Validation of health and cultural belief scales about colorectal cancer screening among Korean Americans

Colorectal cancer (CRC) is one of the most common cancers among Korean Americans (KAs). KAs have low CRC screening rates and they tend to receive a later-stage cancer diagnosis. Therefore, to improve CRC screening rates among KAs, it is necessary to increase our understanding of factors that influence CRC screening behaviors, especially beliefs. The purpose of this study was to establish a culturally appropriate conceptual framework specific to fecal occult blood test (FOBT) for CRC screening among KA immigrants aged 50 and older by adapting existing belief concepts and theories after modifying existing instruments measuring beliefs. This study had two phases (Phase I instrument modification and Phase II hypothesis testing with modified instruments) utilizing descriptive qualitative study and cross-sectional quantitative study. In Phase I, three translators translated the English version of the health and cultural belief scales into Korean using a committee translation method. Individual interviews using cognitive interviewing technique (total N=26) was used to make the health and cultural belief scales culturally appropriate. Items reflecting familism and Korean traditional beliefs were added to health and cultural belief scales based on findings from individual interviews. Three Korean experts reviewed the scales to ensure content validity. Several items were further modified to increase their clarity and understandability according to the experts’ suggestions. In Phase II, a cross-sectional survey (N=202) was conducted after pilot testing (N=11) to test the conceptual framework and psychometric properties of the scales. This study found that physician recommendation was a strong factor affecting FOBT utilization in KAs. KAs appeared to follow doctor’s recommendation regardless of their beliefs or situations because they believed that doctors are experts in health. The results revealed a positive association between health fatalism and FOBT among KAs, contrary to previous research that found a negative association between fatalism and cancer screening. This suggests that health fatalism may not be a barrier to cancer screening in KAs but may function in a positive way. In practice, study results suggested the need for public education, programs to increase physician recommendation, and the inclusion of family in promoting CRC screening test among KAs.