Mammography-Specific Self-Efficacy Scale – Arabic Version

Authors

Purpose

In the realm of preventative oncology, understanding why women delay or avoid mammograms is essential. While structural barriers like cost and transportation are important, psychological barriers often play an equally significant role. The primary purpose of the MSSE-Ar is to fill a critical measurement gap in Arab populations, offering a validated metric to assess a woman's perceived capability to obtain a mammogram.

For clinicians and health psychologists, having a reliable Arabic instrument means they can move beyond merely asking if a patient intends to get screened, and instead measure the underlying psychological readiness. This facilitates the development of tailored educational campaigns that specifically target self-efficacy, ultimately aiming to increase early detection rates of breast cancer in Saudi Arabia and the broader Arab world.

Construct

The scale is grounded in Albert Bandura's Social Cognitive Theory, which posits that self-efficacy is a primary driver of human behavior. In this specific context, the construct reflects a woman's confidence in her ability to schedule and attend a Mammography appointment, even when faced with common deterrents such as fear of pain, anxiety about potential results, or logistical inconveniences.

The MSSE-Ar operates as a unidimensional construct, meaning all items feed into a single, overarching domain of Mammography-specific confidence. This single-factor structure aligns with the theoretical perspective that while barriers may vary, the psychological resilience to overcome them represents a unified cognitive trait.

Validity

To establish the scale's validity, researchers utilized a known-groups approach, which tests whether the instrument can accurately distinguish between populations expected to have different scores based on theoretical assumptions. The findings demonstrated robust predictive validity: women who had successfully obtained a mammogram within the past two years scored significantly higher (mean of 39.0) compared to those who had never been screened (mean of 35.88).

Furthermore, when evaluated through the lens of the Transtheoretical Model of behavior change, the scale successfully differentiated between women in the action stage versus those in the contemplation or precontemplation stages. These results provide compelling evidence that the MSSE-Ar does not just measure an abstract concept, but captures a psychological state that directly translates into real-world health behaviors.

Reliability

A psychometric tool must yield consistent results to be clinically useful, and the MSSE-Ar demonstrated excellent internal consistency. The calculated Cronbach's alpha of 0.88 indicates a high degree of cohesion among the 10 items, meaning they reliably measure the same underlying construct of self-efficacy.

This value comfortably exceeds the standard acceptable threshold of 0.70 and mirrors the reliability metrics of the original English version. Additionally, item-total correlations ranged from 0.44 to 0.74, confirming that every individual question contributes meaningfully to the total score without being psychometrically redundant.

Factor Analysis

To verify the internal structure of the translated scale, researchers conducted a Confirmatory Factor Analysis (CFA) testing the hypothesized single-factor model. While the initial fit was only mediocre, the model was refined by allowing certain error terms to correlate—a common and theoretically sound practice when items share similar phrasing or contextual nuances.

Following these adjustments, the model demonstrated a strong fit to the data, evidenced by a Comparative Fit Index (CFI) of 0.961 and a Tucker-Lewis Index (TLI) of 0.943. Furthermore, the Root Mean Square Error of Approximation (RMSEA) dropped to an acceptable 0.076, and the Standardized Root Mean Square Residual (SRMR) was 0.045. With factor loadings ranging from 0.42 to 0.85, the CFA firmly supports the unidimensional structure of the Arabic adaptation.

Instrument

Scoring & Interpretation Guidelines

Mammography-Specific Self-Efficacy Scale – Arabic Version Items

Sample

221 women aged 30 years and older (mean age = 39.6) recruited from primary healthcare centers in Al-Madinah Al-Munawrah, Saudi Arabia, using a cluster sampling approach with probability-proportional-to-size.