Psychometric validation of a knowledge, attitudes, and practices (KAP) scale for breast cancer screening among Chinese women

BACKGROUND: Breast cancer screening participation remains suboptimal in China, partly due to psychological and behavioral barriers. A validated instrument is needed to assess knowledge, attitudes, and practices (KAP) related to screening behaviors among Chinese women. METHODS: A cross-sectional study with a multistage sampling approach was conducted in Guizhou Province, China. A total of 611 women aged 18-70 participated, with samples allocated for exploratory factor analysis (EFA: n = 314) and confirmatory factor analysis (CFA: n = 297). The KAP questionnaire, adapted from existing instruments and culturally tailored, included 24 knowledge items, 12 attitude items, and 8 practice items. Psychometric evaluation involved EFA, CFA, reliability testing, and measurement invariance (MI) analysis across residential settings. RESULTS: EFA revealed a five-factor structure encompassing three domains: knowledge (symptoms and screening/treatment), attitude (screening self-efficacy), and practice (breast self-examination and mammography utilization). CFA confirmed good model fit (CFI = 0.978; TLI = 0.976; RMSEA = 0.045 [90% CI: 0.038-0.051]; SRMR = 0.082). Internal consistency, composite reliability, and convergent validity were acceptable across all subscales (ω = 0.703-0.919; CR ≥ 0.70; AVE ≥ 0.50). Measurement invariance was supported across residential groups. CONCLUSIONS: The validated KAP scale demonstrates strong psychometric properties and is suitable for assessing breast cancer screening behaviors in Chinese women. It provides a reliable tool for both research and practice, facilitating the identification of women at risk of low screening participation and informing tailored intervention strategies.