title: An international measure of awareness and beliefs about cancer: development and testing of the ABC.
abstract: OBJECTIVE
  To develop an internationally validated measure of cancer awareness and beliefs; the awareness and beliefs about cancer (ABC) measure.
  
  
  METHODS
  Items 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.
  
  
  METHODS
  Testing 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.
  
  
  RESULTS
  Psychometric 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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Department of Epidemiology and Public Health,  Cancer Research UK Health Behaviour Research Centre, University College London, London,  UK.
authors.forename: Alice E
authors.initials: AE
authors.lastname: Simon
authors.forename: Lindsay J L
authors.initials: LJ
authors.lastname: Forbes
authors.forename: David
authors.initials: D
authors.lastname: Boniface
authors.forename: Fiona
authors.initials: F
authors.lastname: Warburton
authors.forename: Kate E
authors.initials: KE
authors.lastname: Brain
authors.forename: Anita
authors.initials: A
authors.lastname: Dessaix
authors.forename: Michael
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authors.lastname: Donnelly
authors.forename: Kerry
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authors.lastname: Haynes
authors.forename: Line
authors.initials: L
authors.lastname: Hvidberg
authors.forename: Magdalena
authors.initials: M
authors.lastname: Lagerlund
authors.forename: Lisa
authors.initials: L
authors.lastname: Petermann
authors.forename: Carol
authors.initials: C
authors.lastname: Tishelman
authors.forename: Peter
authors.initials: P
authors.lastname: Vedsted
authors.forename: Maria Nyre
authors.initials: MN
authors.lastname: Vigmostad
authors.forename: Jane
authors.initials: J
authors.lastname: Wardle
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Ramirez