ASPO Abstracts

Measuring cancer awareness in Africa: Considering cultural relevance of measures including the Cervical Cancer Awareness Measure

Authors: Lott BE, Halkiyo AB, Worku D, Aboma B, Kebede T, Samuel L, Jemal M

Category: Culture and Cancer
Conference Year: 2021

Abstract Body:
Purpose: To present breast and cervical cancer awareness measures used in Africa with discussion about cultural relevance of each. Lessons learned from translation and administration of the Cervical Cancer Awareness Measure (CCAM) in Ethiopia are shared. Methods: The CCAM, a reliable and valid tool for measuring awareness of cervical cancer, was created in the United Kingdom, and translated to Amharic and Afan Oromo for use in Ethiopia. The measure contains 22 questions about risk factors (n=11) and signs/symptoms (n=11) of cervical cancer. It was administered to various cadres of health workers (n=772) at eight government health facilities in Ethiopia using a questionnaire. Open- and close-ended items were qualitatively analyzed to explore the cultural relevance of CCAM constructs. Results: Participants preferred culturally relevant terms such as "early marriage” and "polygamy marriage” to describe risk factors like early sexual debut and having a partner with multiple sexual partners. Participants interpreted questions about sexual behavior as pertaining to sex within marriage and cited cultural taboo around topics of pre-marital and extra-marital sex as reasons that these items, as originally written, may not accurately capture risk for Ethiopian women. Another item about parity as a risk factor needed to define what qualifies as "many” children. Furthermore, Ethiopians hold high societal value on motherhood and positively viewed high parity, which was not widely perceived as a risk factor. Conclusions: Few cancer awareness measures have been created with African populations in mind. During translation for use in Africa, some measures may lose meaning and cultural relevance. Additionally, the measures may not query culturally specific risk factors and behaviors such as being in a faithful polygamous relationship. In Ethiopia, administration of a translated CCAM revealed that participants preferred alternative terms to describe sexual behaviors they perceived as risky. Using culturally relevant terms and constructs in cancer awareness measures may contribute to greater health equity by more accurately measuring awareness. Such data can be used to develop culturally relevant cancer prevention interventions and tailor health communication.

Keywords: