Psychometric Evaluation of the Colorectal Cancer Screening Belief Scale Based on Health Belief Model's Constructs for the Fecal Occult Blood Test

  • Tahmasebi, Rahim (Biostatistics, Bushehr University of Medical Sciences,) ;
  • Noroozi, Azita (Health Education, Bushehr University of Medical Sciences) ;
  • Dashdebi, Kamel Ghobadi (Health Education, Bushehr University of Medical Sciences)
  • Published : 2016.02.05


Background: It is important to validate scales related to cancer screening beliefs in order to better understand perceptions. The aim of this study was to test the psychometric properties of the colorectal cancer screening belief scale based on Health Belief Model (HBM) constructs. Materials and Methods: Data were collected from 600 persons referred to outpatient laboratory units in Iran through a convenience sampling procedure. In this cross-sectional study, exploratory and confirmatory factor analyses were used to examine construct validity of scale. Results: Through exploratory factor analysis, 52 items of the scale converged to five constructs of HBM with 4 items omission. Construct validity was determined by confirmatory factor analysis through which correlated model was supported. Cronbach's alpha coefficient for the whole scale was obtained as 0.78, which indicates reliability of the scale. Conclusions: The study findings showed that this scale is a valid and reliable instrument that can be used for measuring HBM constructs about colorectal cancer screening with the fecal occult blood test.


Colorectal cancer screening beliefs;fecal occult blood test;health belief model;validity;Iran


Supported by : National Health Security Office of Nakhon Ratchasima province


  1. American Cancer Society (2006). Cancer prevention and early detection facts & figures 2006. Atlanta, GA: American Cancer Society.
  2. Brislin RW (1970). Back-translation for cross-cultural research. J Cross Cult Psychol, 31, 185-216.
  3. Boyle P, Langman JS (2000). ABC of colorectal cancer: Epidemiology. BMJ, 321, 805-8.
  4. Costello AB and Osborne JW (2005). Best practices in exploratory factor analysis: Four recommendations for getting the most from your analysis. Pract Assess Res Eval, 10, 1-9.
  5. Courneya KS, Friedenreich CM, Quinney HA, et al (2003). A randomized trial of exercise and quality of life in colorectal cancer survivors. Eur J Cancer Care, 12, 347-57.
  6. DeVellis RF (1991). Scale development : theory and applications. Newbury Park ; London: Sage.
  7. Ferketich S (1991). Focus on psychometrics. Aspects of item analysis. Res Nurs Health, 14, 165-8.
  8. Glanz K, Rimer BK, Viswanath K (2008). Health behavior and health education: theory, research, and practice. 4th ed. San Francisco: John Wiley & Sons.
  9. Hou SI (2007). Cancer Screening Belief Scale - Chinese Version (CSBS-C): Validation on scale psychometric properties among a Chinese worksite population. Calif J Health Promot, 5, 79-88.
  10. Jacobson SF (2004). Evaluating instruments for use in clinical nursing research. In Marilyn F, Sharon JO. Instruments for Clinical Health-Care Research (pp. 73-80). London: Jones and Bartlett.
  11. Kline RB (2005). Principles and practice of structural equation modeling 2nd ed. New York: Guilford.
  12. Lawshe CH (1975). A quantitative approach to content validity. Pers Psychol, 28, 563-575.
  13. McQueen A, Tiro JA, Vernon SW (2008). Construct validity and invariance of four factors associated with colorectal cancer screening across gender, race, and prior screening. Cancer Epidemiol Biomarkers Prev, 17, 2231-7.
  14. Nunnally JC, Bernstein IH (1994). Psychometric Theory. New York: McGraw-Hill Inc.
  15. Ozsoy SA, Ardahan M, Ozman D (2007). Reliability and validity of the colorectal cancer screening belief scale in Turkey. Cancer Nurs, 30, 139-45.
  16. Rawl SR, Champion VL, Menon U, et al (2001). Validation of scales to measure benefits and barriers to colorectal cancer screening. J Psychosoc Oncol, 19, 47-63.
  17. Rawl SM, Menon U, Champion VL, et al (2005). Do benefits and barriers differ by stage of adoption for colorectal cancer screening? Health Educ Res, 20, 137-48.
  18. Schumacker RE, Lomax RG (2004). A beginner's guide to structural equation modelling. 2nd ed. London: Lawrence Erlbaum Associates.
  19. Tiro JA, Vernon SW, Hyslop T, Myers RE (2005). Factorial validity and invariance of a survey measuring psychosocial correlates of colorectal cancer screening among african americans and caucasians. Cancer Epidemiol Biomarkers Prev, 14, 2855-61.
  20. United States cancer statistics: 2000 incidence (2006). Atlanta, GA: Department of health and human services, centers for disease control and prevention and national cancer institute. From