According to the World Health Organization (WHO), cancer is the second most common cause of death worldwide, accounting for 9.6 million deaths in 2018. Of the various types of cancer, that most often encountered in women is breast cancer, followed by colo-rectal, lung, cervical, and thyroid cancers (WHO, 2021a). As breast cancer progresses, it has a major impact both on patients themselves and on their families: both the sufferers themselves and their family members find themselves facing negative consequences at both physical and psychological levels (Grunfeld et al., 2004; Glajchen, 2012; Campbell-Enns H, & Woodgate, 2015; Vintilă et al., 2019; Ştefǎnuţ et al., 2020; Ştefǎnuţ et al., 2021). Consequences of breast cancer, breast surgery, partial or complete removal of the breast often leads to higher breast awareness, appearance dissatisfaction and lowering of the level of psychological well-being (Swami et al., 2020).
The WHO has drawn attention to the fact that between 30% and 50% of deaths caused by cancer could be prevented by the avoiding of risk factors and by the implementation of proof-based intervention strategies, while the burden of suffering inflicted by this disease could be reduced by early detection (WHO, 2021b). Given that there are no specific methods of preventing breast cancer and that research has demonstrated that early detection leads to a reduction in mortality (Arrospide et al., 2015), such early detection is of paramount importance.
The screening methods that can be utilized in relation to breast cancer are self-examination, mammography, and clinical examination by medical professionals (Siu, 2016). Breast self-examination is a non-invasive procedure that costs nothing, takes only a little time, and does not involve seeking professional help, yet it has been shown that in spite of all these benefits it is little practiced (Carelli et al., 2008; Karayurt et al., 2008; Akhtari-Zavare et al., 2015). An understanding of the factors that influence the adopting of this behavior has therefore become the focus of interest of research concerned with encouraging health-related attitudes and behaviors, and one of the theoretical models employed has been the Health Belief Model (HBM).
The HBM (Rosenstock, 1974) is a psycho-social model that was initially developed in an attempt to explain a low level of adherence to tuberculosis screening and prevention programs. Over time, this model has frequently been used to explain health-related behaviors in the context of a range of chronic conditions such as diabetes (Wdowik et al., 2001), chronic obstructive pulmonary disease (Wang et al., 2014) and coronary heart disease (Ali, 2002). The constructs currently included in the HBM are perception of susceptibility (the perceived probability of developing a given disease), perception of severity (the seriousness of the consequences of the disease), perception of benefits (the helpful effects of the proposed behaviors in reducing the chances of developing the disease or in reducing the negative consequences of having it), perception of barriers (obstacles that can appear in the way of adopting the proposed behaviors), cues to action (internal and external stimuli involved in the decision to adopt the behaviors), and self-efficacy (a person’s belief that they are capable of carrying out these actions).Thus, according to the HBM, the chances that a person will carry out breast self-examination increase in line with the strength of their belief that they are likely to develop breast cancer, that the consequences of that happening are serious, and that the suggested behavior will be effective in reducing the negative outcome of the disease. A high level of confidence in self ability to carry out self-examination is likely to increase the probability that this behavior will be followed, while the existence of barriers such as embarrassment, fear or pain is likely to have a negative effect on the probability of their carrying out this self-examination. Previous studies have demonstrated a significant association between the HBM constructs and this screening behavior (Ashton et al., 2001; Karayurt et al., 2008).
The purpose of Champion’s Health Belief Model Scale (CHBMS) is to identify the beliefs that influence breast self-examination from the perspective of the HBM. This instrument was devised in 1984 (Champion, 1984), later revised (Champion, 1993), and subsequently translated and adapted for a variety of cultures (Lee et al., 2002; Karayurt et al., 2008; Dewi, 2018). The psychometric properties of the scale, whether we are talking about the original versions or about the adaptations, were adequate.
In Romania, the incidence of breast cancer is 11.5%, with a mortality rate of 6.6% (WHO, 2021c). Given that over 33% of new cases in this country are diagnosed at stage IV (Tofan et al., 2018) (that is, in the last – most advanced stage in which the disease has spread to other organs), encouraging screening with a view to early detection is a priority. Breast self-examination is a health behavior largely popularized that should be known and practiced monthly by all adult women (Champion, 1984). Research on monitoring breast self-examination is widespread among scientific community but there are no data regarding Romanian population. Understanding the beliefs of women in Romania regarding self-examination as well as knowing the level of adherence to this behavior can help health professionals to create more effective educational programs in promoting this behavior. In order to monitor levels of adherence to breast self-examination, it is necessary to use an instrument that has been adapted to the Romanian population; however, to the best of the present authors’ knowledge no such questionnaire is currently available. That being the situation, the aim of this study is to translate the CHBMS for the Romanian population and to evaluate the psychometric properties of this version.