cancer awareness in general women population, also it can be used for evaluating the impacts of interventions attempting to raise breast cancer awareness.

Translation and Validation of the Breast Cancer Awareness Measurement Tool in Malaysia (B-CAM-M)

“…The internal reliability of the B-CAM-M was measured by Cronbach's alpha, and the findings suggested that there was high internal consistency between the items regarding knowledge about breast cancer symptoms (.83). This finding is in keeping with previous translation and validation studies of B-CAM in Arabic (Cronbach's alpha: .89), and Persian languages (Cronbach's alpha: .88) (Al-Khasawneh et al, 2016;Heidari and Feizi, 2018).…”

“…Some items from the domains of symptoms, risk factors and barriers had ICC values lower than 0.4 and discrepancies mainly occurred with respect to participants' knowledge and barriers for health care seeking. In comparison, a higher ICC value of 0.84 was reported for warning signs in the Persian version (Heidari and Feizi, 2018). A possible explanation for the lower ICC value might be related to the fact that although participants were not informed that they would be asked the same questions, some participants may have searched for information about breast cancer from the media and websites due to their interest and curiosity being stimulated by the first interview.…”

“…The Breast Cancer Awareness Measure (B-CAM) is the internationally recognised measure that was developed (Linsell et al, 2010;CancerResearchUK, 2011) to measure breast cancer awareness in the UK (Campbell et al, 2016). Since then, it has been translated and validated in Arabic, Persian and Swahili (Al-Khasawneh et al, 2016;Heidari and Feizi, 2018;Wachira et al, 2017).…”

Accuracy of Self-Perceived Risk Perception of Breast Cancer Development in Iranian Women

“…More speci cally, these data composed of age, the rst menstrual age, age at rst childbirth, family history of breast cancer in rstdegree female relatives (mother, daughters, and sisters), history of taking a biopsy of the breast, number of biopsies, presence of dysplasia in the biopsy, educational level, marital status and occupation. We also used the Persian version of the breast cancer awareness measure (BCAM) questionnaire 25 . This scale originally developed by UK cancer center and validated speci c to BC awareness 26 .…”

“…This scale originally developed by UK cancer center and validated speci c to BC awareness 26 . The Persian version of this scale was investigated by Heidari and Feizi 25 that showed a high test-retest reliability (ICC=0.84) and internal consistency (Cronbach's alpha=0.88). This scale composed of the knowledge of women in breast cancer risk factors and the sign and symptoms of breast cancer that included 14 items of multiplechoice scale to measure the awareness of risk factors and 8-item scale to assess the signs and symptoms with binary response.…”