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
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
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
|Barriers temptations (Velicer
et al., 1990) - Appendix
||1-5 "how tempted"
||∝ = .80 - .95
||Three factors or components to structure of temptations scale
|Mammography barriers - Appendix 2 (Champion
et al., 2007)
||1 to 5 "strongly agree to strongly disagree"
||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"
||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
||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)
||Definitely false (1) to definitely true (4)
||∝ = .73
||Predicted HTN medication adherence in cross-sectional analyses
|Barriers to CRC screening (Zheng
et al., 2006) - Appendix
||1-5 "strongly disagree to strongly" agree
||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).