Thompson Vetta L Sanders, Bugbee Alan, Meriac John P, Harris Jenine K
Washington University in St. Louis, George Warren Brown School , MO.
Imagination Station, Inc. , Conshohocken, PA.
J Public Health Res. 2013 Sep 2;2(2):e11. doi: 10.4081/jphr.2013.e11.
Data suggest that colorectal cancer could be cut by approximately 60% if all people aged 50 years or older received regular screening. Studies have identified socio-cultural attitudes that might inform cancer education and screening promotion campaigns. This article applies item response theory (IRT) to a set of survey items selected to assess sociocultural attitudes in order to determine how current measures may affect what we know about how these attitudes affect colorectal cancer screening (CRCS).
A survey of colorectal cancer screening, screening attitudes and cultural beliefs was administered to 1021 African Americans - 683 women and 338 men, ages 50 to 75. Eligibility criteria for participation included being born in the United States, self-identified African American male or female, age 50 to 75 years. The IRT analysis was performed on 655 individuals with complete data for the 43 observed variables.
Twenty-nine items comprise the Multi-construct African American Cultural Survey (MAACS) that addresses seven cultural constructs: mistrust/distrust, privacy, ethnic identity, collectivism, empowerment, and male gender roles. The items provide adequate information about the attitudes of the population across most levels of the constructs assessed. Among the sociocultural variables considered, empowerment (OR=1.078; 95% CI: 1.008, 1.151) had the strongest association with CRCS adherence and privacy showed promise.
The MAACS provides a fixed length questionnaire to assess African American CRCS attitudes, two new constructs that might assist in CRCS promotion, and a suggested focus for identification of additional constructs of interest. Significance for public healthThe 29 items of the Multi-construct African American Cultural Survey, identified through IRT analyses, can be used by community health researchers interested in determining the relevance of cultural constructs in the design and implementation of colorectal cancer screening programs in the African American community. With appropriate identification of sociocultural concerns, CRC health education materials and promotion strategies may avoid unnecessary conflicts with community beliefs and values. Avoiding conflicts between beliefs and values increases the likelihood that evidence and the recommended behaviours are considered for adoption. In addition, the short survey, as well as the broader item set, may be useful as a starting point for surveys to be used with other cancer sites. The application of IRT analysis to measures of cultural constructs to facilitate the development of accurate and efficient measures may prove useful in other racial/ethnic communities where cultural concerns may be relevant for health education and promotion.
数据表明，如果所有50岁及以上的人接受定期筛查，结直肠癌发病率可降低约60%。研究已经确定了一些社会文化态度，这些态度可能为癌症教育和筛查推广活动提供参考。本文将项目反应理论（IRT）应用于一组为评估社会文化态度而选择的调查项目，以确定当前的测量方法可能如何影响我们对这些态度如何影响结直肠癌筛查（CRCS）的了解。
对1021名非裔美国人进行了一项关于结直肠癌筛查、筛查态度和文化信仰的调查，其中683名女性和338名男性，年龄在50至75岁之间。参与的资格标准包括在美国出生、自我认定为非裔美国男性或女性、年龄在50至75岁之间。对655名拥有43个观测变量完整数据的个体进行了IRT分析。
29个项目构成了多结构非裔美国人文化调查（MAACS），该调查涉及七个文化结构：不信任/怀疑、隐私、种族认同、集体主义、赋权和男性性别角色。这些项目为所评估的大多数结构水平上的人群态度提供了充分的信息。在考虑的社会文化变量中，赋权（OR=1.078；9%CI：1.008，1.151）与CRCS依从性的关联最强，隐私也显示出有希望的关联。
MAACS提供了一份固定长度的问卷，用于评估非裔美国人对CRCS的态度，两个可能有助于促进CRCS的新结构，以及一个用于识别其他感兴趣结构的建议重点。对公共卫生的意义通过IRT分析确定的多结构非裔美国人文化调查的29个项目，可供社区卫生研究人员使用，他们有兴趣确定文化结构在非裔美国人社区结直肠癌筛查项目的设计和实施中的相关性。通过适当识别社会文化问题，CRC健康教育材料和推广策略可以避免与社区信仰和价值观产生不必要的冲突。避免信仰和价值观之间的冲突增加了人们考虑采用证据和推荐行为的可能性。此外，简短的调查以及更广泛的项目集，可能作为与其他癌症部位一起使用的调查的起点。将IRT分析应用于文化结构的测量，以促进准确和有效测量的发展，可能在其他文化问题可能与健康教育和推广相关的种族/族裔社区中证明是有用的。
