The measurement of modesty among Jewish American women

Abstract

Modesty has been suggested as influencing breast cancer screening adherence among certain cultures. Jewish women have explicit religious and cultural rules about modesty and may also be influenced by modesty. The primary purpose of this study was to develop and test an instrument measuring modesty. An expansion of Champion's Behavioral Model for Mammography Utilization was used to guide the research questions. A cross-sectional mailed survey design was used. Jewish women (N = 306) completed a self-administered survey packet containing: (a) "Your Views of Modesty"; (b) selected subscales from the Fetzer Multidimensional Measure of Religiousness/Spirituality; and (c) a demographic form requesting information about predisposing characteristics, enabling resources, breast cancer risk, and screening behaviors. Jewish women aged 26--95 years (mean 67 years) comprised the sample. They were 89% Ashkenazi and religious group denominations were 21% Reform, 54% Conservative, and 17% Orthodox. The reliability estimate for "Your Views of Modesty" was an alpha .92. Item-total correlations ranged from .34--.74. Modesty was correlated with religiosity (r = .26, p < .01) providing some evidence for discriminant validity. Total modesty scores and self ranked modesty were related (r = .67, p < .01) providing evidence for convergent validity. Exploratory factor analysis was conducted on all of the 25 items in "Your Views of Modesty". Four factors explained 55% of the variance of modesty: (a) religion driven modesty; (b) exposure driven modesty; (c) public modesty; and (d) situational modesty supporting evidence for construct validity. Stepwise regression analysis was conducted with religiosity, modesty, predisposing, enabling, and risk variables tested as predictors of breast cancer screening. For BSE, at Step 1, religiosity was entered into the regression equation and was significantly related to BSE F(1,289) = 4.28, p = .040. Modesty and religiosity were not significant predictors of mammography or clinical breast examination. "Your Views of Modesty" was found to have evidence for both reliability and validity in this sample of Jewish women. Modesty appears to be a multidimensional construct with attributes of appearance, dress, beliefs, culture, and gender differentiation. Further testing of the measure of modesty in other cultures will provide new knowledge of cultural perspectives and health care utilization among diverse populations.