Adaptation of the fear of cancer scale and examination of its psychometric properties

Cancer fear is an important issue in public health that awaits solutions in areas such as early diagnosis and screenings, and access to health services. It is important to determine the level of cancer fear in society and identify the factors affecting the level of cancer fear. There are scales in Turkey that are proven to be valid and reliable for cancer fear and are extensively used in the literature. However, despite their high validity and reliability, these tools have limited application scopes due to characteristics such as being specific to a single target cancer type and not being used for individuals without a cancer history. To our knowledge, there is no systematic, comprehensive Turkish measurement tool available to measure cancer fear in society considering the multidimensional structure of cancer fear. The aim of this study is to adapt the 17-item Cancer Fear Scale developed by Feng et al. in 2022 in China to Turkish and to determine its psychometric properties. This methodological research was conducted at Pamukkale University Medical Faculty Hospital between October 16 and November 30, 2024. The population of the study consisted of individuals over the age of 18 who applied to the hospital during the specified dates. The minimum sample size required for the adaptation of the scale was calculated as 170. Participants were selected using purposive sampling, one of the non-probability sampling methods, in 14 different waiting rooms of the hospital in both the morning and afternoon. As a data collection tool, a questionnaire including sociodemographic characteristics and information about cancer, the Cancer Fear Scale, the Cancer Anxiety Scale, and the Generalized Anxiety Disorder-7 (GAD-7) Test, totaling 46 questions, was used. For the adaptation of the scale into Turkish, a rigorous process including translation-back translation technique with two independent translators, an expert committee, and the researcher who developed the scale was followed. A pilot test was conducted with a group of 15 people at Pamukkale University Hospital to evaluate the comprehensibility and application time of the scale, and necessary corrections were made. In the study, to evaluate the validity of the scale, content validity (Davis technique), construct validity (Confirmatory Factor Analysis), convergent validity (AVE and CR), divergent validity (HTMT), concurrent validity, and hypothesis-based construct validity were used. For reliability analysis, Cronbach's alpha, McDonald's Omega, item-total correlation, group comparison method, test-retest, and intra-class correlation coefficient (ICC) were calculated. The R software version 4.4.2 was used for data analysis. A p-value of less than 0.05 was considered statistically significant. This study was conducted with 1195 participants. Due to missing data in the survey responses of 6 participants and pilot study data for 15 participants, a total of 21 participants were excluded from the study. During data analysis, 61 participants with a history of cancer were excluded. Consequently, the data of 1174 participants were used in the analysis. The mean age of the participants was found to be 36,00±14,00 years, 54,10% of the participants were women, and 57,30% stated that they intended to undergo all age-appropriate cancer screenings. The mean total score of the Cancer Anxiety Scale was found to be 15,38±5,05, the mean total score of the Generalized Anxiety Disorder-7 Test was 6,80±5,49, and the mean total score of the Cancer Fear Scale was 33,06±13,56. According to the confirmatory factor analysis, it was shown that the fit indices were at a good or excellent level (CFI =0,972, TLI =0,966, NNFI =0,966, RMSEA =0,08 SRMR=0,074, NFI=0,968 GFI = 0,990 and AGFI = 0,983) and the original 2-factor structure was confirmed. A significant and moderate positive correlation was found between the Cancer Anxiety Scale and the Cancer Fear Scale (r = 0,599, p <0.001). A statistically significant but low-level correlation was found between the Cancer Fear Scale and the Generalized Anxiety Disorder-7 Test (r = 0,290, p <0.001). It was observed that the Cancer Fear Scale met the hypothesis validity and concurrent validity. The Cronbach Alpha coefficient of the Cancer Fear Scale was found to be 0,90, the McDonald's Omega coefficient (ω) was 0,91, and McDonald's Hierarchical Omega coefficient (ωh) was 0,90. The Cronbach Alpha coefficients of the sub-factors were found to be 0,87 and 0,83, and McDonald's Omega coefficients (ω) were 0,88 and 0,84, respectively. The test-retest reliability coefficient was found to be 0,88, and the ICC value was 0,90. The Turkish Cancer Fear Scale is valid and reliable. Keywords: Cancer, Fear, Validity, Reliability, Adaptation