Measuring social impacts of breast carcinoma treatment in Chinese women

Background: There is no existing instrument that is suitable for measuring the social impact of breast carcinoma (BC) and its treatment among women of Southern Chinese descent. In the current study, the authors assessed the validity of the Chinese Social Adjustment Scale, which was designed to address the need for such an instrument.

Methods: Five dimensions of social concern were identified in a previous study of Cantonese-speaking Chinese women with BC; these dimensions were family and other relationships, intimacy, private self-image, and public self-image. The authors designed 40 items to address perceptions of change in these areas. These items were administered to a group of 226 women who had received treatment for BC, and factor analysis subsequently was performed to determine construct characteristics. The resulting draft instrument then was administered, along with other measures for the assessment of basic psychometric properties, to a second group of 367 women who recently had undergone surgery for BC.

Results: Factor analysis optimally identified 5 factors (corresponding to 33 items): 1) Relationships with Family (10 items, accounting for 22% of variance); 2) Self-Image (7 items, accounting for 15% of variance); 3) Relationships with Friends (7 items, accounting for 8% of variance); 4) Social Enjoyment (4 items, accounting for 6% of variance); and 5) Attractiveness and Sexuality (5 items, accounting for 5% of variance). Subscales were reliable (alpha = 0.63-0.93) and exhibited convergent validity in positive correlations with related measures and divergent validity in appropriate inverse or nonsignificant correlations with other measures. Criterion validity was good, and sensitivity was acceptable. Patterns of change on the scales were consistent with reports in the literature. Self-administration resulted in improved sensitivity.

Conclusions: The 33-item Chinese Social Adjustment Scale validly, reliably, and sensitively measures the social impact of BC on Cantonese-speaking Hong Kong Chinese women. Further development of the scale to increase its sensitivity is underway.