UCLA

Background: Lung cancer is the leading cause of cancer death and the third prevalent disease among Chinese Americans. Lung cancer screening with low dose computed tomography is an effective method to detect lung cancer. Compared to chest X-ray, low dose computed tomography can reduce the mortality rate of lung cancer by 20% in the high-risk smokers. Since 2013, lung cancer screening has been recommended by most health organizations and covered both by private and public insurances. However, the uptake rate of lung cancer screening is still low in the US, and there are few studies on lung cancer screening among Chinese Americans. Previous studies indicated that the uptake rate of lung cancer screening was significantly associated with the health belief of lung cancer screening. However, there is no instrument available to investigate the health belief of lung cancer screening among Chinese Americans. This study aims to cross-culturally adapt and validate the Lung Cancer Screening Health Belief Scale and enable its application in Chinese Americans. Methods: The study adapted an existing instrument by conducting instrument translation, expert reviews, and cognitive individual interviews in order to establish cross-cultural equivalence between the original and adapted instruments as well as to establish its content validity. The instrument was translated using the Brislin’s back-translation approach. The instrument modification included expert reviews among a panel of 5 experts in cancer nursing and cross-cultural research, and cognitive individual interviews with 9 participants. Results: We adapted a cross-cultural fitted instrument measuring Chinese American high-risk smokers’ health belief toward lung cancer screening. The modified culturally fitted Lung Cancer screening Health Belief Scale included 57 items and 6 sub-scales, which content was proved highly valid through the expert review and participants’ review. The forward and backward translation step established the translated scale’s semantic equivalency. The expert review step established the modified scale’s content equivalency, with the item level-content validity index ranged from 0.8 to 1 at the item level and the scale level content validity index/universal agreement ranged from 0.75 to 1 at the scale level. The content validity coefficients for clarity and translation equivalent ranged from 0.76 to 0.79, which were at an acceptable level. The cognitive interview step established the translated scale’s semantic and content equivalency. Strategies including changing wording, adding extra explanations to the items, changing/combing the two sections in the sentence to one section, and deleting redundant item were used in the adaptation process. Conclusions: This study adapted the Lung Cancer Screening Health Belief Scale to be used in Chinese Americans. It provides a content valid instrument to evaluate Chinese Americans’ health belief toward lung cancer screening. This study reported a reliable methodology for cross-culturally adapting an instrument to be used in another culture. It also provided an example for novice cross-cultural researchers to adapt an instrument to be used in another population with different language. Further research is needed to establish the modified instrument’s reliability and validity.