Transcultural adaptation of the Breast Cancer Awareness Measure

Aim: To overcome the lack of a validated and robust Arabic instrument to measure breast cancer awareness.

Background: Currently, there is no validated Arabic instrument for measuring breast cancer awareness levels. We adapted, translated and validated the Breast Cancer Awareness Measure developed by Cancer Research UK.

Methods: The instrument was translated into Arabic and back-translated for validation. Validation and reliability tests were conducted using purposively sampled 972 Arab women older than 20 years, living in Oman. The adapted content was validated by a panel of medical, linguistic and cultural experts, followed by cognitive interviews (n = 10), behavioural coding (n = 30) and criterion validation (n = 646). The instrument was tested for acceptability and its subscales for internal consistency. Inter-rater reliability was estimated between two similar groups (n = 144 and n = 142) to test homogeneity.

Results: The adapted and translated instrument had a high acceptability (98.7% completed). The validation process shaped the adaptation, and resulted in strong criterion validity (R = 0.58, P < 0.01). The instrument subscales for risk factors and warning signs had high internal consistency (Cronbach's alpha 0.856 and 0.890, respectively), with all floor and ceiling effects less than 15%. The correlation measure for inter-rater reliability was 0.97 (P < 0.01).

Discussion: Through the incorporation of contextual characteristics and prevalent beliefs among Arab populations, the adapted Best Cancer Awareness Measure is a robust Arabic instrument for the measurement of breast cancer awareness and early detection practices among Arab women.

Limitations: The purposively selected sample may not be representative of the population.

Conclusion and implications for health policy: Improvement of awareness and early detection of breast cancer can contribute towards reducing mortality from the disease. The adapted instrument has policy implications, since measurement of awareness levels is essential towards breast health promotion policies in Arab countries.