Table 4 Cultural Issues and Revisions

Culturally appropriateness of item wording

Scale Item (Seriousness): “Problems I would experience with colon cancer would last a long time”. One participant who completed the English language version indicated that the wording was suggestive and intoned that the individual had colon cancer, which was a culturally sensitive issue for those who believed there were connotations to being diagnosed. As well, quite a number of Urdu language participants (n = 5) also used “if” in their qualitative statements.

To better place this item in the context of the meaning, and make it more culturally appropriate, the wording was modified to: “Problems I would experience if I had colon cancer would last a long time”. This was tested in round 2, and no further problems emerged.

Urdu language

English language

Topic not discussed among family members

Scale Item (Subjective norm): “Members of my immediate family think I should have colon cancer screening.” Among English language participants (n = 3), comments indicated that the topic of colon cancer was not discussed in the family. However, for two participants, the responses were in line with their selection. Only one participant suggested having a “Not applicable” option.

No modifications were made to the response categories as doing so would compromise data quality and analysis.

English language