Cross-cultural validation of instruments measuring health beliefs about colorectal cancer screening among Korean Americans.
OBJECTIVE
The purpose of this study was to report the instrument modification and validation processes to make existing health belief model scales culturally appropriate for Korean Americans (KAs) regarding colorectal cancer (CRC) screening utilization.


METHODS
Instrument translation, individual interviews using cognitive interviewing, and expert reviews were conducted during the instrument modification phase, and a pilot test and a cross-sectional survey were conducted during the instrument validation phase. Data analyses of the cross-sectional survey included internal consistency and construct validity using exploratory and confirmatory factor analysis.


RESULTS
The main issues identified during the instrument modification phase were (a) cultural and linguistic translation issues and (b) newly developed items reflecting Korean cultural barriers. Cross-sectional survey analyses during the instrument validation phase revealed that all scales demonstrate good internal consistency reliability (Cronbach's alpha=.72~.88). Exploratory factor analysis showed that susceptibility and severity loaded on the same factor, which may indicate a threat variable. Items with low factor loadings in the confirmatory factor analysis may relate to (a) lack of knowledge about fecal occult blood testing and (b) multiple dimensions of the subscales.


CONCLUSIONS
Methodological, sequential processes of instrument modification and validation, including translation, individual interviews, expert reviews, pilot testing and a cross-sectional survey, were provided in this study. The findings indicate that existing instruments need to be examined for CRC screening research involving KAs.
Department of Nursing, Chosun University, Gwangju, Korea. shinyoung0114@gmail.com.
Shin-Young
SY
Lee
School of Nursing, University of California, Los Angeles, LA, USA.
Eunice E
EE
Lee
D000368:Aged; D001213:Asian / Q000523:psychology*; D015179:Colorectal Neoplasms / Q000473:pathology*; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009780:Occult Blood; D010865:Pilot Projects; D056910:Republic of Korea; D020377:Self Efficacy; D011795:Surveys and Questionnaires
Beliefs; Colorectal cancer; Instruments; Korean Americans; Screening