title: Developing and testing an instrument for identifying culture-specific barriers to breast cancer screening in Israeli Arab women.
abstract: OBJECTIVE
  To develop and assess an instrument for studying culture-specific barriers to performing examinations for early detection of breast cancer.
  
  
  METHODS
  A three-step design: (a) content analysis of five focus groups (n=51); (b) constructing and initial testing of the Arab culture-specific barriers (ACSB) instrument in a pilot study (n=79); (c) testing for validity and reliability of the revised ACSB instrument (n=300, of these 200 Muslim and 100 Christian, mean age 48). Construct validity was examined using factor analysis. Performance of screenings (mammography and clinical and self breast examination) was used to test criterion validity by logistic regression and receiver operating characteristic (ROC) curve; convergent validity was tested by the barriers subscale of the health beliefs questionnaire. Internal consistency reliability was tested by Cronbach's alpha coefficients.
  
  
  RESULTS
  Factor analysis revealed five subscales: social barriers, exposure barriers, environmental barriers, uneasiness with own body, and traditional beliefs concerning cancer. The factors accounted for 54.6% of cumulative variance. Twelve items not meeting item-scale criteria were removed, resulting in a 21-item instrument. Convergent validity was confirmed for all subscales except traditional beliefs. ACSB mean score explained between 0.79 (95% CI .72-.86) and 0.85 (95% CI .79-.94) of the area under the ROC curve of the screening procedures. Internal consistency of the subscales ranged from 0.76 to 0.90.
  
  
  CONCLUSIONS
  The study showed initial satisfactory reliability of the ACSB. Validity was approved for social barriers, exposure barriers, environmental barriers and uneasiness with own body subscales, and only partially for traditional beliefs. Further examination of the instrument with different populations of Arab women is needed.
authors.affiliation: Faculty of Social Welfare and Health Sciences, Haifa University, Haifa, Israel. cohenm@research.haifa.ac.il
authors.forename: Miri
authors.initials: M
authors.lastname: Cohen
authors.forename: Faisal
authors.initials: F
authors.lastname: Azaiza
mesh_terms: D000328:Adult; D000368:Aged; D018912:Arabs / Q000208:ethnology; D001294:Attitude to Health / Q000208:ethnology*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000208:ethnology; D003431:Cross-Cultural Comparison; D042241:Early Diagnosis; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008327:Mammography / Q000295:instrumentation / Q000523:psychology*; D008403:Mass Screening / Q000295:instrumentation / Q000523:psychology*; D008875:Middle Aged; D010865:Pilot Projects; D012372:ROC Curve; D011795:Surveys and Questionnaires; D014930:Women / Q000523:psychology*