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.
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