Adaptation and validation of the Arabic version of self-efficacy scale for mammography. A report on psychometric properties

Abdulmohsen Hamdan Al-Zalabani


Objectives: To culturally adapt and validate a mammography-specific self-efficacy (MSSE) scale into Arabic for the Saudi Arabian context.


Methods: A methodological study aimed at tool translation and adaptation conducted in primary healthcare centers in Al Madinah, Saudi Arabia between March 2016 and May 2016. The MSSE scale was translated and adapted into Arabic using standard procedures. Content and face validity were investigated. Confirmatory factor analysis and reliability analysis were used to determine the scale’s psychometric properties.


Results:  The scale showed a good internal consistency (Cronbach’s alpha=0.88). The confirmatory factor analysis supported the scale’s single-factor structure and the goodness-of-fit indices confirmed the model’s good fit (comparative fit index=0.961, Tucker‐Lewis index=0.943, root-mean-square error of approximation=0.076, and standardized root-mean-square residual=0.045). Women who had a mammogram in the last 2 years scored significantly higher on the scale (39±6.2) than women who had never received a mammogram (35.88±7.2; p=0.009).


Conclusion: The study confirmed that the scale’s Arabic version has good psychometric properties, using reliability analysis, confirmatory factor analysis, and extreme groups validation. The scale is likely to be useful for evaluating interventional studies aimed at improving mammography screening participation rates.



Saudi Med J 2019; Vol. 40 (7): 707-713
doi: 10.15537/smj.2019.7.23938

How to cite this article:
Al-Zalabani AH. Adaptation and validitation of Arabic version of self-efficacy scale for mammography. Saudi Med J 2019; 40 (7): 707-713. doi: 10.15537/smj.2019.7.23938.



self-efficacy; mammography; breast cancer; Psychometrics; Factor Analysis

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Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394-424.

Alrawaji A, Alzahrani W, Alshahrani Z, Alomran F, Almadouj A., editors. Saudi Cancer Registry. Cancer Incidence Report Saudi Arabia 2015. Riyadh: Saudi Health Council; 2018.

Althubiti MA, Nour Eldein MM. Trends in the incidence and mortality of cancer in Saudi Arabia. Saudi Med J 2018; 39: 1259-1262.

Saggu S, Rehman H, Abbas ZK, Ansari AA. Recent incidence and descriptive epidemiological survey of breast cancer in Saudi Arabia. Saudi Med J 2015; 36: 1176-1180.

Nelson HD, Fu R, Cantor A, Pappas M, Daeges M, Humphrey L. Effectiveness of breast cancer screening: systematic review and meta-analysis to update the 2009 U.S. Preventive Services Task Force Recommendation. Ann Intern Med 2016; 164: 244-255.

Al-Wassia RK, Farsi NJ, Merdad LA, Hagi SK. Patterns, knowledge, and barriers of mammography use among women in Saudi Arabia. Saudi Med J 2017; 38: 913-921.

Al-Zalabani AH, Alharbi KD, Fallatah NI, Alqabshawi RI, Al-Zalabani AA, Alghamdi SM. Breast cancer knowledge and screening practice and barriers among women in Madinah, Saudi Arabia. J Cancer Educ 2018; 33: 201-207.

Plourde N, Brown HK, Vigod S, Cobigo V. Contextual factors associated with uptake of breast and cervical cancer screening: A systematic review of the literature. Women Health 2016; 56: 906-925.

Bowser D, Marqusee H, El Koussa M, Atun R. Health system barriers and enablers to early access to breast cancer screening, detection, and diagnosis: a global analysis applied to the MENA region. Public Health 2017; 152: 58-74.

Glanz K, Rimer BK, Viswanath K. Health behavior: theory, research, and practice. 5th ed. San Francisco (CA): Jossey-Bass; 2015.

Aldohaian AI, Alshammari SA, Arafah DM. Using the health belief model to assess beliefs and behaviors regarding cervical cancer screening among Saudi women: a cross-sectional observational study. BMC Womens Health 2019; 19: 6.

Almadi MA, Alghamdi F. The gap between knowledge and undergoing colorectal cancer screening using the Health Belief Model: A national survey. Saudi J Gastroenterol 2019; 25: 27-39.

Abolfotouh MA, BaniMustafa AA, Mahfouz AA, Al-Assiri MH, Al-Juhani AF, Alaskar AS. Using the health belief model to predict breast self examination among Saudi women. BMC Public Health 2015; 15: 1163.

Kelder SH, Hoelscher D, Perry CL. How individuals, environments, and health behaviors interact. In: Glanz K, Rimer BK, Viswanath K, editors. Health behavior: theory, research, and practice. 5th ed. San Francisco (CA): Jossey-Bass; 2015. p. 159-181.

Sheeran P, Harris PR, Epton T. Does heightening risk appraisals change people’s intentions and behavior? A meta-analysis of experimental studies. Psychol Bull 2014; 140: 511-543.

Jerome-D’Emilia B, Suplee PD. Mammogram use and self-efficacy in an urban minority population. Public Health Nurs 2015; 32: 287-297.

El Bcheraoui C, Basulaiman M, Wilson S, Daoud F, Tuffaha M, AlMazroa MA, et al. Breast cancer screening in Saudi Arabia: free but almost no takers. PLoS One 2015; 10: e0119051.

Moshki M, Shahgheibi S, Taymoori P, Moradi A, Roshani D, Holt CL. Psychometric properties of the mammography self-efficacy and fear of breast cancer scales in Iranian women. BMC Public Health 2017; 17: 534.

Champion V, Skinner CS, Menon U. Development of a self-efficacy scale for mammography. Res Nurs Health 2005; 28: 329-336.

Anagnostopoulos F, Dimitrakaki C, Niakas D, Tountas Y. Validity and reliability assessment of health belief scales for mammography screening in Greek asymptomatic women. Psychooncology 2013;22:1912-1917.

Secginli S. Mammography self-efficacy scale and breast cancer fear scale: psychometric testing of the Turkish versions. Cancer Nurs 2012; 35: 365-373.

Hashemian M, Hidarnia A, Aminshokravi F, Lamyian M, Hassanpour K, Akaberi A, et al. Farsi version of the mammography self-efficacy scale for Iranian women. Cancer Nurs 2015; 38: 484-489.

Khresheh RM, Ahmad NM. Breastfeeding self efficacy among pregnant women in Saudi Arabia. Saudi Med J 2018; 39: 1116-1122.

Albeshan SM, Mackey MG, Hossain SZ, Alfuraih AA, Brennan PC. Breast cancer epidemiology in Gulf cooperation council countries: a regional and international comparison. Clin Breast Cancer 2018; 18: e381-e392.

Schumacker RE, Lomax RG. A beginner’s guide to structural equation modeling. 4th ed. New York (NY) : Routledge; 2016.

Streiner DL, Norman GR, Cairney J. Health measurement scales: a practical guide to their development and use. 5th ed. Oxford: Oxford University Press; 2015.

von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, et al. The Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg 2014; 12: 1495-1499.

Byrne BM. Structural equation modeling with Amos: basic concepts, applications, and programming. 3rd ed. New York (NY): Routledge, Taylor & Francis Group; 2016.


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