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Behavioral Research

Table of Contents
1 Description and Theoretical Background
2 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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Measures and Measurement

Assessment Procedures

A variety of barrier assessment procedures have been developed for a spectrum of diverse cancer screening behaviors, other conditions including diabetes, HIV, pain, and panic attacks, and specific behaviors including medication adherence, healthy eating, physical activity, smoking cessation, and weight management. A PubMed search for "barriers to adherence" produced 1,002 articles and a search for "barriers to cancer screening" produced 1,346. Various procedures have been used to assess barriers including qualitative interviews, open-ended questionnaires, and structured surveys. Barrier items are sometimes based on theory, sometimes on experience, and occasionally on frequency or strength of endorsement in prior research. Several research programs have developed and revised barrier lists over time as a result of data obtained in prior studies. For example, Champion et al. (2007) have evolved a measure of barriers to mammography over time, as have McCauley and colleagues (1998) for physical activity, and Glasgow et al. (2001) for diabetes self-management. Ideally, barrier items would be culturally appropriate, based on both theory and prior research, and pilot tested with one's target population.

Responses to barrier items have been assessed using scales of frequency, probability, strength of barrier, level of concern, how often the barrier has prevented the desired behavior, and finally self-efficacy level. A few studies have investigated use of a combination of frequency and strength responses, but this strategy has not enhanced predictive validity compared to that of a frequency scale alone (Glasgow et al., 2001).


A number of analysis procedures have been used to validate barriers measures, but the typical analysis relies on cross-sectional correlations (Glasgow et al., 2001). To justify use as a practical method of predicting future behavior, a better strategy would be to determine that a barrier instrument explains incremental variance over and above that explained by simple and more easily obtained variables, such as demographics and past behavior. (For explanatory purposes and to understand why, for example, demographic subgroups may have different levels of cancer screening, a barrier instrument may still be useful). In addition, stronger conclusions can be made based upon prospective than cross-sectional analyses of predictive validity. The issue of how respondents make judgments about barriers is of particular concern. Especially problematic are scales and analyses that a) ask the respondent to rate how often a given barrier caused the person to not be able to engage in behavior X (see Glasgow et al., 2001, for more details), and then b) use this rating to predict concurrent self-reports of behavior X. For example, part of my judgment of "how often the weather prevented me from exercising" is based upon my frequency of exercise. It then does not make sense to use such a barrier measure to predict exercise frequency, since the self-assessment of exercise frequency is part of both barrier and exercise constructs.

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Health Behavior Constructs: Theory, Measurement, & Research