Developing and testing an instrument for identifying culture-specific barriers to breast cancer screening in Israeli Arab women

Figures & data

Table I.  Participants’ demographic characteristics and breast examination rate (N = 300).

Demographics
Age
Mean (SD)	48.21 (5.81)
Range	40–65
Marital status N (%)
Married	245 (81.7)
Not married	55 (18.3)
Years of education
Mean (SD)	10.33 (4.42)
Range	0–25
Employment status N (%)
Employed	110 (36.7)
Not employed	190 (63.3)
Economic background N (%)
Good	102 (34.0)
Average	161 (53.7)
Poor	37 (12.3)
Religiosity N (%)
Secular	26 (8.7)
Mildly religious	143 (47.7)
Very religious	131 (43.6)
Mammography test^1 N (%)
Done in previous two years	52 (41.3)
Never done	74 (58.7)
Clinical examination N (%)
Done in previous two years	96 (32.0)
Never done	204 (68.0)
Breast self-examination N (%)
Done once in two months or more	161 (53.7)
Never done	139 (46.3)
Has a first-degree relative with breast cancer N (%)	12 (4.0)

¹Women over 50 (n = 105).

Table II.  Factor loadings^a, Eigen values^b, means and reliability scores in the final factor-analysis model (N = 300).

	Factor 1 Exposure barriers	Factor 2 Social barriers	Factor 3 Traditional beliefs	Factor 4 Environment barriers	Factor 5 Uneasiness with own body
Exposure of body to male physician	0.82
Exposure of body to female physician	0.73
Body exposure forbidden by religion	0.70
Fear of being seen at the clinic	0.68
Fear of pity		0.77
Fear of disrespect by family		0.65
Fear of losing job		0.63
Fear of losing friends		0.62
Fear of husband's detachment, resentment		0.58
Fear of neglecting the family		0.55
Cancer is a way of punishment by God			0.74
Cancer is a way of atonement for bad deeds by God			0.73
Cancer is a trial by God			0.73
Reading religious writings helps			0.63
Communication barriers				0.65
Accessibility barriers				0.57
Cost barriers				0.51
No privacy for examining breast					0.67
Uneasiness looking at own body					0.55
Uneasiness touching own body					0.55
Eigen value	4.81	2.55	1.95	1.73	1.47
Mean	3.03	2.86	3.08	3.21	1.64
(SD)	(0.36)	(0.90)	(0.93)	(0.79)	(0.97)
Range	1–5	1–5	1.29–5	1–5	1–4.60
Cronbach's alpha	0.87	0.78	0.76	0.86	0.85

^aFactor loadings represent the degree of correlation between the initial raw score and the final factor score.

^bEigen values are indicators of variance accounted for each factor.

Table III.  Pearson correlations between ACSB subscales and barriers and benefits subscales of the health belief questionnaire (N = 300).

	Mammography		Clinical examination		Breast self-examination
	Barriers	Benefits	Barriers	Benefits	Barriers	Benefits
Exposure barriers	.47***	−.32***	.51***	−.32***	.25***	−.21*
Social barriers	.15*	.10	.19**	.02	.20**	−.14*
Traditional beliefs	−.01	.13*	−.06	.18*	.24***	.04
Environmental barriers	.22***	−.07	.22***	−.19**	.12*	−.10
Self-uneasiness	.18**	−.05	.21**	−.07	.34***	−.26***

Table IV.  Logistic regression analysis with breast examination performance as dependent variable and ACSB scales as independent variables (N = 300).

	Mammography^1 (n = 126)		Clinical examination (n = 300)		Breast self-examination (n = 300)
Variables	OR	CI 95%	OR	CI 95%	OR	CI 95%
Exposure barriers	20.22***	5.06–37.86	1.72**	1.24–3.15	1.33*	1.13–2.56
Social barriers	1.39*	0.76–2.06	2.74***	1.73–4.34	1.36*	1.10–2.12
Traditional beliefs	1.15	0.71–2.43	0.79	0.43–1.46	4.33***	.81–10.331
Environmental barriers	5.22**	1.58–17.22	3.40***	1.70–6.79	.850	.59–1.240
Self-uneasiness	1.27**	1.64–2.91	1.15	0.76–1.29	12.70***	5.82–21.70
χ^2 (5)	81.80***		96.29***		152.43***

¹Women aged 50 and over; OR = odds ratio, CI = confidence interval.

*p < 0.05, **p < 0.01, ***p < 0.001.

Table

Factor 1: Exposure barriers
A male physician examining my breast embarrasses me	1.
A female physician examining my breast embarrasses me	2.
Body exposure is forbidden by religion	3.
I fear being seen at the clinic	4.
Factor 2: Social barriers
Fear pity by others	5.
Fear disrespect by my family	6.
Fear losing my job	7.
Fear my husband's detachment, resentment	8.
Fear neglecting my family	9.
Fear losing my friends	10.
Factor 3: Religious beliefs concerning cancer
Cancer is a way of punishment by God	11.
Cancer is a way of atonement for bad deeds by God	12.
Cancer is a trial by God	13.
Reading religious writings assists healing	14.
Factor 4: Environmental barriers
Language and communication	15.
Distance and accessibility of the clinic	16.
Cost of the examinations	17.
Factor 4: Uneasiness with own body
I feel embarrassed looking at my body	18.
I feel embarrassed touching my body	19.
I have no privacy to examine my body	20.
I do not know my body sufficiently to recognize changes in it.	21.