Development and validation of the African Women Awareness of CANcer (AWACAN) tool for breast and cervical cancer

Article Authors: Moodley, J. Scott, S. E. Mwaka, A. D. Constant, D. Githaiga, J. N. Stewart, T. S. Payne, A. Cairncross, L. Somdyala, N. I. M. Walter, F. M

    • Abstract


    Abstract
    Background: Measuring 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).
    Methods: Development 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.
    Results: ICC 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.
    Conclusion: The 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.

    Bibliographical metadata

    Volume 14
    Issue No. 8
    DOI https://doi.org/10.1371/journal.pone.0220545
    Related Faculties/Schools
    Affiliation
    • 1Women’s Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town; Observatory, Cape Town, South Africa.
    • 2Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town; Observatory, Cape Town, South Africa.
    • 3SAMRC Gynaecology Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, South Africa.
    • 4Centre for Oral, Clinical and Translational Sciences, Faculty of Dentistry, Oral and Craniofacial Sciences, King’s College London, London, United Kingdom.
    • 5Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
    • 6Department of Obstetrics & Gynaecology, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth, Devon, United Kingdom.
    • 7Surgical Endocrine Oncology Unit, Division of General Surgery, Department of Surgery, University of Cape Town; Observatory, Cape Town, South Africa.
    • 8Eastern Cape Cancer Registry, South African Medical Research Council, Burden of Disease Research Unit, Tygerberg, South Africa.
    • 9The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom.