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Psychometric validation of a knowledge, attitudes, and practices (KAP) scale for breast cancer screening among
Yang Liao1,2, Suhaily Mohd Hairon3, Najib Majdi Yaacob4
1Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
Background:
Breast cancer screening participation remains suboptimal in China, partly due to psychological and behavioral barriers. A validated instrument is needed to assess knowledge, attitudes, and practices (KAP) related to screening behaviors among Chinese women.
Methods:
A cross-sectional study with a multistage sampling approach was conducted in Guizhou Province, China. A total of 611 women aged 18-70 participated, with samples allocated for exploratory factor analysis (EFA: n = 314) and confirmatory factor analysis (CFA: n = 297). The KAP questionnaire, adapted from existing instruments and culturally tailored, included 24 knowledge items, 12 attitude items, and 8 practice items. Psychometric evaluation involved EFA, CFA, reliability testing, and measurement invariance (MI) analysis across residential settings.
Results:
EFA revealed a five-factor structure encompassing three domains: knowledge (symptoms and screening/treatment), attitude (screening self-efficacy), and practice (breast self-examination and mammography utilization). CFA confirmed good model fit (CFI = 0.978; TLI = 0.976; RMSEA = 0.045 [90% CI: 0.038-0.051]; SRMR = 0.082). Internal consistency, composite reliability, and convergent validity were acceptable across all subscales (ω = 0.703-0.919; CR ≥ 0.70; AVE ≥ 0.50). Measurement invariance was supported across residential groups.
Conclusions:
The validated KAP scale demonstrates strong psychometric properties and is suitable for assessing breast cancer screening behaviors in Chinese women. It provides a reliable tool for both research and practice, facilitating the identification of women at risk of low screening participation and informing tailored intervention strategies.
