Development and validation of the African Women Awareness of CANcer (AWACAN) tool for breast and cervical cancer
Development and validation of the African Women Awareness of CANcer (AWACAN) tool for breast and cervical cancer
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DOI：
10.1371/journal.pone.0220545
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发表时间：
2019-08-06
期刊：
影响因子：
3.7
通讯作者：
Walter, F. M.
中科院分区：
文献类型：
--
作者：
Moodley, J.;Scott, S. E.;Walter, F. M.
背景测量影响陈述时间的因素在开发和评估促进及时癌症诊断的干预措施方面很重要，但缺乏经过验证的、与文化相关的测量工具。本研究旨在开发和验证非洲妇女癌症意识(AWACAN)工具，以衡量撒哈拉以南非洲(SSA)对乳腺癌和宫颈癌的认识。方法AWACAN工具的开发经历了4个步骤：1)基于现有测量和相关文献的条目生成。2)通过使用癌症专家的评级和对乌干达和南非社区参与者的大声思考采访来评估内容和面孔有效性，从而完善项目。3)向社区参与者、大学工作人员和癌症专家管理该工具，以使用重测信度(使用组内相关性(ICC)和调整后的Kappa系数)、结构效度(使用t检验比较专家和社区参与者的反应)和内部可靠性(使用Kuder-Richarson(KR-20)系数)来评估有效性。4)将最终的AWACAN工具翻译成isiXhosa和Acholi.结果ICC得分对所有乳腺癌知识领域、宫颈癌危险因素和世俗信念领域都有良好的重测信度(>；=0.7)。与社区参与者相比，专家对乳腺癌危险因素(p<；0.001)、宫颈癌危险因素(p=0.003)和症状(p=0.001)的了解更高，但对乳腺癌症状的知识相似(p=0.066)。乳腺癌危险因素、世俗信念和症状以及子宫颈癌症状子量表的内部信度较好，KR-20值和GT；0.7，而子宫颈癌风险子量表的内部信度较低(0.6)。结论最终的AWACAN工具包括社会人口学细节、乳腺癌和宫颈癌症状认知、危险因素认知、世俗信仰、预期求助行为和寻求治疗的障碍。这些工具显示了内容、面孔、结构和内部效度以及测验-重测可靠性的证据，并可用于三种语言的SSA。
BackgroundMeasuring factors influencing time to presentation is important in developing and evaluating interventions to promote timely cancer diagnosis, yet there is a lack of validated, culturally relevant measurement tools. This study aimed to develop and validate the African Women Awareness of CANcer (AWACAN) tool to measure awareness of breast and cervical cancer in Sub-Saharan Africa (SSA).MethodsDevelopment of the AWACAN tool followed 4 steps: 1) Item generation based on existing measures and relevant literature. 2) Refinement of items via assessment of content and face validity using cancer experts' ratings and think aloud interviews with community participants in Uganda and South Africa. 3) Administration of the tool to community participants, university staff and cancer experts for assessment of validity using test-retest reliability (using Intra-Class Correlation (ICC) and adjusted Kappa coefficients), construct validity (comparing expert and community participant responses using t-tests) and internal reliability (using the Kuder-Richarson (KR-20) coefficient). 4) Translation of the final AWACAN tool into isiXhosa and Acholi.ResultsICC scores indicated good test-retest reliability (>= 0.7) for all breast cancer knowledge domains and cervical cancer risk factor and lay belief domains. Experts had higher knowledge of breast cancer risk factors (p < 0.001), and cervical cancer risk factors (p = 0.003) and symptoms (p = 0.001) than community participants, but similar knowledge of breast cancer symptoms (p = 0.066). Internal reliability for breast cancer risk factors, lay beliefs and symptom and cervical cancer symptom subscales was good with KR-20 values > 0.7, and lower (0.6) for the cervical cancer risk subscale.ConclusionThe final AWACAN tool includes items on socio-demographic details; breast and cervical cancer symptom awareness, risk factor awareness, lay beliefs, anticipated help-seeking behaviour; and barriers to seeking care. The tools showed evidence of content, face, construct and internal validity and test-retrest reliability and are available for use in SSA in three languages.