Enter your email address
Submit
Write your message
Volume 18, Issue 3 (Iranian Journal of Breast Diseases 2025)
ijbd 2025, 18(3): 26-51 |
Back to browse issues page
Research code: ۲۸۸۹
Ethics code: IR.ARAKMU.REC.1396.273
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Jafarimanesh H, Jaras M, Nejat N, Yavari A, Kwok C. Breast Cancer Screening Beliefs Questionnaire: Psychometric Properties Assessment of the Persian Version. ijbd 2025; 18 (3) :26-51
URL: http://ijbd.ir/article-1-1178-en.html
URL: http://ijbd.ir/article-1-1178-en.html
1- Department of Nursing, Shazand School of Nursing, Arak University of Medical Sciences, Arak, Iran & Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran , nurse_science@yahoo.com
2- Department of Nursing, Shazand School of Nursing, Arak University of Medical Sciences, Arak, Iran
3- Department of Nursing, School of Nursing, Arak University of Medical Sciences, Arak, Iran
4- Imam Khomini Hospital, Tehran University of Medical Sciences, Tehran, Iran
5- Sydney Nursing School, School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
2- Department of Nursing, Shazand School of Nursing, Arak University of Medical Sciences, Arak, Iran
3- Department of Nursing, School of Nursing, Arak University of Medical Sciences, Arak, Iran
4- Imam Khomini Hospital, Tehran University of Medical Sciences, Tehran, Iran
5- Sydney Nursing School, School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
Abstract: (525 Views)
Introduction: The Breast Cancer Screening Beliefs Questionnaire (BCSBQ) is a validated instrument designed to assess beliefs related to breast cancer screening. Although the BCSBQ has been validated in several populations, including Chinese, Arabic, and Korean women residing in Australia, its psychometric properties have not been assessed among Iranian women. Given the cultural differences and the scarcity of local data, this study aimed to translate, culturally adapt, and evaluate the validity and reliability of the Persian version of the BCSBQ among Iranian women.
Materials and Methods: This methodological study involved a forward–backward translation process of the original questionnaire. Face, content, construct, convergent, and discriminant validity were assessed. Exploratory factor analysis (EFA) was conducted using the Principal Component Analysis (PCA) method with Varimax rotation, which was applied to identify underlying factors and ensure that items grouped coherently based on their correlations. Confirmatory factor analysis (CFA) was then used to assess the fit of the three-factor model. Internal consistency was evaluated using Cronbach's alpha coefficient. Data analysis was performed using SPSS (version 20) and Amos (version 24) software.
Results: The Persian version of the questionnaire consisted of 13 items across three dimensions. The EFA confirmed the three-factor structure, which explained approximately 59.72% of the total variance. The CFA demonstrated an appropriate model fit (RMSEA = 0.05, CFI = 0.94, GFI = 0.95). Since CFA indices of CFI > 0.90 and RMSEA < 0.06 indicate acceptable model fit, the results confirmed the adequacy of the three-factor model. Cronbach's alpha values for the subscales ranged from 0.74 to 0.83. Convergent validity was supported by significant correlations between each item and its respective subscale, while low correlations between unrelated dimensions confirmed discriminant validity.
Conclusion: The Persian version of the BCSBQ is a valid, reliable, and culturally appropriate tool for assessing Iranian women’s beliefs and attitudes toward breast cancer screening. This culturally adapted instrument can support targeted educational programs and inform public health strategies to improve breast cancer screening uptake among Iranian women.
Materials and Methods: This methodological study involved a forward–backward translation process of the original questionnaire. Face, content, construct, convergent, and discriminant validity were assessed. Exploratory factor analysis (EFA) was conducted using the Principal Component Analysis (PCA) method with Varimax rotation, which was applied to identify underlying factors and ensure that items grouped coherently based on their correlations. Confirmatory factor analysis (CFA) was then used to assess the fit of the three-factor model. Internal consistency was evaluated using Cronbach's alpha coefficient. Data analysis was performed using SPSS (version 20) and Amos (version 24) software.
Results: The Persian version of the questionnaire consisted of 13 items across three dimensions. The EFA confirmed the three-factor structure, which explained approximately 59.72% of the total variance. The CFA demonstrated an appropriate model fit (RMSEA = 0.05, CFI = 0.94, GFI = 0.95). Since CFA indices of CFI > 0.90 and RMSEA < 0.06 indicate acceptable model fit, the results confirmed the adequacy of the three-factor model. Cronbach's alpha values for the subscales ranged from 0.74 to 0.83. Convergent validity was supported by significant correlations between each item and its respective subscale, while low correlations between unrelated dimensions confirmed discriminant validity.
Conclusion: The Persian version of the BCSBQ is a valid, reliable, and culturally appropriate tool for assessing Iranian women’s beliefs and attitudes toward breast cancer screening. This culturally adapted instrument can support targeted educational programs and inform public health strategies to improve breast cancer screening uptake among Iranian women.
Keywords: Breast Cancer, Cultural Adaptation, Factor Analysis, Iranian Women, Psychometrics, Reliability, Screening, Validity
Type of Study: Research |
Subject:
Diagnosis, treatment, rehabilitation
Received: 2025/04/11 | Accepted: 2025/08/24 | Published: 2025/10/2
Received: 2025/04/11 | Accepted: 2025/08/24 | Published: 2025/10/2
References
1. Kwok C, Endrawes G, Lee CF. Breast Cancer Screening Beliefs Questionnaire: psychometric properties assessment of the Arabic version. European Journal of Oncology Nursing. 2016;20:42-8. [DOI:10.1016/j.ejon.2015.08.003] [PMID]
2. Sanaat Z, Dolatkhah R. Epidemiologic profile of breast cancer in Iran: a systematic review and meta-analysis. Clinical Epidemiology and Global Health. 2024;26:101537. [DOI:10.1016/j.cegh.2024.101537]
3. Anderson BO, Jakesz R. Breast cancer issues in developing countries: an overview of the Breast Health Global Initiative. World journal of surgery. 2008;32(12):2578-85. [DOI:10.1007/s00268-007-9454-z] [PMID]
4. Youn HJ, Han W. A review of the epidemiology of breast cancer in Asia: focus on risk factors. Asian Pacific journal of cancer prevention: APJCP. 2020;21(4):867.
https://doi.org/10.31557/APJCP.2020.21.4.867 [DOI:10.31557/apjcp.2020.21.4.867] [PMID] []
5. Meshkani Z, Moradi N, Aboutorabi A, Farabi H, Moini N. A cost-benefit analysis of genetic screening test for breast cancer in Iran. BMC cancer. 2024;24(1):279.
https://doi.org/10.1186/s12885-024-12003-4 [DOI:10.1186/s12885-024-12003-4.] [PMID] []
6. Seyed-Nezhad M, Effatpanah M, Moradi T, Akbari M, Manzouri L, Moradi-Joo M. Incidence, Prevalence, Mortality, and Direct Costs of Breast Cancer in Iran: Using the Iran Health Insurance Organization Database. cancer. 2025;1:2.
https://doi.org/10.5812/ijcm-157981 [DOI:10.5812/ijcm-157981.]
7. Kazeminia M, Salari N, Hosseinian-Far A, Akbari H, Bazrafshan M-R, Mohammadi M. The prevalence of breast cancer in Iranian women: a systematic review and meta-analysis. Indian Journal of Gynecologic Oncology. 2022;20(1):14.
https://doi.org/10.1007/s40944-022-00613-4 [DOI:10.1007/s40944-022-00613-4.]
8. Monticciolo DL, Hendrick RE, Helvie MA. Outcomes of breast cancer screening strategies based on cancer intervention and surveillance modeling network estimates. Radiology. 2024;310(2):e232658.
https://doi.org/10.1148/radiol.232658 [DOI:10.1148/radiol.232658.] [PMID]
9. Aminisani N, Fattahpour R, Dastgiri S, Asghari-Jafarabadi M, Allahverdipour H. Determinants of breast cancer screening uptake in Kurdish women of Iran. Health promotion perspectives. 2016;6(1):42. [DOI:10.15171/hpp.2016.07] [PMID] []
10. Dolatshahi Z, Dehkordi PR, Gorji HA, Hashemi SM, Reisi N, Khalilabad TH. Breast cancer screening and early detection programs in Iran: A health policy analysis and recommendations. World Medical & Health Policy. 2024;16(4):649-76.
https://doi.org/10.1002/wmh3.629 [DOI:10.1002/wmh3.629.]
11. Babu GR, Samari G, Cohen SP, Mahapatra T, Wahbe RM, Mermash S, et al. Breast cancer screening among females in Iran and recommendations for improved practice: a review. Asian Pac J Cancer Prev. 2011;12(7):1647-55.
12. Noroozi A, Jomand T, Tahmasebi R. Determinants of breast self-examination performance among Iranian women: an application of the health belief model. Journal of Cancer Education. 2011;26(2):365-74. [DOI:10.1007/s13187-010-0158-y] [PMID]
13. Jafari M, Nassehi A, Moayeri H, Baghi V, Ghanei Gheshlagh R. The Prevalence of Breast Self-Examination Practice Among Women in Iran: A Systematic Review and Meta-Analysis. Indian Journal of Gynecologic Oncology. 2025;23(1):14. [DOI:10.1007/s40944-024-00943-5]
14. Ghahramani S, Kasraei H, Shahabi S, Lankarani KB. Facilitating factors and barriers of women's cancer screening in Iran: a systematic review. International Journal of Preventive Medicine. 2020;11(1):199.
https://doi.org/10.4103/ijpvm.IJPVM_509_18 [DOI:10.4103/ijpvm.ijpvm_509_18] [PMID] []
15. Vallone F, Lemmo D, Martino ML, Donizzetti AR, Freda MF, Palumbo F, et al. Factors promoting breast, cervical and colorectal cancer screenings participation: A systematic review. Psycho‐Oncology. 2022;31(9):1435-47. [DOI:10.1002/pon.5997] [PMID] []
16. Charkazi A, Samimi A, Razzaghi K, Kouchaki GM, Moodi M, Meirkarimi K, et al. Adherence to recommended breast cancer screening in Iranian Turkmen women: the role of knowledge and beliefs. ISRN preventive medicine. 2013;2013. [DOI:10.5402/2013/581027] [PMID] []
17. Tahmasebi R, Noroozi A. Factors influencing breast cancer screening behavior among Iranian women. Asian Pacific journal of cancer prevention: APJCP. 2011;12(5):1239-44
18. Allahverdipour H, Asghari-Jafarabadi M, Emami A. Breast cancer risk perception, benefits of and barriers to mammography adherence among a group of Iranian women. Women & health. 2011;51(3):204-19. [DOI:10.1080/03630242.2011.564273] [PMID]
19. Bao Y, Kwok C, Lee CF. Psychometric properties of the modified Breast Cancer Screening Beliefs Questionnaire among mainland Chinese women. European Journal of Oncology Nursing. 2017;28:35-40. [DOI:10.1016/j.ejon.2017.02.006] [PMID]
20. Baena-Cañada JM, Rosado-Varela P, Exposito-Alvarez I, Gonzalez-Guerrero M, Nieto-Vera J, Benítez-Rodríguez E. Women's perceptions of breast cancer screening. Spanish screening programme survey. The Breast. 2014;23(6):883-8.
https://doi.org/10.1016/j.breast.2014.09.010 [DOI:10.1016/j.breast.2014.09.010.] [PMID]
21. Banegas MP, Bird Y, Moraros J, King S, Prapsiri S, Thompson B. Breast cancer knowledge, attitudes, and early detection practices in United States-Mexico border Latinas. Journal of Women's Health. 2012;21(1):101-7.
https://doi.org/10.1089/jwh.2010.2638 [DOI:10.1089/jwh.2010.2638.] [PMID] []
22. Funnell R, Koutoukidis G, Stainton K, Lawrence K, Hughson J. Tabbner's nursing care: Theory and practice: Elsevier Australia; 2008.
23. Crips J, Taylor C. Fundamrntals of Nursing. 2nd Sydney. Elsevier; 2005.
24. Wondmu KS, Tessema MT, Degu G, Mihiret GT, Sinshaw MT. Effect of breast cancer education based on the health belief model on knowledge, health belief, and breast self-examination among female students of Debre Markos University, Northwest Ethiopia, in 2021. Frontiers in oncology. 2022;12:1034183. [DOI:10.3389/fonc.2022.1034183] [PMID] []
25. Timby BK, Smith NE. Introductory medical-surgical nursing: Lippincott Williams & Wilkins; 2013.
26. Khodayarian M, Mazloomy M. Assessment of awareness and attitude of women about breast cancer screening behavior in Yazd city, Iran in1391. Iranian Quarterly Journal of Breast Disease. 2013;6(2).
27. Haji‐Mahmoodi M, Montazeri A, Jarvandi S, Ebrahimi M, Haghighat S, Harirchi I. Breast Self‐Examination: Knowledge, Attitudes, and Practices Among Female Health Care Workers in Tehran, Iran. The breast journal. 2002;8(4):222-5. [DOI:10.1046/j.1524-4741.2002.08406.x] [PMID]
28. Nafissi N, Saghafinia M, Motamedi MHK, Akbari ME. A survey of breast cancer knowledge and attitude in Iranian women. Journal of cancer research and therapeutics. 2012;8(1):46. [DOI:10.4103/0973-1482.95173] [PMID]
29. Kwok C, Fethney J, White K. Chinese breast cancer screening beliefs questionnaire: development and psychometric testing with Chinese‐Australian women. Journal of advanced nursing. 2010;66(1):191-200. [DOI:10.1111/j.1365-2648.2009.05177.x] [PMID]
30. Kwok C, Lee M-J, Lee CF. Validation of the Korean version of the breast cancer screening beliefs questionnaire. Cancer nursing. 2017;40(4):E1-E8. [DOI:10.1037/t65632-000]
31. Kwok C, Ogunsiji O, Lee CF. Validation of the breast cancer screening beliefs questionnaire among African Australian women. BMC Public Health. 2015;16(1):117. [DOI:10.1186/s12889-016-2793-7] [PMID] []
32. Kwok C, Pillay R, Lee CF. Psychometric properties of the Breast Cancer Screening Beliefs Questionnaire among women of Indian ethnicity living in Australia. Cancer nursing. 2016;39(4):E24-E31.
https://doi.org/10.1097/NCC.0000000000000294 [DOI:10.1097/ncc.0000000000000294] [PMID]
33. Nobakht Z, Sourtigi H, Rassafiani M. Translation, cultural adaptation, validity and reliability of a test: Factors influencing researcher decisions. Scientific Journal of Rehabilitation Medicine. 2015;4(4):173-83. [DOI:10.22037/jrm.2015.1100177]
34. Lawshe CH. A quantitative approach to content validity. Personnel psychology. 1975;28(4). [DOI:10.1111/j.1744-6570.1975.tb01393.x]
35. Waltz C, Bausell B. Design, statistics and computer analysis. Nursing Research. 1983:39-116. [DOI:10.1016/0010-4485(76)90182-2]
36. Romero Jeldres M, Díaz Costa E, Faouzi Nadim T, editors. A review of Lawshe's method for calculating content validity in the social sciences. Frontiers in Education; 2023: Frontiers Media SA. [DOI:10.3389/feduc.2023.1271335]
37. Madadizadeh F, Bahariniya S. Tutorial on how to calculating content validity of scales in medical research. Perioperative Care and Operating Room Management. 2023;31:100315. [DOI:10.1016/j.pcorm.2023.100315]
38. Polit DF, Beck CT. The content validity index: are you sure you know what's being reported? Critique and recommendations. Research in nursing & health. 2006;29(5):489-97. [DOI:10.1002/nur.20147] [PMID]
39. Polit DF, Beck CT. Study guide for essentials of nursing research: appraising evidence for nursing practice: Lippincott Williams & Wilkins; 2014.
40. jafarimanesh h, Zagheri-Tafreshi m, Imanzad m, Alavi-Majd h, Ranjbaran m, Nourmohammadi a. Designing and Validating the Nursing Advocacy Scale. scientific journal of ilam university of medical sciences. 2014;21(7):242-51
41. Lin C-C, Wu C-JJ, Hsiao Y-C, Han C-Y, Hung C-C. An exploratory factor analysis for developing and validating a scale of Nursing Students Competence Instrument. Nurse education today. 2017;50:87-91. [DOI:10.1016/j.nedt.2016.12.007] [PMID]
42. Jokiniemi K, Pietilä AM, Mikkonen S. Construct validity of clinical nurse specialist core competency scale: An exploratory factor analysis. Journal of clinical nursing. 2021;30(13-14):1863-73. [DOI:10.1111/jocn.15587] [PMID]
43. Grove SK, Burns N, Gray JR. The practice of nursing research. Missouri: Elsevier. 2013
44. Hu Lt, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural equation modeling: a multidisciplinary journal. 1999;6(1):1-55. [DOI:10.1080/10705519909540118]
45. Baharum H, Ismail A, Awang Z, McKenna L, Ibrahim R, Mohamed Z, et al. The study adapted instruments based on Confirmatory Factor Analysis (CFA) to validate measurement models of latent constructs. International Journal of Environmental Research and Public Health. 2023;20(4):2860.https://10.3390/ijerph20042860 [DOI:10.3390/ijerph20042860] [PMID] []
46. Jöreskog KG, Olsson UH, Y. Wallentin F, Jöreskog KG, Olsson UH, Wallentin FY. Confirmatory factor analysis (CFA). Multivariate analysis with LISREL. 2016:283-339. [DOI:10.1007/978-3-319-33153-9_7]
47. Kline E, Wilson C, Ereshefsky S, Tsuji T, Schiffman J, Pitts S, et al. Convergent and discriminant validity of attenuated psychosis screening tools. Schizophrenia research. 2012;134(1):49-53. [DOI:10.1016/j.schres.2011.10.001] [PMID]
48. Polit DF, Beck CT. Nursing research: Generating and assessing evidence for nursing practice: Lippincott Williams & Wilkins; 2008.
49. Waltz CF, Strickland OL, Lenz ER. Measurement in nursing and health research: Springer publishing company; 2010.
50. Hall P. Measurement in nursing and health research. Nephrology Nursing Journal. 2006;33(1):76.
51. Tilden VP, Nelson CA, May BA. Use of qualitative methods to enhance content validity. Nursing Research. 1990. [DOI:10.1097/00006199-199005000-00015] [PMID]
52. Davis LL. Instrument review: Getting the most from a panel of experts. Applied nursing research. 1992;5(4):194-7. [DOI:10.1016/S0897-1897(05)80008-4]
53. Lawshe CH. A quantitative approach to content validity. Personnel psychology. 1975;28(4):563-75. [DOI:10.1111/j.1744-6570.1975.tb01393.x]
54. Kwok C, White K, Roydhouse JK. Chinese-Australian women's knowledge, facilitators and barriers related to cervical cancer screening: a qualitative study. Journal of immigrant and minority health. 2011;13:1076-83.
https://doi.org/10.1007/s10903-011-9491-4 [DOI:10.1007/s10903-011-9491-4.] [PMID]
55. Islam RM, Billah B, Hossain MN, Oldroyd J. Barriers to cervical cancer and breast cancer screening uptake in low-income and middle-income countries: a systematic review. Asian Pacific journal of cancer prevention: APJCP. 2017;18(7):1751.
https://doi.org/10.1093/heapol/czac104 [DOI:10.1093/heapol/czac104.] [PMID] []
56. Hossaini F, Akbari ME, Soori H, Ramezankhani A. Perceived barriers to early detection of breast Cancer in Iranian women: a qualitative content analysis. International Journal of Cancer Management. 2020;13(9):e101467.
https://doi.org/10.5812/ijcm.101467 [DOI:10.5812/ijcm.101467.]
57. Munro BH. Statistical methods for health care research: lippincott williams & wilkins; 2005.
58. Streiner DL, Norman GR, Cairney J. Health measurement scales: a practical guide to their development and use: Oxford University Press, USA; 2015. [DOI:10.1093/med/9780199685219.001.0001]
59. Ersin F, Bahar Z. Effect of health belief model and health promotion model on breast cancer early diagnosis behavior: a systematic review. Asian Pac J Cancer Prev. 2011;12(10):2555-62.
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
