National Cancer Institute   National Cancer Institute

Behavioral Research

Table of Contents
1 Description and Theoretical Background
2 Use in Health Behavior Theories
3 Measures and Measurement
4 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

Download Full Text (PDF)

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.

<< Previous


Barriers Related to Cancer: Measurement and Methodological Issues

Given the limited scope of this review, I have focused on 1) barriers to cancer screening, 2) barriers to health behaviors related to cancer prevention and management-such as cigarette smoking cessation, exercise, and following a healthy eating pattern, and 3) a scale that uses response options not covered above.

Characteristics of some of the most widely used barriers to self-management scales are summarized in Table 2. As can be seen, there is variability across almost all of the scale characteristics in Table 2 including target behavior, response type and scale, reliability and validity data, as well as primary purpose of the barrier instruments. Three scales in Table 2 assess barriers to different types of cancer screening. These scales have been developed primarily to help tailor psychosocial interventions (Champion et al., 2007; Glasgow et al., 2000). As can be seen, such papers tend to report fewer data on traditional psychometric characteristics, since the focus tends to be on individual barriers used to tailor individualized recommendations (Zheng et al., 2006). Many investigators conceptualize barriers as a multi-dimensional construct and would not predict that a person's perception of one barrier should strongly predict their perception of other barriers. From this perspective, psychometric measures of internal consistency are less appropriate than other criteria, such as predictive validity and usefulness for tailoring intervention. The other primary use of barrier scales has been to predict health behaviors/adherence. Typically, average or total barrier responses across items are most often used for such purposes (see Appendices 1 and 3).

Table 2. Characteristics of Barriers to Self-Management Scales
Measure Target Behavior Response Scale Reliability Validity
Test-Retest Internal Consistency
Barriers temptations (Velicer et al., 1990) - Appendix 1 Smoking Cessation 1-5 "how tempted" Not reported ∝ = .80 - .95 Three factors or components to structure of temptations scale
Mammography barriers - Appendix 2 (Champion et al., 2007) Mammography Screening 1 to 5 "strongly agree to strongly disagree" Not reported Not reported Used to tailor counseling
Pap Smear and mammography screening barriers (Glasgow et al., 2000) Pap Smear Screening 4-point "not at all to great deal" Not reported 3 factors identified with eigenvalues > 1.0 Used to tailor counseling; women due for cancer screenings had greater barriers than those up to date
Barriers efficacy (Garcia & King et al., 1991) - Appendix 3 Physical Activity 0 to 100 Confidence r = .67 ∝ = .90 Prospectively associated with exercise adherence
Barriers efficacy (Glasgow et al., 2001) Multiple behaviors (for diabetes) 1 to 5 "how difficult" and 0-10 "how confident can overcome" Mean r = .60 (.43 - .80) Mean ∝ = .90(.74 - .98) Prospectively related to dietary, exercise, and stress management
Medication taking (Hong et al., 2006) Medication taking Definitely false (1) to definitely true (4) Not reported ∝ = .73 Predicted HTN medication adherence in cross-sectional analyses
Barriers to CRC screening (Zheng et al., 2006) - Appendix 4 Colorectal screening 1-5 "strongly disagree to strongly" agree Not reported Not reported Related to intention to follow-up abnormal FOBT result

Measures of Cancer-related Barriers

Appendices 1-4 present examples of some of the most widely used types of barrier scales for health behaviors related to cancer prevention and management. The footnote to each table contains contact information to secure information about administration, scoring, norms, and interpretation. Appendix 1 asks smokers to rate their confidence that they can resist a variety of barriers (or temptations based on TTM theory). Appendix 2 is a mammography screening barriers scale to identify targets for intervention; the scale was used successfully to tailor counseling (Champion et al., 2007). Appendix 3 is an example of barriers efficacy related to physical activity (Garcia & King et al., 1991). Finally, Appendix 4 illustrates a 5-point "strongly agree" to "strongly disagree" response scale for barriers to colorectal screening (Zheng et al., 2006).

<< Previous

Search | Help | Contact Us | Accessibility | Privacy Policy

DCCPSNational Cancer Institute Department of Health and Human Services National Institutes of Health

Health Behavior Constructs: Theory, Measurement, & Research