Development of the Thai Breast Cancer Belief Scale for Thai Immigrants in the United States
Kumsuk, Suwattana, Flick, Louise H., Schneider, Joanne K., Journal of Nursing Measurement
Asian American women have not benefited from the decline in breast cancer mortality and have lower rates of mammography use. Understanding mammography behaviors among these Asian American women requires culturally specific measures. Champion's Belief Scale was translated into Thai and cultural items were added. The Thai Breast Cancer Belief Scale (TBCBS), the Suinn-Lew Self-Identification Acculturation, and the Asian Values Scale-Revised were administered to 250 Thai immigrants. The TBCBS was tested for face validity, construct validity, and internal consistency. Factor analysis reflected the 4 constructs of the Health Belief Model and accounted for 45.8% of the variance. Cronbach's alpha ranged from .77 to .90. Modest correlations were observed between TBCBS subscales and acculturation scales. Results indicate that the TBCBS measures breast cancer beliefs among Thai immigrant population.
Keywords: Thai immigrants; Asian Americans; breast cancer; mammograms; Health Belief Model
The National Cancer Institute (NCI) estimates that one in eight women will be diagnosed with breast cancer at some point during their lives (Jemal et al., 2008). Fortunately, the increase in mammography screening and effective treatments has contributed to a decrease in the overall mortality rate for breast cancer by 2.1% per year from 1992 to 2006 (Horner et al, 2009). However, this decline did not occur among all ethnic minorities. Asian Americans continue to show a low rate of mammography screening and showed no change in the mortality rate over the last decade (American Cancer Society [ACS], 2011; Surveillance Epidemiology and End Results [SEER], 2009). About 61.9% of Asian Americans received mammograms within 2 years and 47.7% within 1 year compared to 67% and 51.5% respectively for Whites, 65.9% and 50.6% respectively for African Americans, and 64.4% and 46.5% respectively for Hispanics. When focusing on the use of mammography screening within immigrants, 51.6% of those who were born in the United States received mammography screening within 1 year and 67.1% within 2 years compared to 26.8% and 37.4% respectively for women living in the United States fewer than 10 years (ACS, 2011). These rates suggest low mammography use among Asian American women making the need for increasing mammography use particularly important. The ACS advises all women age 40 years and older to have mammography screening every year, whereas the NCI (2009) recommends mammography screening every 1-2 years for women age 40 years and older. Promoting culturally appropriate programs is a promising approach to increase the use of mammography screening among Thai immigrants, a growing subgroup of Asian Americans, but first we must develop culturally appropriate measures to assess their understanding about mammograms and breast cancer. In this study, we built on Victoria Champion's work to develop a culturally specific scale to measure breast cancer beliefs and mammography use among Thai immigrants.
BACKGROUND AND CONCEPTUAL FRAMEWORK
We used the Health Belief Model (HBM) to guide this study. This model focuses on beliefs related to breast cancer and mammography behaviors including individual perceptions of the targeted health problem, modifying factors, and the likelihood of action (Janz, Champion, & Strecher, 2002). Individual perceptions are affected by one's beliefs and attitudes toward health and the severity of the given disease. Modifying factors include demographic characteristics, perceived threat, and cues to action. Perceived health threat is influenced by three factors: general health values (ones' interest and concern about health), specific health beliefs about vulnerability to a particular health threat, and beliefs about the health problem. Individuals who perceive a threat to their health and are cued to action, who also perceive that the benefits of the action outweigh the perceived barriers to action, are those most likely to undertake the recommended preventive action. …