Prostate Cancer Screening Intention Among African American Men: An Instrument Development Study

Cancer is the second leading cause of death in the United States. Prostate cancer is the leading cause of cancer deaths among African American men, and African American men have the highest incidence of prostate cancer in the world. Limited studies have been conducted that address this critical issue. Existing literature reveals that the primary cause of increased mortality rates of prostate cancer in African American men is lack of participation in prostate cancer screening activities. The purpose of this three-phase study was to develop a valid and reliable instrument to measure prostate cancer screening intention among African American men. Three gender-specific focus groups were conducted in the first phase of the study. Twenty men from two north Florida churches participated in the focus groups. Eight dominant themes emerged from the focus groups and were utilized to develop the items for the intention instrument: fear, healthy lifestyle, hopelessness/helplessness, machismo, mistrust of healthcare providers, social/familial support, job requirements and transportation barriers. The second and third phases of the study consisted of development of the instrument and assessment of the instrument for validity and reliability. The Cancer Screening Intention Scale-Prostate (CSIS-P) consists of 43 items and was developed utilizing the results of the focus groups. The reading level of the CSIS-P was 5.6 utilizing the Flesch-Kincaid index and 7.0 utilizing the SMOG Readability Formula. The CSIS-P was assessed for content validity by a panel of oncology experts. The content validity index for the scale was .90 and internal consistency was found to be .92. The CSIS-P was evaluated for construct validity utilizing factor analysis techniques. Test-retest procedures were also conducted to assess stability of the CSIS-P and the reliability coefficient was .93. Factor analysis techniques demonstrated a three-structure model. The factors that emerged were benefits to prostate cancer screening, barriers to prostate cancer screening, and health promotion. The internal consistency of the three factors were found to be .88, .81, and .86 respectively. Factor analysis procedures reduced the CSIS-P to a 17-item scale. The CSIS-P is a parsimonious, culturally sensitive instrument that is valid and reliable in assessing prostate cancer screening intention. Recommendations for future study of the instrument include replication of the study with a more heterogeneous sample and utilization of the scale with other cancers