Aims To effectively develop and target interventions, a valid and reliable measure is needed to quantify barriers to participation in population mail-out bowel cancer screening. The aim of the current study was to develop and evaluate the psychometric properties of the Barriers to Home Bowel Cancer Screening Scale (BHBCSS) and assess individual and demographic differences in the types of barriers experienced.
Methods A comprehensive list of 118 barriers were identified in the scientific literature and popular media sources. The list was reviewed for content validity by a panel of consumers and experts and revised down to 89 items. These items were presented in an online survey of Australian adults aged 50 to 74 years (n=437). Frequencies and percentages of responses to barrier were calculated, and exploratory factor analysis (EFA) was conducted to identify latent barrier types. Associations between barrier types and demographics were assessed using linear regression.
Results Common barriers included misplacing the screening kit or forgetting about it (24.0%) and the unpleasantness of collecting a stool sample (15.3%). EFA revealed five factors reflecting disgust, pessimism regarding outcomes, concerns about autonomy, practical challenges, and lack of perceived necessity. Older participants were less likely to report disgust (b = -.296, p < .01) or practical challenges (b = -335, p < .01) and females were less likely to report pessimism regarding outcomes (b = .344, p < .01) or concerns about autonomy (b = .255, p < .05). Socio-economic status was positively associated with concerns about autonomy (b = .287, p < .05) and negatively associated with a lack of perceived necessity (b = -.262, p < .05).
Conclusions The BHBCSS is a psychometrically sound tool for clinicians and researchers to identify and address barriers to bowel cancer screening. Findings support the development of multi-faceted interventions targeted at specific demographic groups.