Date of Award


Degree Name

Doctor of Philosophy in Nursing (PhD)


Sandra K. Hanneman, PhD, RN, FAAN


Background: Arabic is the mother tongue of 26 countries, including Saudi Arabia where cancer is the fourth leading cause of death. Cancer is a sensitive issue in the Arabic population and a clear understanding of patients’ perceptions of self-efficacy for coping with cancer and quality of life helps assess interventions designed to facilitate optimal patient outcomes. In preliminary studies, the Cancer Behavior Inventory-Brief (CBI-B) was translated and back translated between English and Arabic, and reviewed for translational validity by an expert panel. The Arabic version of the CBI-B (CBI-BA) had acceptable evidence of translational validity with an overall translational validity index of 0.83. The CBI-BA was tested for evidence of internal consistency reliability with Arabic-speaking patients with cancer in Houston, Texas. Cronbach’s alphas were ≥ .76, indicating acceptable evidence of reliability.

Purpose: The purpose of this study was to develop psychometrically sound and culturally acceptable measures of self-efficacy for coping with cancer and quality of life for the Arabic-speaking population.

Methods: Using a cross-sectional design, Arabic-speaking patients with cancer were recruited from two oncology centers in Riyadh, Saudi Arabia. All patients completed the CBI-BA; a randomly selected subsample participated in cognitive interviews to determine semantic equivalence of the CBI-BA with the CBI-B. From the total sample, a subsample of women with breast cancer also completed the Arabic version of the Functional Assessment of Cancer Therapy –Breast (FACT-BA). Psychometric performance of both instruments was assessed for internal consistency reliability using Cronbach’s alpha (α) and construct validity using exploratory factor analyses, using principal axis factoring, with both orthogonal and oblique rotations.

Results: Internal consistency estimates were acceptable for the CBI-BA (α = .79 -.80) and the total FACT-BA (α = .88) scales, but variable for the FACT-BA subscales (α = .63- .89). Exploratory factor analyses showed evidence of construct validity for the CBIBA; one factor was derived, compared with four in the CBI-B. Cognitive interviews indicated satisfactory semantic equivalence of the CBI-BA with the CBI-B. The Breast Cancer subscale of the FACT-BA had inadequate α and a low response rate, which precluded testing construct validity. The Arabic version of the general FACT-G scale (FACT-GA) had four factors, according to expectation, in Arabic women with breast cancer.

Conclusions and Implications: The CBI-BA has adequate evidence of translation validity, internal consistency reliability, construct validity, and semantic equivalence to measure self-efficacy for coping in Arabic-speaking patients with cancer. The FACT-GA, but not the FACT-BA, has adequate evidence of internal consistency and construct validity in Arabic-speaking women with breast cancer to measure quality of life. Demonstration of adequate psychometric performance of these instruments is expected to advance research with Arabic (1) patients with cancer by providing a means to assess self-efficacy for coping with cancer, and (2) women with breast cancer by providing a means to assess the patient-centered outcomes of self-efficacy for coping with cancer and quality of life.


CBI-B, coping, Arabic, CBI-BA, cognitive interview, FACT-BA, quality of life, reliability, self-efficacy for coping, semantic equivalence, validity