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Validation of a Cultural Cancer Screening Scale for Mammogram Utilization in a Sample of African American Women

Jerome-D’Emilia, Bonnie PhD, MPH, RN; Chittams, Jesse MS

doi: 10.1097/NCC.0000000000000147

Background: The Cultural Cancer Screening Scale (CCSS) was developed to identify cultural factors relevant to breast and cervical cancer screening in a sample of Hispanic and white women in Southern California. This scale identified 5 distinct cultural factors as relevant in cancer screening decision making.

Objective: The purpose of this study was to consider psychometric estimates of the validity and reliability of this scale in a sample of African American women residing in an urban area of New Jersey.

Interventions/Methods: A total of 122 women, aged 40 to 90 years, with no history of breast cancer participated in the study. Internal consistency, reliability, construct, and predictive validity were assessed.

Results: Exploratory factor analysis resulted in the formation of 5 subsets: cancer screening fatalism, negative beliefs about health professionals, catastrophic disease expectations, symptomatic deterrents, and sociocultural deterrents, all clearly independent of each other. The Cronbach’s α for the composite score of the scale was .89. Predictive validity of the composite scale score was not significant, but 4 cultural items were significant: problems making an appointment, lack of transportation, discomfort with health professionals, and health professionals inappropriately touch their patients.

Conclusions: Overall, the CCSS demonstrated acceptable preliminary values of reliability and validity in this population.

Implications for Practice: Cultural and social factors relevant to cancer screening are very important for all women. The CCSS has not yet been used in nursing research but would be very appropriate for nurses to use to better understand why women choose to access cancer screening services.

Author Affiliations: School of Nursing-Camden, Rutgers, The State University of New Jersey (Dr Jerome-D’Emilia); School of Nursing, University of Pennsylvania, Philadelphia (Mr Chittams).

The authors have no funding or conflicts of interest to disclose.

Correspondence: Bonnie Jerome-D’Emilia, PhD, MPH, RN, School of Nursing-Camden, Rutgers University, 311 N 5th St, Camden, NJ 08102 (

Accepted for publication February 15, 2014.

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