Table 4.

Instrument details.

Study and Outcome Measures	Data Collection Periods	Method of Evaluation and Content of Instrument	Psychometric Properties
Akhtari Zavare et al., 2016 [16] -BSE frequency -Knowledge of BC and BSE -HBM scales	-Baseline -6 months after the intervention -12 months after the intervention	-SAQ (self-administrative questionnaire) dual-language (English and Malay). -BSE frequency: measured by questions on multiple answer choices (“once a month”, “occasionally”, “other” and “never”). -Knowledge data form: 35 items included general facts of BC, BC symptoms, risk factors, BSE, CBE, and MMG. With responses of true, false, I do not know. A correct answer scored 1 and a wrong or unsure answer scored 0. -HBM scale contains 40 questions on the seriousness, susceptibility, BSE barriers and benefits, confidence, and health motivation. Scores rated on a five-point Likert scale that ranged from “strongly disagree” to “strongly agree”.	-The study reported content validity index (CVI), face validity, test–retest reliability. Kappa value for BC general facts (0.70–0.80), risk factors (0.52–0.97), BC symptom (0.70–0.97), CBE and MMG (0.80–0.90), and BSE knowledge (0.70–0.87). -Intra-class correlation coefficient for: seriousness (0.89–0.96), susceptibility (0.79–0.86), benefit (0.85–0.98), barrier (0.70– 0.80), confidence (0.88–0.97), motivation (0.92–0.98). -Kappa value for practice of BSE (0.82) and frequency of BSE (0.85).
Heydari and Noroozi, 2015 [49] -Knowledge -HBM scales -MMG screening	-Baseline -1 week after the intervention -3 months after the intervention	-SAQ. -Items included questions about knowledge on BC, a correct answer scored 1 and a wrong answer scored 0. -30 questions on susceptibility, severity, benefits, barriers, and health motivation. Items scored by a 5-point -Likert scale that ranged from “strongly disagree” to “strongly agree”. -One question on MMG screening, with yes/no answer. If the response is no, another question on intention to do MMG was asked.	-Kuder Richardson coefficient of knowledge = 0.78. -Cronbach’s alpha coefficients of HBM ranged from 0.72 to 0.89 (health motivation to susceptibility).
Eskandari-Torbaghan et al., 2014 [47] -BC behaviors -Awareness -HBM scales	-Baseline -1 month after the intervention	-SAQ. -5 items assessed BC behaviors, with responses answered as: always, sometimes, often, and never. Scores ranged from 3 to 0. -16 questions measured awareness, with scores of 2 for right response, 1 for no comment response, and 0 for wrong response. -HBM assessed through 6 items on susceptibility, 5 items on seriousness, 5 items on benefits, 5 items on barriers, 5 items on self-efficacy, 6 items on cues to action. Scores were rated on a 5-point Likert scale that ranged from totally agree (5) to totally disagree (0). Scoring for the cues to action construct was rated in percentages.	Accepted items had content validity ratio larger than 0.62 and content validity indices larger 0.79. Cranach’s alpha = 0.76.
Goel and O’Conor, 2016 [55] -BC knowledge -MMG screening	-Baseline -3 days post-test	-Telephone interview. -Knowledge was measured using 10 items, with “true, false” answers, in 5 domains: family history of BC, BC symptoms, physical test findings, MMG curability, and effectiveness. -MMG screening was assessed through self-report questions + chart reviews.	Psychometric properties were not reported.
Kocaoz et al., 2017 [59] -BSE practice -MMG practice -HBM scales	-Baseline -6 months after the intervention	-SAQ. -16 questions on participation in early screening programs, reasons if the exam had not been performed, and opinions on future involvement in such programs. -HBM was measured through 52 items on susceptibility, seriousness, BSE benefits and barriers, confidence, health motivation, MMG benefits and barriers. Items rated on a 5-point Likert scale that ranged from strongly disagree to strongly agree.	-First evaluation Cronbach’s alpha = 0.82–0.88. -Second evaluation Cronbach’s alpha = 0.79–0.88.
Elder et al., 2017 [54] -MMG -CBE -BC knowledge -Barriers to screening	-Baseline -12 months after the intervention -24 months after the intervention	-SAQ. -Cancer screening behaviors were assessed using the 2010 Behavioral Risk Factor Surveillance System Survey (BRFSS). If the respondent answered yes, they were asked how long it had been since their last screening was obtained. Answer comprised of 5 options. -Knowledge was assessed using the 6 items of the “Esperanza y Vida” cancer knowledge questionnaire. Scores were evaluated based on the percentage of correct responses. -Barriers were evaluated using 9 items of the 1990 Tampa survey. Answers rated on a 5-point Likert scale that ranged from “strongly disagree to strongly agree”, with higher scores imply greater perceived barriers to screening.	Psychometric properties were not reported.
Yilmaz et al., 2017 [11] -Knowledge of BC and BCS -HBM scales	-Baseline -1 week after the intervention	-Face-to-face interviews. -Knowledge was measured using 18 items, with “true or false” responses. A correct response was scored 1 and incorrect response 0. -A 5-point Likert scale rated the HBM scales.	-HBM pre-test Cronbach’s Alpha = 0.74–0.88. -HBM post-test Cronbach’s Alpha = 0.76–092.
Freund et al., 2017 [9] -Adherence to screening (BSE, CBE, MMG)	-Baseline -3 months after the intervention	A telephone questionnaire of 22 items that included questions on socio-demographic factors, questions on adherence to MMG, CBE, and BSE screening, and questions on cultural health beliefs.	-Content validity tested by 4 professional experts. -Construct validity was assessing by determining the correlations between barriers of HBM and cultural barriers of the current study. -Cultural and religious perceptions of Arab women were tested among 300 Arab women. -Cronbach’s alpha for religious beliefs and being cured = 0.86, fear of social losses = 0.72, accessibility barriers = 0.71, and exposure barriers = 0.61. -Factor analysis revealed 5 factors that explained 63.13% of the variance.
Mirmoammadi et al., 2018 [51] -MMG screening -CBE performance -Knowledge -HBM scales	-Baseline -1 month after the intervention -3 months after the intervention	-SAQ. -BCS included questions about history of doing CBE and MMG, how many times they had done it, questions about the sources of information, and the reasons for not doing BCS. -Knowledge (44 questions) using a previously standard questionnaire, with response options of (yes, no, I do not know); correct response rated 1 and wrong and I do not know rated 0. -HBM scales (63 questions). A 5-point Likert scale assessed the responses; agree scored 5 and disagree scored 1.	-Knowledge Cronbach’s alpha = 0.96. -HBM Cronbach’s alpha = 0.87.
Khiyali et al., 2017 [50] -BSE performance -Knowledge on BSE -HBM scales	-Baseline -3 months after the intervention	-SAQ. -BSE was tested using 6 items, with 2 options (1 score for I do and 0 score for I do not know/do not answer) -20 items on knowledge (1 score for correct answer and 0 score for wrong answer) -HBM was assessed using questions on susceptibility (8 items), severity (8 items), benefits (6 items), barriers (6 items), self-efficacy (8 items). All scales were rated based on a 5-point Likert scale that ranged from totally agree (5) to totally disagree (1).	-The validity of the questionnaire items was evaluated with CVI of higher than 0.15, and CVR of higher than 0.77. -Exploratory factor analysis revealed 6 factors. -Face validity was conducted among 40 women. -Content validity: was evaluated through the opinions of 12 specialists and experts. -Cronbach’s alpha = 0.86. -The reliability values for knowledge, susceptibility, severity, benefits, barriers, and self-efficacy were 0.85, 0.75, 0.80, 0.79, 0.82, and 0.77, respectively.
Masoudiyekta et al., 2018 [19] -BSE performance -CBE performance -MMG performance -Knowledge -HBM scales	-Baseline -3 months after the intervention	-SAQ. -3 questions on BCS. -19 questions to measure the level of awareness, 1 point for the right response and 0 point for false response. -Questions on HBM included, benefits, susceptibility, barriers, severity, self-efficiency, and cues to action. Rating in a 5-point Likert scale, from strongly agree (5) to strongly disagree (1).	-The questionnaire was assessed for validity by professional experts. -Accepted items had content validity ratio larger than 0.62 and content validity indices larger than 0.79. -Cronbach’s alpha for susceptibility = 0.90, severity = 0.82, benefits = 0.85, barriers = 0.97, self-efficacy = 0.82, and cues to action = 0.94.
Lee-Lin et al., 2015b [53] -Knowledge -Perceived susceptibility -Perceived barriers to MMG	-Baseline -3 months after the intervention -6 months after the intervention	-A telephone questionnaire. -Knowledge assessed using 11 items, with answers of “increase risk, decrease risk, and not sure”. Scores range from 0 to 10). Results reported as percentages and frequency counts. -Susceptibility (3 items) on a Likert-scale (range from 3 to 13). -MMG barriers (21 items) on a Likert-type scale (range from 4 to 70).	-HBM Cronbach’s alphas ranged from 0.64 to 0.90. -HBM subscales items were evaluated with: (1)A review of the literature (2)Validity through content and cultural experts (3)Scales were pretested and critiqued among 10 Chinese American immigrants.
Fathollahi-Dehkordi and Farajzadegan, 2018 [48] -CBE screening -Knowledge -Beliefs	-Baseline -3 months after the intervention	-A telephone questionnaire. -CBE stages were evaluated using Rakoweski classification stages: a) Precontemplation, b) Contemplation, c) Relapse, d) Action, e) Maintenance. -12 items (wrong-right checklist) were used to assess knowledge. Right response was given 1 score and wrong response was given 0 score. -Beliefs were evaluated by 5 subscales of CHBMS construct including, sensitivity (3 items), severity (7 items), barriers (10 items), benefits (6 items), and health motivation (7 items), with a Likert scale that ranged from strongly disagree “1” to strongly agree “5”.	Cronbach’s alpha for sensitivity = 0.82, severity = 0.84, barriers = 0.73, benefits = 0.72, and health motivation = 0.77.
Taymoori et al., 2015 [52] -Changes in the HBM and TPB constructs -MMG screening	-Baseline -6 months after the intervention	-SAQ translated to Farsi language. -The questionnaire included items on socio-demographic factors and 37 items for both constructs (HBM + TPB) related to susceptibility (3 items), severity (7 items), MMG benefits (6 items), MMG barriers (9 items), self-efficacy (10 items), subjective norms (1 item), and perceived control (1 item). -The HBM was evaluated on a 4-point scale ranging from strongly disagree “1” to strongly agree “4”. Self-efficacy scale ranging from not at all confident “1” to very confident “4”. -The TPB construct, subjective norms, and behavioral control were each assessed through 1 item. With scoring using a 4-point scale that ranged from never “1” to often “4”. -MMG screening was ascertained through self-report + medical records.	Content validity was conducted by panel experts Reliability: -The HBM constructs: Cronbach’s alpha for susceptibility = 0.84, severity = 0.82, benefits of MMG = 0.72, barrier = 0.73, self-efficacy = 0.90. -The TPB constructs: The test-retest reliability coefficient was 0.84 for subjective norms and 0.87 for perceived behavioral control.
Rabbani et al., 2019 [61] -BC knowledge	-Baseline -4 weeks after the intervention	-Face-to-face questionnaire. Adapted questionnaire consisted of 3 questions that assessed general knowledge of BC, 6 questions on BC symptoms, 2 questions on knowledge of age-related and BC lifetime risks, 8 questions on BC risk factors, 4 questions on BC awareness, 2 questions on BC treatment, 2 questions on skills, behavior, and confidence, 4 questions on barriers of seeking medical help.	Psychometric properties were not reported.
Gondek et al., 2015 [58] -BC knowledge -MMG screening	-Knowledge was assessed during a single session (pre–post test) -MMG was assessed at: -Baseline -2 years after the intervention	-An audience response system (ARS) or paper surveys + MMG records. -Participants received an audience answer technique or paper surveys to deliver their replies regarding BCS. -6 items assessed knowledge. Details of the items were not stated.	Psychometric properties were not reported.
Ouyang and Hu, 2014 [62] -BSE practice -Knowledge of BC -HBM scales	-Baseline -1 month after the intervention -3 months after the intervention	-SAQ. -A 14-item checklist used to assess BSE, with yes and no answers. Scores range from 0–14. -17 items assessed knowledge in 3 domains, BC symptoms, BC risk factors, and early screening approaches, with yes and no answer. Right answer (1 point) and incorrect answer (0 point). -HBM scales: 35 items on susceptibility, seriousness, BSE benefits and barriers, and confidence, with a 5-point Likert scale that range from disagrees to agree.	-BSE checklist Cronbach’s alpha coefficient = 0.89. -Knowledge questionnaire Cronbach’s alpha = 0.54. -HBM scales Cronbach’s alpha coefficients for susceptibility = 0.78, seriousness = 0.68, benefits = 0.63, barriers = 0.74, confidence = 0.89.
Seven et al., 2014 [60] -MMG performance -Knowledge -HBM scales	-Baseline -3 months after the intervention	-SAQ. -5 items reason identification questionnaire (RIF) used to assess factors that effect a participant’s decision to get screening, and to evaluate satisfaction with screening practice. -(PDQ) questionnaire that included items on Knowledge Evaluation Form (KEF): included 15 positive statements on knowledge on BC, BSE, and CBE and the proper time of getting MMG. With true or false choices ranging from 0–15. -CHBMS consists of 3 items on susceptibility, 6 items on seriousness, 5 items on health motivation, 5 items on MMG benefits, and 11 items on MMG barriers. With a 5-point Likert scale that ranged from 1–5.	-Cronbach’s alpha coefficient for the KEF = 0.86. -Cronbach’s alpha coefficients for susceptibility = 0.99, seriousness = 0.8, health motivation = 0.94, benefits = 0.61, barriers = 0.86.
Tuzcu et al., 2016 [10] -BSE practice -CBE practice -MMG practice -HBM scales	-Baseline -3 months after the intervention -6 months after the intervention	-A question/answer method through face-to-face interviews, performing BCS through a telephone interview with 3 questions on the practice of BSE, CBE, and MMG. -The screening behaviors status were assessed through a telephone interview at month 3, and by using a structured questionnaire at month 6. -The CHBMS used to assess health beliefs using 3 items on susceptibility, 6 items on seriousness, 5 items on health motivation, 4 items on BSE benefits, 8 items on BSE barriers, 10 items on self-efficacy, 5 items on MMG benefits, 11 items on MMG barriers. With 5-point Likert options. -Health responsibility was assessed using the Turkish version of Healthy Lifestyle Behaviors Scale II, with scores that ranged from 9–36.	-CHBMS Cronbach’s alpha coefficients were between 0.61 and 0.71. -Health responsibility Cronbach’s alpha coefficient = 0.70
Vasishta et al., 2018 [63] -Knowledge about BC and BSE	-Baseline -Post-intervention	-SAQ in English language. -20 MCQs measure BC and BSE knowledge and awareness. Scores were classified as poor from 0 to 7, average from 8 to 12, and good from 13 and above.	Tests of validity and reliability were conducted, but details of the psychometric properties were not reported in the article.
Lee-Lin et al., 2015a [57] -MMG screening	-Baseline -3 months after the intervention -6 months after the intervention -12 months after the intervention	Self-report questionnaire.
Wu and Lin, 2016 [56] -MMG screening	-Baseline -4 months after the intervention	Self-report questionnaire.