National Cancer Institute   National Cancer Institute

Behavioral Research

Table of Contents
1 Description and Theoretical Background

Use in Health Behavior Theories


Measures and Measurement


Most Common Barriers


Measurement and Methodological Issues

6 Summary
7 References
8 Appendix 1
9 Appendix 2
10 Appendix 3
11 Appendix 4
12 Published Examples

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Other Constructs



Dispositional Optimism




Illness Representations

  Implementation Intentions
  Intention, Expectation, and Willingness
  Normative Beliefs
  Optimistic Bias
  Perceived Benefits
  Perceived Control
  Perceived Severity
  Perceived Vulnerability
  Self-Reported Behavior
  Social Influence
  Social Support

Perceived Barriers to Self-Management and Preventive Behaviors
Russell E. Glasgow, Ph.D.

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Use in Health Behavior Theories

Barriers are a central part of many theories of health behavior. The health belief model (HBM) was one of the earliest to prominently feature perceived barriers (Becker et al., 1979) In the HBM, both barriers to and perceived benefits of a behavior lead to the likelihood of taking recommended action (as do other components such as perceived threat).

Perceived barriers are also involved in social cognitive theory (as partial determinants of self-efficacy as illustrated in Figure 1) and social-ecological theory (judgments of barriers are commonly used as proxies for objective measures of multi-level determinants of behavior). Social-ecological theory (Glanz et al., 2002; Stokols, 2000) conceptualizes barriers along a continuum from proximal (e.g., family) to intermediate (e.g., health care team, work-related) to more distal (e.g., community access, media advertising and regulatory policy) factors. Perceived barriers are also an important, though largely implicit aspect of goal, goal attainment, and self-regulation theories (Locke et al., 2002; Leventhal et al., 1991). In these theories, goals are established and health behaviors are executed in attempts to attain these goals. Barriers, and how barriers are perceived, interpreted, and addressed, have a large influence on both goal setting and goal attainment. The Transtheoretical Model (TTM) also incorporates the concept of barriers. In the TTM, barriers are called "temptations" and questions framed as "how tempted are you in different situations?" (see Table 2).

Much recent attention has been devoted to social problem-solving theory (D’Zurilla, 1996) and related self-management conceptual models such as the 5 A's: Assess-Advise-Agree upon goals-Assist with problem solving; and Arrange follow-up support (Glasgow et al., 2006; Whitlock et al., 2002). These theories involve identification of specific barriers to self-management, followed by construction and implementation of barrier-related coping or problem-solving strategies (Hill-Briggs, 2003; D’Zurilla, 1996; Glasgow et al., 2007).

The top section of Table 1 summarizes how different theories have explicitly defined perceived barriers and conceptualized barriers. The commonality across these definitions seems to be emphasis on perceptions of the difficulty or psychological costs of different situations-thus, the first part of the definition used in this chapter of "a person's estimation of the level of challenge of social, personal, environmental, and economic obstacles to a specified behavior". The bottom section of Table 1 provides definitions of related concepts, such as temptations or barriers-based self-efficacy that have focused on the impact of barriers on one's confidence or perceived ability. This estimated impact of a barrier is captured in the later part of the definition used in this summary of "estimation of the level of challenge…(to) their desired goal status on that behavior".

Table 1. Definitions Used by Different Theories of Barriers, Related Constructs, or the Impact of Barriers on Key Theoretical Constructs
Theory Definition
I. Theories Explicitly Defining Barriers or Related Constructs
A. Health Belief Model One's opinion of the tangible and psychological costs of advised action
B. Precaution Adoption Theory Important issue is "beliefs about difficulty" (of barriers)
C. Perceived Power Construct in Theory of Planned Behavior Perceived effect of each condition in making behavioral performance difficult or easy
II. Theories Focused on Impact of Barriers on Key Constructs
A. Barriers-based Self-efficacy in Social Cognitive Theory Person's confidence…in overcoming barriers to that behavior
B. Temptations in Transtheoretical Model Temptation to engage in unhealthy behavior(s) across different challenging situations
C. Secondary Appraisal in Transactional Model of Stress and Coping Perception of one's ability to change the situation or cope effectively (with situation)
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Health Behavior Constructs: Theory, Measurement, & Research