Commonly Experienced Health Care Barriers Index

Abstract

The Commonly Experienced Health Care Barriers Index (CEHCBI), developed by Rivers et al. (2023), is a specialized, 6-item index designed to quantify the frequency and impact of common Health Care Barriers experienced by the general adult population within various healthcare settings. The scale’s development followed rigorous psychometric standards, spanning three distinct studies and adhering specifically to recommendations for constructing Causal Indicator Models.

The index was validated using large online samples of adult participants, demonstrating strong psychometric properties, including high Reliability and robust Validity. The core objective of the CEHCBI is to provide researchers and policymakers with a concise tool to identify specific, potentially modifiable elements that contribute significantly to Health Care Inequities and persistent challenges in healthcare access and utilization.

Keywords

Test Responsiveness, Health Care Barriers, Health Care Services, Treatment Barriers, Treatment Process and Outcome Measures, Health Care Inequities, Psychometrics.

Authors

Rivers, Alannah Shelby; Sanford, Keith; Brewington, Morgan; Buchanan, Ashley

Purpose

The primary purpose of the Commonly Experienced Health Care Barriers Index (CEHCBI) is to serve as a focused diagnostic tool. It is specifically intended to systematically identify and measure factors that impede individuals from seeking or receiving necessary medical attention, ultimately contributing to poorer health outcomes.

By pinpointing these factors, the index facilitates research aimed at understanding and addressing Health Care Inequities. The index focuses on barriers that are considered modifiable, meaning interventions can potentially be designed and implemented to reduce their impact and improve overall health care utilization across diverse populations.

Construct

The CEHCBI measures the frequency and severity of practical, structural, and interpersonal obstacles that the general population encounters when attempting to access or engage with medical services. This construct is conceptualized as a composite of external factors that causally influence an individual’s decision or ability to seek care, rather than a latent trait within the individual.

These measured obstacles encompass key domains of access, including financial limitations (insurance/cost), logistical challenges (transportation, scheduling time off work), systemic issues (lack of a regular doctor, excessive wait times for appointments), and perceived quality of care (negative treatment experiences).

Validity

The Validity of the CEHCBI was established through several distinct methods, confirming its suitability for measuring the intended construct.

Content Validity: To achieve maximum content representation with minimal item burden, the researchers utilized a qualitative study to generate an initial item pool. This pool was rigorously refined using cluster analysis, ensuring that the final six indicators comprehensively covered the entire domain of commonly experienced Health Care Barriers.

Test Responsiveness: The index demonstrated significant sensitivity in detecting disparities between demographic groups. Specifically, the test revealed significant differences between Black and White adult participants (d = .29, t(739) = 3.65, p < .001). This finding supports the scale’s ability to appropriately identify racial Health Care Inequities.

Convergent Validity: The CEHCBI exhibited expected associations with a wide range of related outcomes, confirming its Convergent Validity. These associations included correlations with various health care utilization problems (e.g., missed appointments, omitting needed care, emergency room reliance), negative health experiences (e.g., reduced patient–practitioner alliance, medical confusion, lower health-related quality of life), and heightened life stressors (e.g., neighborhood violence, financial instability, general stress).

Reliability

The Reliability of the CEHCBI was assessed primarily through its temporal stability, demonstrating consistency over time.

Test-Retest Reliability: The overall scale showed a high degree of stability over a three-week interval, with a strong test–retest reliability coefficient (r = .83, p < .001). Furthermore, the reliability coefficients for the individual six items ranged from moderate to high, spanning from .54 to .79, indicating that the index provides dependable and consistent measurements of Health Care Barriers.

Factor Analysis

Based on the available academic documentation regarding the scale’s development, specific results related to traditional exploratory or confirmatory factor analysis (EFA/CFA) that might confirm a single underlying latent factor structure are not explicitly reported. The scale was developed adhering to recommendations for Causal Indicator Models, which often aggregate indices based on content domain coverage rather than relying on internal correlation structures typically assessed through factor analysis.

Instrument

Test Type: Original

Format: The index consists of 6 items, which are rated using a 4-point Likert scale. The response options range from 1 = “NOT true” to 4 = “completely true”. The standardized administration method is electronic. The full list of test items is available in the original publication (2024-13469-001, Table 1, Page 5).

Language Available: English

Population Group: Human (Male and Female)

Age Group: Adulthood (18 years and older)

Population Details: The validation samples consisted of adult participants residing in the United States.

Test Methodology: The scale’s development and evaluation methodology included analyses of Test Validity (Content and Convergent), Test Reliability, and Test-Retest Reliability.

Keywords

Treatment Barriers, Health Care Services, Treatment Process and Outcome Measures, Test Responsiveness, Health Care Utilization, Health Disparities, Causal Indicator Models.

Authors

Author ORCID Identifier:

• Rivers, Alannah Shelby: http://orcid.org/0000-0001-8826-4606

• Brewington, Morgan: http://orcid.org/0009-0002-3357-8020

Affiliation Email addresses:

• Rivers, Alannah Shelby: Texas Woman’s University, School of Social Work, Psychology, and Philosophy

• Sanford, Keith: Baylor University, Department of Psychology and Neuroscience

• Brewington, Morgan: Baylor University, Department of Psychology and Neuroscience

• Buchanan, Ashley: Baylor University, Department of Psychology and Neuroscience

• Email (Rivers, Alannah Shelby): [email protected]

Correspondence Address:

Rivers, Alannah Shelby: Texas Woman’s University, School of Social Work, Psychology, and Philosophy, P.O. Box 425470, Denton, Texas, United States, 76204-5470, [email protected]

Permissions & Fee and Test Year

Permissions: The scale may be used freely for Research and Teaching purposes.

Fee: No fee is required for use.

Commercial: Commercial use is not permitted.

Test Year: 2023

Reference’s

Rivers, A. S., Sanford, K., Brewington, M., & Buchanan, A. (2024). Development of a new measure of encounters with health care barriers: The Commonly Experienced Health Care Barriers Index. Psychological Assessment, 36(1), 30–40. https://doi.org/10.1037/pas0001284

Items of the Commonly Experienced Health Care Barriers Index

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

This is a 6-item scale.

• Not having enough money or insurance stops me from going to a doctor.

• Not having good transportation stops me from going to a doctor.

• Not being able to take time off work stops me from going to a doctor.

• Not having a regular doctor stops me from going to a doctor.

• Having to wait too many days for an appointment stops me from going to a doctor.

• Not liking the way I am treated at the doctor’s office stops me from going to a doctor.

Note. Items were preceded with instructional text: “At times when you are due for a medical checkup, and at times when you are sick and it would be good to visit a doctor, do any of the following issues stop you from going to a doctor?” Response options were “NOT true” (1), “a little true” (2), “moderately true” (3), and “completely true” (4).