# Translation, adaptation and validation of the AWACAN tool for breast and cervical cancer awareness among Arabic-speaking women: a study from Libya

## TL;DR

This study translated and validated a cancer awareness tool for Arabic-speaking women, showing it can reliably measure knowledge about breast and cervical cancer.

## Contribution

The study provides a culturally adapted and validated Arabic version of the AWACAN tool for breast and cervical cancer awareness.

## Key findings

- The adapted AWACAN tool showed good internal consistency and strong test-retest reliability for most domains.
- Medical experts scored significantly higher on knowledge questions than community participants, supporting construct validity.
- The 'Risk Lay Beliefs' domain had lower reliability, suggesting room for improvement in this area.

## Abstract

Breast cancer (BC) and cervical cancer (CC) pose significant health challenges in the Arab world, exacerbated by limited awareness and restricted access to healthcare services, resulting in poor outcomes and late diagnoses. This study aimed to translate and culturally adapt the African women’s awareness cancer (AWACAN) tool for Arabic-speaking women and pilot test it to evaluate its reliability and validity in assessing BC and CC awareness among Arabic-speaking women.

Originally developed for Sub-Saharan African populations, the AWACAN tool underwent a systematic translation and adaptation process involving forward and backward translations by bilingual experts. A panel of specialists ensured cultural sensitivity and content validity. The final tool was administered online to a pilot sample of Arabic-speaking women, recruited voluntarily through non-probability sampling on social media. Reliability was evaluated using internal consistency and test-retest reliability, while construct validity was assessed by comparing knowledge scores between medical experts and community participants.

The adapted tool comprised of 116 questions covering socio-demographic characteristics, the awareness of BC and CC symptoms, risk factor awareness, help-seeking behaviours, barriers to care and interest in receiving information. The adapted AWACAN tool demonstrated good internal consistency in the ‘Known Risk Factors’ and ‘Symptoms’ domains for both BC and CC Kuder-Richardson Formula 20 ranging from 0.682 to 0.871 and strong test-retest reliability (Cohen's kappa values indicating moderate to almost perfect agreement). Construct validity was supported by significantly higher knowledge scores among medical experts. However, the ‘Risk Lay Beliefs’ domains exhibited moderate to lower reliability. In conclusion, the adapted Arabic version of the AWACAN tool is a reliable and valid instrument for measuring BC and CC awareness among Arabic-speaking women. It can help identify knowledge gaps and inform targeted interventions to improve cancer awareness and early detection efforts in this population.