Barriers to Specialty Alcohol Treatment Scale

Abstract

The Barriers to Specialty Alcohol Treatment (BSAT) Scale, developed by Pinedo and colleagues in 2023, is a specialized psychometric instrument designed to systematically identify and quantify the reasons why individuals diagnosed with Alcohol Use Disorder (AUD) may delay, refuse, or fail to utilize specialty alcohol treatment services. The foundation of the BSAT Scale lies in the Theory of Planned Behavior (TPB; Ajzen, 1985), incorporating Ajzen’s recommendations for measuring TPB components (Ajzen, 2002).

Scale development involved extensive formative work and a comprehensive literature review, resulting in an initial pool of 45 items. The scale items were rigorously translated into Spanish using standard back-translation procedures. Validation utilized data collected from a national online sample of White and Latino adults recently diagnosed with AUD. Through combined exploratory and confirmatory factor analyses (CFA), the final validated model comprises 36 items distributed across seven distinct factors. The BSAT Scale typically requires approximately 13 minutes for completion and has demonstrated good reliability across its subscales.

Keywords

Alcohol Use Disorder, Cultural Factors, Health Disparities, Immigration-Related Concerns, Latinos, Logistical Issues, Low Perceived Social Support, Low Perceived Treatment Efficacy, Low Problem Recognition, Recovery Goals, Specialty Treatment, Theory of Planned Behavior, Treatment Barriers, Whites

Authors

Pinedo, M., Castro, Y., Gilbert, P. A., Caetano, R., Zemore, S. E.

Purpose

The primary purpose of the BSAT Scale is to precisely assess factors that impede access to or engagement with specialty alcohol treatment. It was specifically developed and validated using a diverse sample of White and Latino adults who meet the criteria for a recent Alcohol Use Disorder diagnosis. By focusing on these specific demographic groups, the scale aims to uncover potential cultural and systemic barriers that contribute to health disparities in treatment utilization.

Construct

The BSAT Scale is theoretically grounded in the Theory of Planned Behavior (TPB), which posits that behavioral intention is influenced by three core psychological constructs: attitudes, subjective norms, and perceived behavioral control. The 36 items of the BSAT measure barriers across these three domains, which are further delineated into seven distinct factors:

• Attitudes toward specialty alcohol treatment: Includes Low Problem Recognition, Recovery Goals, Low Perceived Treatment Efficacy, Cultural Factors, and Immigration-Related Concerns.

• Subjective norms toward specialty alcohol treatment: Measures Low Perceived Social Support.

• Perceived control toward specialty alcohol treatment: Measures Logistical Barriers.

Validity

Formal reports detailing criterion validity or construct validity (beyond the factor structure) were not provided in the primary development publication (Pinedo et al., 2023). Future research is recommended to establish these forms of validity for the BSAT Scale.

Reliability

The reliability of the BSAT Scale was assessed through internal consistency measures for each of its seven subscales. Using Cronbach’s alpha, the values for the subscales ranged from 0.82 to 0.93. These results indicate that the scale possesses good to excellent internal consistency, suggesting that the items within each factor reliably measure the same underlying construct.

Factor Analysis

The scale development employed both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to establish the underlying structure. The initial model derived from Exploratory Factor Analysis (EFA) consisted of 39 items across seven factors. Although initial model fit indices (RMSEA = 0.05, CFI = 0.93, TLI = 0.92, SRMR = 0.05) were marginally below stringent cut-off values, subsequent model trimming procedures led to the removal of three items, resulting in the final 36-item, seven-factor scale. Specifically, all 11 items related to perceived control converged onto a single factor, labeled as logistical barriers.

Measurement Invariance

The study rigorously tested the measurement invariance of the BSAT in two critical contexts. First, invariance was tested across White and Latino participants who completed the English version of the scale. Second, invariance was tested across the English and Spanish versions within the Latino sample. In both analyses, the results supported both configural invariance (the factor structure is the same across groups/languages) and metric invariance (the strength of item-factor relationships is the same).

However, scalar invariance was not supported (White vs. Latino: χ2diff [36,846] = 94.82, p < 0.0001; English vs. Spanish: χ2diff [36, 600] = 61.65, p = 0.005). The lack of scalar invariance suggests that while the conceptual meaning of the measured constructs remains similar across groups and languages, direct comparisons of mean scores (e.g., stating that Latinos experience significantly higher logistical barriers than Whites) may be biased and should be interpreted with caution.

Instrument

Test Type: Original Inventory/Questionnaire

Format: The BSAT Scale presents statements reflecting potential barriers to specialty alcohol treatment. Respondents indicate their degree of agreement or disagreement with each statement as a reason for not seeking treatment, utilizing a 5-point Likert scale, ranging from (1) “strongly disagree” to (5) “strongly agree.” Administration is typically electronic.

Language Available: English, Spanish

Population Group: Human; Male; Female

Age Group: Adulthood (18 years & older), including Young Adulthood (18-29 years), Thirties (30-39 years), Middle Age (40-64 years), and Aged (65 years & older).

Population Details:

• Location: United States

• Respondents: Adults aged 18–74 years with a recent Alcohol Use Disorder (AUD) diagnosis, specifically Latino and White individuals.

Test Methodology: The methodology employed in the development and validation of the BSAT Scale included: Test Reliability, Internal Consistency, Factor Analysis, Confirmatory Factor Analysis, Exploratory Factor Analysis, and Measurement Invariance.

Keywords

Alcohol Use Disorder, Cultural Factors, Health Disparities, Immigration-Related Concerns, Latinos, Logistical Issues, Low Perceived Social Support, Low Perceived Treatment Efficacy, Low Problem Recognition, Recovery Goals, Specialty Treatment, Theory of Planned Behavior, Treatment Barriers, Whites

Authors

Author ORCID Identifier: No data is Available

Affiliation Email addresses: No data is Available

Correspondence Address: 2109 San Jacinto Blvd., Stop D3700, Austin, Texas, United States, 78712-1415 (Pinedo, M.)

Permissions & Fee and Test Year

Permissions: May be used for Research/Teaching purposes.

Commercial Use: No

Fee: No

Test Year: 2023

Reference’s

Pinedo, M., Castro, Y., Gilbert, P. A., Caetano, R., & Zemore, S. E. (2023). Improving assessment of alcohol treatment barriers among Latino and White adults with an alcohol use disorder: Development of the barriers to specialty alcohol treatment scale. Drug and Alcohol Dependence, 248, 1–9. doi:10.1016/j.drugalcdep.2023.109895

Items of the Barriers to Specialty Alcohol Treatment Scale

The BSAT Scale is a 36-item measure. The items assess barriers across seven factors (subscales), as identified through factor analysis:

• Attitudes toward specialty alcohol treatment:

  • Low problem recognition

  • Recovery goals

  • Low perceived treatment efficacy

  • Cultural factors

  • Immigration-related concerns

• Subjective norms toward specialty alcohol treatment:

  • Low perceived social support

• Perceived control toward specialty alcohol treatment:

  • Logistical barriers

Attitudes toward specialty alcohol treatment

Low problem recognition

• I didn’t think treatment was needed because I could still function (for example, I had a job, provided for my family, took care of my kids, etc.).

• I didn’t feel I had a drinking problem.

• I thought I could stop drinking any time I wanted to.

• I didn’t think I needed treatment because my drinking didn’t interfere with my responsibilities (like paying rent/mortgage, taking care of my kids).

• I didn’t think my problem was serious enough to get treatment.

Recovery goals

• I was afraid of being judged or punished for not wanting to stop drinking completely.

• I was afraid of being judged or punished for using alcohol or drugs again after having quit.

• I was concerned about missing drinking (for example, that I would miss getting drunk, miss my old lifestyle, or have cravings).

• I wanted to reduce my drinking but not stop completely.

Low perceived treatment efficacy

• I didn’t think treatment would work for me because I didn’t think the counselors would understand my drinking or me.

• I didn’t think treatment would be helpful because most counselors lack ‘real world experiences.’

• I didn’t think treatment would be helpful because most counselors have never experienced a problem with alcohol.

• I didn’t think treatment would work for me because alcohol treatment is not effective.

Cultural factors

• I was concerned that treatment counselors might not understand my cultural background.

• I didn’t think I could find a counselor with the same racial/ethnic or cultural background as me.

• Attending an alcohol treatment program is something that is not accepted in my culture.

• It is not common to attend an alcohol treatment program in my culture.

Immigration-related concerns

• I was afraid that using treatment would have negative consequences for my immigration status (for example, having my green card revoked).

• I was afraid that using treatment would have negative consequences for the immigration status of someone in my family (like my parents, children).

• I was concerned about disclosing sensitive information, such as my immigration status.

Subjective norms toward specialty alcohol treatment

Perceived lack of social support

• I didn’t want my friends to judge me for going to treatment.

• I was afraid of being rejected by my friends for going to treatment.

• I was concerned that going to treatment would bring shame to my family.

• I didn’t want my family to judge me for going to treatment.

• I was afraid of being rejected by my family for going to treatment.

Perceived control toward specialty alcohol treatment

Logistical barriers

• My health insurance didn’t cover alcohol treatment.

• I didn’t have time due to other responsibilities (like work, taking care of my family or household).

• I was concerned that treatment would interfere with my home responsibilities (for example, taking care of my children or household).

• I was concerned that treatment would interfere with my work.

• I didn’t want to or couldn’t request time off work to go to treatment.

• The treatment program’s hours were inconvenient.

• The wait time to get an appointment to start treatment was too long.

• I didn’t know where to go for treatment.

• I wasn’t comfortable communicating in English.

• I had no one to take care of my children or couldn’t afford childcare.

• I was concerned that I couldn’t afford to pay for it.

Note: Participants are asked to indicate to what extent they agreed or disagreed with each statement, using a 5-point Likert scale ranging from (1) strongly disagree to (5) strongly agree, as a reason for not using specialty alcohol treatment.