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The concept of perceived barriers is both important and central
to a variety of prominent health behavior theories. There
are a number of validated barrier measures available for use
that target screening for cancer and other diseases, and especially
for preventive health behaviors. Additional research is needed
to address issues such as: 1) the impact of culture, race,
ethnicity, health literacy, and other factors on perceptions
of barriers; 2) if a standard, feasible core set of barrier
questions and responses can be identified by content area
for the different purposes of prediction and individual tailoring
of intervention; and 3) interpretive problems and lack of
conceptual clarity that are discussed above (Glasgow
et al., 2001
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Glasgow, R. E., Gillette, C., & Toobert, D. (2001). Psychosocial
barriers to diabetes self-management and quality of life.
Diabetes Spectrum, 14, 33-41.; McCauley
et al., 1998
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McCauley, E. & Mihalko, S. L. (1998). Measuring exercise-related
self-efficacy. In J.L.Duda (Ed.), Advances in sport and
exercise psychology measurement (Morgantown, WV: Fitness
Information Technology).). Future research should also
pay increased attention to emotional and "distress"-related
issues that are proving to be of critical importance in chronic
illness (Anderson
et al., 2007
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Anderson, D., Horton, C., O’Toole, M. L., Brownson,
C. A., Fazzone, P., & Fisher, E. B. (2007). Integrating
Depression Care With Diabetes Care in Real-World Settings:
Lessons From Robert Wood Johnson Foundation Diabetes Initiative.
Diabetes Spectrum, 20, 10-16.; Fisher
et al., 2007
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Fisher, L., Skaff, M. M., Mulllan, J. T., Arean, P., Mohr,
D., Masharani, U. et al. (2007). Clinical depression versus
distress among patients with type 2 diabetes: Not just a question
of semantics. Diabetes Care, 30, 542-548.).
A final topic for further research is the issue of barriers
among patients who have several comorbid conditions and receive
multiple health behavior recommendations. Such "high-risk"
patients may face barriers that are qualitatively and quantitatively
different than those experienced by those with fewer conditions
(Bayliss
et al., 2003
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Bayliss, E. A., Steiner, J. F., Fernald, D. H., Crane, L.
A., & Main, D. S. (2003). Descriptions of barriers to
self-care by persons with comorbid chronic conditions. Annals
of Family Medicine, 1, 15-21.).
As in many areas of research, several investigative teams have
made progress, but often appear to be unaware of or not influenced
by alternative approaches or developments in different areas.
With barriers, the key issue is not the exact measure or analysis
used, but how the results are interpreted. As with many attempts
to apply theory to real-world health behaviors, there are
challenges to appropriate operationalization and interpretation
of results (Weinstein,
2007
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Weinstein, N. D. (2007). Misleading test of health behavior
theories. Annals of Behavioral Medicine, 33, 1-10.).
Future research will likely see continued and expanded use
of barrier concepts and measures, especially in areas such
as barriers to genetic screening.
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