The overall aim of this proposal is to conduct qualitative and quantitative cultural analyses of the Cancer Behavior Inventory (CBI) to assure that it is appropriate for African American patients and to establish a methodology for testing cultural bias in other measures. Self-efficacy theory was used to guide the development of the CBI, which assesses patients' expectations about their ability to perform coping behaviors in seven domains: 1) Maintaining Activity and Independence, 2) Seeking and Understanding Medical Information, 3) Stress Management for Medical Appointments, 4) Coping With Treatment-Related Side Effects, 5) Accepting Cancer/ Maintaining Positive Attitude, 6) Affective Regulation, and 7) Seeking Social Support. Data will be collected in order to accrue 200 African American patients and 200 Caucasian patients with cancer. The accrual is designed to assure the development of a comprehensive database that includes adequate numbers of African Americans. All participants will complete the CBI and other measures of coping, adjustment, and quality of life. In addition, African American participants will complete measures of racial identity development, perceived maltreatment, and acculturation. Information on medical treatment and other medically relevant data (e.g., stage at diagnosis) will be obtained from the participant's chart and physician, Data analyses will include both qualitative and quantitative approaches. Qualitative approaches will include narrative analyses to assess perceived bias in items. Quantitative analyses will include: 1) item bias analysis and tests of the structural invariance as a function of race, racial identity, perceived maltreatment, gender, type of cancer and age; and 2) traditional psychometrics. Based on this cultural analysis, the CBI may be modified to be more useful in clinical trials research as a) a screening devise to select people for psychosocial interventions, b) a process measure, which when given repeatedly during the course of treatment would detect changes in efficacy, and c) as an outcome measure. Also, the cultural analysis will make the CBI useful for assessing coping with African American patients. Finally, the methodology for the cultural analysis may be used with other measures and ethnic groups. Further refinement of the CBI can include the standardization of the scales of the CBI and the development of norms based on relevant individual difference variables.
