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

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 xClose
Becker, M. H., Maiman, L. A., Kirscht, J. P., Haefner, D. P., Drachman, R. H., & Taylor, D. W. (1979). Patient perceptions and compliance: Recent studies of the Health Belief Model. In R.B.Haynes & D. L. Sckett (Eds.), Compliance in health care (Baltimore: Johns Hopkins University Press).) 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 xClose
Glanz, K., Lewis, F. M., & Rimer, B. K. (2002). Health behavior and health education: Theory, research and practice. (3rd ed.) San Francisco: John Wiley & Sons.; Stokols, 2000 xClose
Stokols, D. (2000). Social ecology and behavioral medicine: Implications for training, practice, and policy. Behavioral Medicine, 26, 129-138.) 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 xClose
Locke, E. A. & Latham, G. P. (2002). Building a practically useful theory of goal setting and task motivation. A 35-year odyssey. American Psychologist, 57, 705-717.; Leventhal et al., 1991 xClose
Leventhal, H. & Diefenbach, M. (1991). The active side of illness cognition. In J.A.Skelton & R. T. Croyle (Eds.), Mental representation in health and illness (pp. 246-272). New York: Springer-Verlag.). 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 xClose
D’Zurilla, T. J. (1996). Problem-solving therapy: A social competence approach to clinical intervention. New York: Springer.) 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 xClose
Glasgow, R. E., Emont, S., & Miller, D. S. (2006). Assessing the delivery of the 5 "As" for patient-centered counseling: alternatives and future directions. Health Promotion International, 21, 2245-255.; Whitlock et al., 2002 xClose
Whitlock, E. P., Orleans, C. T., Pender, N., & Allan, J. (2002). Evaluating primary care behavioral counseling interventions: An evidence-based approach. American Journal of Preventive Medicine, 22, 267-284.). 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 xClose
Hill-Briggs, F. (2003). Problem solving in diabetes self-management: A model of chronic illness self-management behavior. Annals of Behavioral Medicine, 25, 182-193.; D’Zurilla, 1996 xClose
D’Zurilla, T. J. (1996). Problem-solving therapy: A social competence approach to clinical intervention. New York: Springer.; Glasgow et al., 2007) xClose
Glasgow, R. E., Fisher, L., Skaff, M., Mullan, J., & Toobert, D. J. (2007). Problem-solving and diabetes self-management: Investigation in a large, multi-racial sample. Diabetes Care, 30, 33-37..

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".