title: Development and psychometric testing of a barriers to HIV testing scale among individuals with HIV infection in Sweden; The Barriers to HIV testing scale-Karolinska version.
abstract: BACKGROUND
  Barriers to HIV testing experienced by individuals at risk for HIV can result in treatment delay and further transmission of the disease. Instruments to systematically measure barriers are scarce, but could contribute to improved strategies for HIV testing. Aims of this study were to develop and test a barriers to HIV testing scale in a Swedish context.
  
  
  METHODS
  An 18-item scale was developed, based on an existing scale with addition of six new items related to fear of the disease or negative consequences of being diagnosed as HIV-infected. Items were phrased as statements about potential barriers with a three-point response format representing not important, somewhat important, and very important. The scale was evaluated regarding missing values, floor and ceiling effects, exploratory factor analysis, and internal consistencies.
  
  
  RESULTS
  The questionnaire was completed by 292 adults recently diagnosed with HIV infection, of whom 7 were excluded (≥9 items missing) and 285 were included (≥12 items completed) in the analyses. The participants were 18-70 years old (mean 40.5, SD 11.5), 39 % were females and 77 % born outside Sweden. Routes of transmission were heterosexual transmission 63 %, male to male sex 20 %, intravenous drug use 5 %, blood product/transfusion 2 %, and unknown 9 %. All scale items had <3 % missing values. The data was feasible for factor analysis (KMO = 0.92) and a four-factor solution was chosen, based on level of explained common variance (58.64 %) and interpretability of factor structure. The factors were interpreted as; personal consequences, structural barriers, social and economic security, and confidentiality. Ratings on the minimum level (suggested barrier not important) were common, resulting in substantial floor effects on the scales. The scales were internally consistent (Cronbach's α 0.78-0.91).
  
  
  CONCLUSIONS
  This study gives preliminary evidence of the scale being feasible, reliable and valid to identify different types of barriers to HIV testing.
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. maria.wiklander@ki.se.|Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden. maria.wiklander@ki.se.|Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 23300, SE-141 83, Huddinge, Sweden. maria.wiklander@ki.se.
authors.forename: Maria
authors.initials: M
authors.lastname: Wiklander
authors.affiliation: Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden. johanna.brannstrom@karolinska.se.|Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden. johanna.brannstrom@karolinska.se.
authors.forename: Johanna
authors.initials: J
authors.lastname: Brännström
authors.affiliation: Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden. veronica.svedhem-johansson@karolinska.se.|Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden. veronica.svedhem-johansson@karolinska.se.
authors.forename: Veronica
authors.initials: V
authors.lastname: Svedhem
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. lars.eriksson@ki.se.|Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden. lars.eriksson@ki.se.|Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden. lars.eriksson@ki.se.|School of Health Sciences, City University London, London, UK. lars.eriksson@ki.se.
authors.forename: Lars E
authors.initials: LE
authors.lastname: Eriksson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D005163:Factor Analysis, Statistical; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000523:psychology*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000523:psychology*; D008875:Middle Aged; D011594:Psychometrics / Q000295:instrumentation*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D013548:Sweden; D055815:Young Adult