Development of Cultural Belief Scales for Mammography Screening

Kathleen M. Russell

Victoria L. Champion

Susan M. Perkins

ONF 2003, 30(4), 633-640. DOI: 10.1188/03.ONF.633-640

Purpose/Objectives: To develop instruments to measure culturally related variables that may influence mammography screening behaviors in African American women.

Design: Instrumentation methodology.

Setting: Community organizations and public housing in the Indianapolis, IN, area.

Sample: 111 African American women with a mean age of 60.2 years and 64 Caucasian women with a mean age of 60 years.

Methods: After item development, scales were administered. Data were analyzed by factor analysis, item analysis via internal consistency reliability using Cronbach's alpha, and independent t tests and logistic regression analysis to test theoretical relationships.

Main Research Variables: Personal space preferences, health temporal orientation, and perceived personal control.

Findings: Space items were factored into interpersonal and physical scales. Temporal orientation items were loaded on one factor, creating a one-dimensional scale. Control items were factored into internal and external control scales. Cronbach's alpha coefficients for the scales ranged from 0.76-0.88. Interpersonal space preference, health temporal orientation, and perceived internal control scales each were predictive of mammography screening adherence.

Conclusions: The three tested scales were reliable and valid. Scales, on average, did not differ between African American and Caucasian populations.

Implications for Nursing: These scales may be useful in future investigations aimed at increasing mammography screening in African American and Caucasian women.

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    Airhihenbuwa, C.O. (1992). Health promotion and disease prevention strategies for African Americans: A conceptual model. In R.L. Braithwaite & S.E. Taylor (Eds.), Health issues in the black community (pp. 267-280). San Francisco: Jossey-Bass.

    American Cancer Society. (2001). American Cancer Society recommends annual mammography starting at age 40. Retrieved June 30, 2002, from

    American Cancer Society. (2002). Cancer facts and figures, 2002. Retrieved May9, 2003, from

    Ashing-Giwa, K. (1999). Health behavior change models and their socio-cul-tural relevance for breast cancer screening in African American women. Women and Health, 28(4), 53-71.

    Bailey, E.J. (2000). Medical anthropology and African American health. Westport, CT: Bergin and Garvey.

    Bundel, N.I., Marks, G., & Richardson, J.L. (1993). Role of health locus of control beliefs in cancer screening of elderly Hispanic women. Health Psychology, 12, 193-199.

    Burnett, C.B., Steakley, C.S., & Tefft, M.C. (1995). Barriers to breast and cervical screening in underserved women of the District of Columbia. Oncology Nursing Forum, 22, 1551-1557.

    Burns, R.B., McCarthy, E.P., Freund, K.M., Marwill, S.L., Shwartz, M., Ash, A., et al. (1996). Variability in mammography use among older women. Journal of the American Geriatrics Society, 44, 922-926.

    Champion, V., & Menon, U. (1997). Predicting mammography and breast self-examination in African American women. Cancer Nursing, 20, 315-322.

    Coleman, E.A., & O'Sullivan, P. (2001). Racial differences in breast cancer screening among women from 65 to 74 years of age: Trends from 1987-1993 and barriers to screening. Journal of Women and Aging, 13(3), 23-39.

    Conrad, M.E., Brown, P., & Conrad, M.G. (1996). Fatalism and breast cancer in black women [Abstract]. Annals of Internal Medicine, 125, 941-942.

    Crump, S.R., Mayberry, R.M., Taylor, B.D., Barefield, K.P., & Thomas, P.E. (2000). Factors related to noncompliance with screening mammogram appointments among low-income African American women. Journal of the National Medical Association, 92, 237-246.

    Dangelis, N.L., Roberson, N.L., Worden, J.K., Flynn, B.S., Dorwaldt, A.L., Ashley, J.A., et al. (1995). Breast screening by African American women: Insights from a household survey and focus groups. American Journal of Preventive Medicine, 11, 311-317.

    Friedman, L.C., Webb, J.A., Weinberg, A.D., Lane, M., Cooper, H.P., & Woodruff, A. (1995). Breast cancer screening: Racial/ethnic differences in behaviors and beliefs. Journal of Cancer Education, 10, 213-216.

    Giger, J.N., & Davidhizer, R.E. (1999). Transcultural nursing: Assessment and intervention (3rd ed.). St. Louis, MO: Mosby.

    Grant, J.S., & Davis, L.L. (1997). Selection and use of content experts for instrument development. Research in Nursing and Health, 20, 269-274.

    Gregg, J., & Curry, R.H. (1994). Explanatory models for cancer among African-American women at two Atlanta neighborhood health centers: The implications for a cancer screening program. Social Science and Medicine, 39, 519-526.

    Hallal, J.C. (1982). The relationship of health beliefs, health locus of control, and self-concept to the practice of breast self-examination in women. Nursing Research, 31, 137-142.

    Hayter, J. (1981). Territoriality as a universal need. Journal of Advanced Nursing, 6, 79-85.

    Hegarty, V.M.B., Burchett, B.M., Gold, D.T., & Cohen, H.J. (2000). Racial differences in the use of cancer prevention services among older adults. Journal of the American Geriatrics Society, 48, 735-740.

    Hoffman-Goetz, L., & Mills, S.L. (1997). Cultural barriers to cancer screening among African American women: A critical review of the qualitative literature. Women's Health: Research on Gender, Behavior, and Policy, 3, 183-201.

    Holm, C.J., Frank, D.I., & Curtin, J. (1999). Health beliefs, health locus of control, and women's mammography behavior. Cancer Nursing, 22, 149-156.

    Hughes, C., Lerman, C., & Lustbader, E. (1996). Ethnic differences in risk perception among women at increased risk for breast cancer. Breast Cancer Research and Treatment, 40(1), 25-35.

    Jennings, K. (1996). Getting black women to screen for cancer: Incorporating health beliefs into practice. Journal of the American Academy of Nurse Practitioners, 8(2), 53-59.

    Kerlikowske, K., Grady, D., Rubin, S.M., Sandrock, C., & Ernster, V.L. (1995). Efficacy of screening mammography: A meta-analysis. JAMA, 273, 149-154.

    King, G., & Williams, D.R. (1995). Race and health: A multidimensional approach to African American health. In B.C. Amick, S. Levine, A.R. Tarlov, & D.C. Walsh (Eds.), Society and health (pp. 93-130). New York: Oxford.

    Lannin, D.R., Mathews, H.F., Mitchell, J., Swanson, M.S., Swanson, F.H., & Edwards, M.S. (1998). Influence of socioeconomic and cultural factors on racial differences in late-stage presentation of breast cancer. JAMA, 279, 1801-1807.

    Mandelblatt, J., Traxler, M., Lakin, P., Kanetsky, P., & Kao, R. (1993). Targeting breast and cervical cancer screening to elderly poor black women: Who will participate? Preventive Medicine, 27, 20-33.

    Marbella, A.M., & Layde, P.M. (2001). Racial trends in age-specific breast cancer mortality rates in U.S. women. American Journal of Public Health, 91, 118-121.

    Mathews, H.F., Lannin, D.R., & Mitchell, J.P. (1994). Coming to terms with advanced breast cancer: Black women's narratives from eastern North Carolina. Social Science and Medicine, 6, 789-800.

    Mickey, R.M., Durski, J., Worden, J.K., & Danigelis, N.L. (1995). Breast cancer screening and associated factors for low-income African-American women. Preventive Medicine, 24, 467-476.

    Murrell, A.A., & Mingrone, M. (1994). Correlates of temporal perspective. Perceptual and Motor Skills, 78, 1331-1334.

    Nunnally, J.C. (1978). Psychometric theory (2nd ed.). New York: McGraw-Hill.

    Pearlman, D.N., Rakowski, W., Ehrich, B., & Clark, M.A. (1996). Breast cancer screening practices among black, Hispanic, and white women: Reassessing differences. American Journal of Preventive Medicine, 12, 327-336.

    Phillips, J.M. (1999). Breast cancer and African American women: Moving beyond fear, fatalism, and silence. Oncology Nursing Forum, 26, 1001-1007.

    Phillips, J.M., Cohen, M.Z., & Moses, G. (1999). Breast cancer screening and African American women: Fear, fatalism, and silence. Oncology Nursing Forum, 26, 561-571.

    Phillips, J.M., Cohen, M.Z., & Tarzian, A.J. (2001). African American women's experiences with breast cancer screening. Image: Journal of Nursing Scholarship, 33, 135-140.

    Phillips, J.M., & Wilbur, J. (1995). Adherence to breast cancer screening guidelines among African-American women of differing employment status. Cancer Nursing, 18, 258-269.

    Price, J.H., Desmond, S.M., Slenker, S., Smith, D., & Stewart, B.A. (1992). Urban black women's perceptions of breast cancer and mammography. Journal of Community Health, 17, 191-204.

    Rajaram, S.S., & Rashidi, A. (1998). Minority women and breast cancer screening: The role of cultural explanatory models. Preventive Medicine, 27, 757-764.

    Reisch, L.M., Barton, M.B., Fletcher, S.W., Kreuter, W., & Elmore, J.G. (2000). Breast cancer screening use by African American and whites in an HMO. Journal of General Internal Medicine, 15, 229-234.

    Rotter, J.B. (1966). Generalized expectancies for internal versus external control of reinforcement. Psychological Monographs, 80(1), 1-28.

    Smith, E.D., Phillips, J.M., & Price, M.M. (2001). Screening and early detection among racial and ethnic minority women. Seminars in Oncology Nursing, 17, 159-170.

    Spector, R.E. (1996). Cultural diversity in health and illness (4th ed.). Stamford, CT: Appleton and Lange.

    Tessaro, I., Eng, E., & Smith, J. (1994). Breast cancer screening in older adult African American women: Qualitative research findings. American Journal of Health Promotion, 8, 286-293.

    Vernon, S., Vogel, V., Halabi, S., Jackson, G., Lundy, R., & Peters, G. (1992). Breast cancer screening behaviors and attitudes in three racial/ethnic groups. Cancer, 69, 165-174.