The Colon Health Survey (Male)<\/strong>, developed by Dr. Ann Mitchell Kimberly (2009)<\/a> at Indiana University, is a comprehensive multidimensional psychometric battery engineered to assess cognitive, behavioral, psychological, and normative barriers to colorectal cancer (CRC<\/a>) screening among adult males. Colorectal adenocarcinoma represents one of the leading causes of cancer-related mortality globally, yet screening adherence via colonoscopy<\/a> remains suboptimal, particularly among men whose adherence behaviors are often attenuated by masculine socialization, privacy apprehensions, and procedural aversion. The instrument comprises 64 items divided into distinct conceptual modules: medical history and prior screening exposure (Items 1\u20136), demographic parameters (Items 7\u201310), colonoscopy history and behavioral intention (Items 11\u201315), disease and procedural knowledge (Items 16\u201323), procedural self-efficacy (Items 24\u201333), generalized barriers and perceived vulnerability (Items 34\u201347), qualitative narrative self-reports (Items 48\u201349), and the embedded, psychometrically validated 15-item Colonoscopy Embarrassment Scale (CES)<\/strong> (Items 50\u201364).<\/p>\n Measurement formats vary logically across sub-constructs, incorporating dichotomous categorical indicators, multiple-choice knowledge metrics, 4-point response formats for self-efficacy (“Not at all sure” to “Very sure”), and 4-point Likert-type scales<\/a> (“Strongly disagree” to “Strongly agree”) for perceived barriers and situational embarrassment. Psychometric evaluation of the embedded CES demonstrated strong internal consistency reliability, yielding a Cronbach’s alpha ranging from α = .88 to .92 across adult male validation cohorts. Exploratory and confirmatory factor analyses validate a distinct multidimensional factor solution reflecting Medical Modesty\/Exposure, Bodily Control and Odor, and Interpersonal Examiner Dynamics. The Colon Health Survey (Male) serves as a pivotal assessment framework in behavioral oncology, preventive medicine, and public health nursing, providing granular diagnostic data necessary to develop tailored behavioral interventions and mitigate affective deterrents to endoscopic cancer prevention<\/span>.<\/p>\n Colon Health Survey, Colonoscopy Embarrassment Scale, Colorectal Cancer Screening, Medical Modesty, Men’s Health, Health Belief Model, Self-Efficacy, Cancer Screening Adherence, Procedural Anxiety, Psychometrics<\/p>\n The Colon Health Survey (Male) and the embedded Colonoscopy Embarrassment Scale (CES) were developed by Ann Mitchell Kimberly, PhD, RN<\/strong>, in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the School of Nursing, Indiana University<\/a> (2009). Dr. Kimberly’s doctoral research committee included prominent nurse scientists and behavioral health researchers specializing in oncology nursing, preventive health behaviors, instrument design, and psychometrics, including Dr. Victoria L. Champion, a distinguished scholar recognized internationally for her empirical expansions of the Health Belief Model in cancer screening contexts.<\/p>\n Inquiries regarding the theoretical conceptualization and original validation cohort characteristics are cataloged within the institutional dissertation archives of Indiana University and scholarly repositories supporting cancer prevention and behavioral medicine initiatives.<\/p>\n Colorectal cancer remains a profoundly preventable disease via endoscopic detection and polypectomy of precancerous adenomatous polyps. In spite of robust epidemiological evidence establishing that screening colonoscopy significantly curtails cancer-specific mortality, male population-level uptake regularly fails to achieve benchmark public health targets. Traditional epidemiological investigations have extensively documented structural determinants of non-adherence—such as socioeconomic status, clinical access, health insurance provisions, and educational attainment—yet these socio-demographic indicators fail to fully explain why socioeconomically stable, insured males continue to avoid or delay screening.<\/p>\n The Colon Health Survey (Male)<\/strong> was purposefully conceptualized and operationalized to address this empirical gap. Its primary objective is to capture the complex matrix of behavioral, cognitive, informational, and emotional determinants that govern male screening decisions, with an unprecedented diagnostic emphasis on procedural embarrassment, modesty, and perceived loss of bodily autonomy. In clinical practice and behavioral research, the survey is implemented to achieve several distinct aims:<\/p>\n The survey measures several interdependent psychological, cognitive, and affective constructs. While early sections capture clinical and objective knowledge dimensions, the core psychological measurement architecture centers on three focal latent constructs: Procedural Self-Efficacy, Perceived Health Barriers\/Vulnerabilities, and Medical\/Procedural Embarrassment.<\/p>\n Grounded in social cognitive formulations, procedural self-efficacy denotes an individual’s perceived capability to organize, execute, and tolerate the prospective sequence of actions necessary to successfully complete an invasive clinical procedure. This construct does not reflect generalized self-esteem, but rather task-specific, behavioral agency across several critical hurdles:<\/p>\n This dimension operationalizes the cost-benefit analysis individuals mentally perform when evaluating health interventions. Items assess structural impediments (lack of time, logistical escort issues), cognitive deficits (failure to understand the rationale for screening in the absence of symptoms), physiological concerns (fear of somatic pain or bowel injury), and fatalistic anxieties (fear of receiving a cancer diagnosis). Subscale items systematically measure how these competing cognitive appraisals suppress preventive action.<\/p>\n The primary theoretical innovation within the survey is the isolated conceptualization of medical embarrassment<\/em> as a multifaceted, acute emotional threat to the social and physical self. Kimberly defined colonoscopy embarrassment as an unpleasant, agitated emotional state characterized by self-consciousness, perceived indignity, and threat to personal modesty elicited by the socio-technical conditions of an endoscopic bowel evaluation. Factor analytic delineation identifies three focal sub-dimensions of this construct:<\/p>\n The theoretical architecture of the Colon Health Survey (Male) draws extensively upon two prominent paradigms in health psychology and behavioral sociology: the Health Belief Model (HBM)<\/a> and Erving Goffman’s dramaturgical sociological theory<\/a> of social stigma and embarrassment, synthesized further through Albert Bandura’s Social Cognitive Theory<\/a>.<\/p>\n The Health Belief Model posits that health-related behavior is dictated by four foundational perceptions: perceived susceptibility to an illness, perceived severity of the consequences, perceived benefits of preventive action, and perceived barriers (both physical and psychological) impeding that action. Later revisions incorporated cues to action<\/em> and self-efficacy<\/em>. The Colon Health Survey directly implements this cognitive-rational framework: Items 16–23 capture the prerequisite cognitive knowledge base; Items 34–47 represent the explicit trade-off between perceived benefits\/susceptibility and perceived barriers; and Items 24–33 assess Bandura’s self-efficacy construct, testing the individual’s subjective estimation of behavioral competence across every link in the colonoscopy chain.<\/p>\n However, traditional HBM frameworks have frequently been critiqued for over-intellectualizing human behavior, reducing complex bodily choices to rational economic calculations while underestimating the profound disruptive force of acute human emotions—particularly shame, modesty, and embarrassment. To capture these dynamics, Kimberly integrated sociological frameworks of embarrassment, notably drawing on Goffman’s conceptualization of interactional modesty and social front. According to Goffman, social encounters require participants to sustain idealized performances of bodily control, cleanliness, and poise. An invasive medical procedure such as a colonoscopy presents a total structural breakdown of these protective social boundaries. The patient is placed in an asymmetrical, highly vulnerable posture (the left lateral decubitus position), physically exposed, and subjected to deliberate physical probing of an anatomical region associated with intense excretory taboos and privacy.<\/p>\n Furthermore, this vulnerability interacts with culturally dictated norms of hegemonic masculinity<\/a>. Male socialization commonly reinforces values of invulnerability, emotional detachment, physical dominance, and rigid homophobia. The physical act of submitting to rectal penetration—even for life-saving clinical purposes—can trigger implicit conflicts with masculine identity, creating profound psychological distress and avoidance. By anchoring the survey simultaneously within the cognitive boundaries of the HBM and the visceral social-affective dimensions of interactional modesty theory, the instrument bridges the gap between cognitive health decision-making and emotionally grounded behavioral avoidance.<\/p>\n The psychometric integrity of the Colon Health Survey (Male) and its integrated Colonoscopy Embarrassment Scale was established through a series of rigorous empirical validation protocols involving diverse adult male community cohorts, clinical samples, and psychometric review panels.<\/p>\n Content validity was evaluated during initial instrument generation through an exhaustive review of the empirical literature on procedural barriers to endoscopy, supplemented by qualitative key-informant interviews with screening-eligible men and clinical consultations with gastroenterologists, oncology nurses, and behavioral scientists. A formal panel of psychometric and clinical experts assessed each candidate item for linguistic clarity, cultural sensitivity, representativeness, and domain relevance using the Content Validity Index (CVI). Items failing to achieve a minimum item-level CVI (I-CVI) of .80 were systematically eliminated or revised to reflect precise anatomical and psychological distinctions.<\/p>\n Construct validity of the survey modules was corroborated through hypotheses-testing methodologies. Significant inverse correlations were observed between the Self-Efficacy subscale and the Perceived Barriers subscale (r<\/em> = −.42 to −.55, p<\/em> < .001), indicating that men possessing higher task self-efficacy systematically reported fewer behavioral and psychological deterrents. The Colonoscopy Embarrassment Scale exhibited robust construct validity, showing significant positive correlations with validated general medical fear scales, situational procedural anxiety metrics, and generalized body shame inventories<\/span>.<\/p>\n Convergent validity of the CES was confirmed by its strong positive correlation with generalized medical avoidance measures (r<\/em> = .48 to .62, p<\/em> < .001) and explicit state anxiety scores immediately prior to clinical appointments. Discriminant validity was substantiated by demonstrating that the CES shared low, statistically non-significant correlations with unrelated personality attributes, such as generalized intellectual curiosity or unrelated somatic awareness. Additionally, the CES demonstrated divergent validity against objective CRC screening knowledge scores, confirming that affective embarrassment operates as an independent psychological construct distinct from mere health literacy or factual ignorance regarding colon cancer epidemiology<\/span>.<\/p>\n Known-groups validity testing confirmed that the instrument clearly differentiates between adherence-ready and non-adherent populations. Men who had never completed a colonoscopy scored significantly higher on the CES (t<\/em>-test comparisons, p<\/em> < .001) and exhibited significantly lower procedural self-efficacy compared to men with a documented history of routine endoscopic screening. Logistic regression models confirmed that high scores on the CES independently predicted reduced intention to schedule a colonoscopy within the subsequent 6 months (Odds Ratio [OR] < 0.65, p<\/em> < .01), controlling for socioeconomic factors, physician recommendations, and baseline knowledge<\/span>.<\/p>\n Empirical analyses validate the Colon Health Survey (Male) as a psychometrically robust, internally reliable measurement tool. Statistical analyses conducted during the initial development and subsequent validation studies produced the following reliability metrics:<\/p>\n The structural dimensionality of the items comprising the psychological sections of the survey—specifically the Colonoscopy Embarrassment Scale (CES)—underwent thorough examination using both Exploratory Factor Analysis (EFA) and subsequent Confirmatory Factor Analysis (CFA).<\/p>\n Principal Axis Factoring (PAF) accompanied by oblique (Promax) rotation was conducted on the 15 items of the CES to accommodate theoretical intercorrelations among affective dimensions. Prior to extraction, the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy yielded a value of .90, and Bartlett’s Test of Sphericity was highly significant (χ² = 1842.36, p<\/em> < .0001), confirming matrix factorability<\/span>.<\/p>\n Scree plot inspection, Kaiser’s eigenvalue-greater-than-one criterion, and parallel analysis converged on a robust three-factor solution<\/strong> accounting for approximately 61.4% of the total variance:<\/p>\n Subsequent CFA testing confirmed the superiority of the correlated three-factor model over a unidimensional model. Goodness-of-fit indices demonstrated acceptable to excellent model fit:<\/p>\n All standardized factor loadings were statistically significant (p<\/em> < .001), confirming the multi-faceted nature of procedural embarrassment<\/span>.<\/p>\n The Colon Health Survey (Male)<\/strong> is a modular, multi-item self-report questionnaire. It can be administered via paper-and-pencil, secure digital web portals, or integrated clinical health application platforms.<\/p>\n The Colon Health Survey (Male) and the Colonoscopy Embarrassment Scale (CES) were developed and validated in 2009<\/strong> by Dr. Ann Mitchell Kimberly<\/strong> as part of her doctoral dissertation at the Indiana University School of Nursing. The instrument is cataloged within public academic repositories and doctoral dissertation registries.<\/p>\n The scale was developed for academic and clinical research purposes. In keeping with typical academic dissemination standards, the instrument may be utilized for non-commercial research, academic inquiry, institutional quality improvement, and clinical evaluation, provided appropriate formal scholarly citation is credited to Dr. Kimberly and Indiana University. Modifying the scale, integrating it into commercial digital health software platforms, or translating it into alternative languages generally necessitates formal written consent from the author or the Indiana University copyright administration. Researchers are encouraged to reference the original doctoral dissertation (Kimberly, 2009) in all derived peer-reviewed publications.<\/p>\n Questions 24-33 are about the steps required to complete a colonoscopy. Please indicate HOW SURE you are that you can complete each step by marking a small X in one box per question.<\/strong><\/p>\n Response Scale: Not at all sure\u201a Not so sure\u201a Somewhat sure\u201a Very sure<\/em><\/p>\n Response Scale: Strongly disagree\u201a Disagree\u201a Agree\u201a Strongly agree<\/em><\/p>\n For questions 48 and 49\u201a please complete the statement by writing in the space provided:<\/strong><\/p>\n Colonoscopy Embarrassment Scale<\/strong><\/p>\n Response Scale: Strongly disagree\u201a Disagree\u201a Agree\u201a Strongly agree<\/em><\/p>\n The Colon Health Survey (Male), incorporating the Colonoscopy Embarrassment Scale (CES) developed by Dr. Ann Mitchell Kimberly (2009), is an extensive psychometric instrument designed to evaluate cognitive, self-efficacy, and affective barriers to colorectal cancer screening among men.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","template":"","categories":[199,109,17887,2],"tags":[17885,17888,17882,17884,4277,17889,17890,17891,161,17892],"class_list":["post-5494","psych_scale","type-psych_scale","status-publish","hentry","category-behavioral-medicine","category-health-psychology","category-oncology-nursing","category-psychometrics","tag-cancer-prevention","tag-colon-health-survey","tag-colonoscopy-embarrassment-scale","tag-colorectal-cancer-screening","tag-health-belief-model","tag-medical-modesty","tag-mens-health","tag-procedural-anxiety","tag-self-efficacy","tag-survey-development"],"_links":{"self":[{"href":"https:\/\/ashadocs.org\/index.php?rest_route=\/wp\/v2\/psych_scale\/5494","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ashadocs.org\/index.php?rest_route=\/wp\/v2\/psych_scale"}],"about":[{"href":"https:\/\/ashadocs.org\/index.php?rest_route=\/wp\/v2\/types\/psych_scale"}],"author":[{"embeddable":true,"href":"https:\/\/ashadocs.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/ashadocs.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=5494"}],"version-history":[{"count":0,"href":"https:\/\/ashadocs.org\/index.php?rest_route=\/wp\/v2\/psych_scale\/5494\/revisions"}],"wp:attachment":[{"href":"https:\/\/ashadocs.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=5494"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ashadocs.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=5494"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ashadocs.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=5494"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}Keywords<\/h2>\n
Authors<\/h2>\n
Purpose<\/h2>\n
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Psychological Construct<\/h2>\n
1. Procedural Self-Efficacy (Items 24\u201333)<\/h3>\n
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2. Perceived Barriers and Subjective Susceptibility (Items 34\u201347)<\/h3>\n
3. Colonoscopy Embarrassment (CES, Items 50\u201364)<\/h3>\n
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Theoretical Framework<\/h2>\n
Validity<\/h2>\n
Content Validity<\/h3>\n
Construct and Structural Validity<\/h3>\n
Convergent and Discriminant Validity<\/h3>\n
Predictive and Known-Groups Validity<\/h3>\n
Reliability<\/h2>\n
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Factor Analysis<\/h2>\n
Exploratory Factor Analysis (EFA)<\/h3>\n
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Confirmatory Factor Analysis (CFA)<\/h3>\n
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Instrument \/ Measurement Tool<\/h2>\n
Subscale Modular Breakdown<\/h3>\n
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Administration Guidelines<\/h3>\n
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Permissions & Fee and Test Year<\/h2>\n
References<\/h2>\n
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Items of the Scale<\/h2>\n
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\n • A person younger than 50 years old
\n • A person older than 50 years old
\n • There is no difference
\n • Don\u2019t know\n <\/li>\n
\n • Someone whose spouse had colon cancer
\n • Someone with one close blood relative (parent\u201a brother\u201a or sister) who had colon cancer
\n • Someone with two close blood relatives (parent\u201a brother\u201a or sister) who had colon cancer
\n • There is no difference
\n • Don\u2019t know\n <\/li>\n
\n • Much higher than a man\u2019s
\n • About the same as a man\u2019s.
\n • Much lower than a man\u2019s.
\n • Don\u2019t know\n <\/li>\n
\n • Exercising regularly
\n • Limiting alcohol
\n • Finding and removing polyps
\n • There is nothing that can be done
\n • Don\u2019t know\n <\/li>\n
\n • Inside only the lower part of the colon
\n • Hidden blood in the stool
\n • Inside the entire length of the colon
\n • Don\u2019t know\n <\/li>\n
\n • 6 months.
\n • 1 year
\n • 2 years
\n • 5 years
\n • 10 years
\n • Don\u2019t know\n <\/li>\n<\/ol>\n\n
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