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

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 xClose
Champion, V., Skinner, C. S., Hui, S., Monahan, P., Juliar, B., Daggy, J. et al. (2007). The effect of telephone versus print tailoring for mammography adherence. Patient Education and Counseling, 65, 416-423.; Glasgow et al., 2000 xClose
Glasgow, R. E., Whitlock, E. P., Valanis, B. G., & Vogt, T. M. (2000). Barriers to mammography and Pap smear screening among women who recently had neither, one or both types of screening. Annals of Behavioral Medicine, 22, 223-228.). 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 xClose
Zheng, Y.-F., Sait, T., Takahashi, M., Ishibashi, T., & Kai, I. (2006). Factors associated with intentions to adhere to colorectal cancer screening follow-up exams. BMC Public Health, 6, 272.). 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).

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 xClose
Champion, V., Skinner, C. S., Hui, S., Monahan, P., Juliar, B., Daggy, J. et al. (2007). The effect of telephone versus print tailoring for mammography adherence. Patient Education and Counseling, 65, 416-423.). Appendix 3 is an example of barriers efficacy related to physical activity (Garcia & King et al., 1991 xClose
Garcia, W. A. & King, A. C. (1991). Predicting Long-Term Adherence to Aerobic Exercise: A Comparison of Two Models. Journal of Sport & Exercise Psychology, 13, 394-410.). Finally, Appendix 4 illustrates a 5-point "strongly agree" to "strongly disagree" response scale for barriers to colorectal screening (Zheng et al., 2006 xClose
Zheng, Y.-F., Sait, T., Takahashi, M., Ishibashi, T., & Kai, I. (2006). Factors associated with intentions to adhere to colorectal cancer screening follow-up exams. BMC Public Health, 6, 272.).