# Empowering Men to Take Control of Their Own Health: Development and Validation of the Men’s Response to Colorectal Cancer Screening Scale (MR–CCSS)

## TL;DR

This study created a tool to understand why men are less likely to get colorectal cancer screening and how to encourage them to participate.

## Contribution

The study introduces a gender-sensitive scale to measure factors influencing men's participation in colorectal cancer screening.

## Key findings

- The MR–CCSS has a five-factor structure explaining 61.9% of the total variance.
- The scale showed acceptable to good internal consistency with Cronbach’s alpha ranging from 0.665 to 0.833.
- The scale has moderate predictive accuracy for screening participation with an AUC of 0.702.

## Abstract

Background/Objectives: Despite the proven effectiveness of colorectal cancer screening, men are less likely to participate than women, with emotional, behavioural and informational barriers contributing to this disparity. The aim of this study was to develop and validate the Men’s Response to Colorectal Cancer Screening Scale (MR–CCSS), a gender-sensitive instrument for measuring key factors that influence the participation of men in colorectal cancer screening. Methods: The scale was developed through a structured process that included qualitative data from focus groups (n = 20 men) and expert review (n = 11 professionals). Initial item pools were refined based on indices of content validity (I-CVI ≥ 0.78; S-CVI/Ave ≥ 0.90), resulting in a 23-item scale. The MR–CCSS was administered to 289 Slovenian men aged 50–74 years, and its psychometric properties were assessed using exploratory factor analysis, confirmatory factor analysis and reliability tests. Results: The EFA revealed a five-factor structure. Together, these factors explained 61.9% of the total variance. The CFA confirmed the robustness of the model (CFI = 0.928, TLI = 0.910 and RMSEA = 0.056). The internal consistency was acceptable to good, with Cronbach’s alpha between 0.665 (factor 4) and 0.833 (factor 5) for the subscales and 0.863 for the total scale. The ROC analysis showed moderate predictive accuracy (AUC = 0.702), with an optimal cut-off value of 92.5 (sensitivity = 0.782 and specificity = 0.509) for participation in screening. Conclusions: The MR–CCSS is a valid and reliable tool for identifying barriers to colorectal cancer screening in men. Its use can serve as a basis for gender-specific interventions, customised health education and strategies to improve screening equity.