Development and Validation of the Ethiopian Women’s Cervical Cancer Awareness and Screening Tool (EWCCaAST)

Abstract

Abstract Background: There is a lack of a standardized tool for assessing barriers to cervical cancer screening uptake. The validation of the tool helps researchers to identify the barriers and facilitators to improve screening uptake. Objective: this study aimed  to develop and validate a tool that can be used to assess the level of awareness, knowledge, and barriers to cervical cancer and screening among Ethiopian women. Methods: A Cross-sectional study design involving four steps: refining and developing, expert panel evaluation, translation of the tool into the local language, and internal reliability testing was employed. About 16 experts and 366 randomly selected target-aged women were included in the study. Content validity ratio, content validity index, modified Kappa, and Cronbach`s alpha were used to validate the tool. Internal reliability was assessed using Cronbach's alpha, with a minimum acceptable value of 0.60. Result: A total of 108 items were categorized into 7 validated domains. The overall content validity ratio (CVR) and item-level content validity index ((I-CVI)) were 0.68 and 0.88, respectively, indicating  strong essentiality and relevance of the items. The overall item-level content validity index for simplicity and clarity of the items was 0.88 and 0.82, respectively, indicating that the items are too simple and clear. The lowest modified Kappa was 0.49, indicating moderate agreement,  while the highest was 0.94, indicating perfect agreement among the experts. The overall Cronbach's alpha was 0.79, reflecting  an acceptable level of reliability for the tool. Conclusion: The refined and developed tool is essential, relevant, simple, and clear. The overall reliability showed an acceptable value. We recommend that the researchers use this comprehensive validated tool to assess the awareness, knowledge of cervical cancer, and socio-cultural barriers to cervical cancer screening service utilization among women. [Ethiop. J. Health Dev. 2025; 39(2)] Keywords: Cervical cancer, screening, socio-cultural barriers, Women, Ethiopia