Cross-Cultural Instrument Adaptation and Validation of Health Beliefs About Cancer Screening A Methodological Systematic Review

Fang Lei, Wei Ti Chen, Mary Lynn Brecht, Zuo Feng Zhang, Eunice Lee

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


Background: The uptake of cancer screening is significantly associated with participants’ health beliefs about cancer screening. Scales measuring health beliefs of cancer screening are available; however, the scales that were developed and validated for the US population may lack cultural appropriateness, which could compromise the reliability and validity of the scales when applied to different ethnic groups or populations. Objective: The aim of this study was to summarize, analyze, and compare the methods used in the cross-cultural instrument adaptation and validation processes of health beliefs about cancer screening. Methods: A systematic review design with narrative methods was used. Electronic databases, including PubMed, Google Scholar, CINAHL, and PsycINFO, were searched. Results: A total of 18 articles were eligible. Results showed (1) the translation methods included committee translation and back translation, which were further refined by using professional translators, using professional interpreters and/or involving the first author, using bilingual individuals, and involving bilingual investigators; (2) the modification methods included embedded and afterward modification; and (3) the validation methods included testing construct validity, internal consistency reliability, item-total subscale correlations, test-retest reliability, content validity, predictive validity, and face validity. Conclusions: Back translation and afterward modification were most frequently used for translating existing instruments to another language. Validity and reliability were most frequently established by construct validity, content validity, face validity, predictive validity, internal consistency reliability, test-retest reliability, and item-total subscale correlation after instruments were translated. Implications for Practice: Clinicians should evaluate the translation and adaptation process for translated versions of instruments before using them to provide culturally appropriate and sensitive care.

Original languageEnglish (US)
Pages (from-to)387-396
Number of pages10
JournalCancer Nursing
Issue number5
StatePublished - Sep 1 2022

Bibliographical note

Funding Information:
This study was supported by the American Cancer Society, Sigma Theta Tau, and China Scholarship Council.

Publisher Copyright:
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.


  • Adaptation
  • Cancer screening
  • Health beliefs
  • Instrument
  • Systematic review
  • Validation

PubMed: MeSH publication types

  • Journal Article
  • Systematic Review


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