title: Barriers to care: operationalizing the variable.
abstract: A measure was developed to operationalize the concept of barriers as the consumer's perceptions of costs or obstacles to care. First, a 12-member panel participated in a three-stage Delphi process to identify indicators of the concept. Of the 81 items generated, 54 were selected as appropriate to a well population seeking preventive care. In a survey of 800 employees of a not-for-profit organization, respondents were asked to rate each barrier indicator on a 5-point Likert scale; the response rate was 70%. Exploratory factor analysis was used to explore the construct validity of the measure. Five factors were found: Provider-Consumer Relationship, Cost, Site-Related, Inconvenience, and Fear. Confirmatory factor analysis was used to refine the indicators for each factor category, producing a scale to measure perceived barriers to secondary preventive care. Based on the factor correlations, a model of the structure of barriers is proposed, showing the relationship factor as central.
authors.affiliation: School of Nursing, University of Rochester Medical Center, NY.
authors.forename: K A
authors.initials: KA
authors.lastname: Melnyk
mesh_terms: D003365:Costs and Cost Analysis; D003697:Delphi Technique; D005163:Factor Analysis, Statistical; D005239:Fear; D006297:Health Services Accessibility; D006801:Humans; D010342:Patient Acceptance of Health Care; D011314:Preventive Health Services; D011369:Professional-Patient Relations; D012938:Social Perception; D011795:Surveys and Questionnaires