Development and Validation of the Barriers to Care Scale: Assessing Access to Care among Canadian Armed Forces Health Care Providers

ABSTRACT

Military health care providers (HCPs) under-access health services. Measures aimed at assessing barriers to care are either limited in scope, do not address barriers to physical healthcare, or are not grounded in theory. The current study developed and validated a measure of barriers to care based on an existing theoretical framework. Forty focus groups were conducted with 182 Canadian Armed Forces (CAF) HCPs across Canada focusing on barriers to accessing care. Focus group content was used to develop 52 unique barrier items. The Barriers to Care scale was completed by 1033 CAF HCPs. The sample was randomly split so that both an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) could be conducted. The identified factors were correlated with intent to access care to assess concurrent validity. Results of the EFA and CFA (CFI = .84; TLI = .84; SRMR = .08; RMSEA = .07) suggested an eight-factor model. The alphas of the eight subscales were excellent (> .85). All subscales significantly and negatively correlated with intent to access care. The findings suggest a promising first step toward creating a theory-based, valid, and reliable measure for assessing barriers to care.

Keywords:

• Barriers to care
• access to care
• scale validation
• scale development
• military
• theoretical domains
• mixed-methods design

Disclosure statement

The authors declare that they have no conflict of interest. This manuscript presents the opinions of the authors and does not necessarily reflect the official position of the Department of National Defence or Canadian Armed Forces.

Notes

1 Environmental Context and Resources: Where I am located, I have limited access to care; The provincial health system impacts the quality of care I receive from CAF health services; and Organizing transport to access care off base would be difficult; Consequences of the Behavior: When I access care, I don’t have control over my care plan and I believe my appointments are less formal (e.g., I’m spoken to more casually than other patients; appointments are squeezed in) than the appointments other patients experience; I have had past negative experiences when accessing care