The Barriers to Health Promoting Activities for Disabled Persons Scale is an 18-item, 4-point scale to measure individual barriers to taking care of health. The original scale had 16 items; two additional barrier items were added in 1991 at the suggestion of people with disabilities. These items address the weather and lack of help from health care professionals. Respondents are asked to indicate how often listed barriers keep them from taking care of their health. Items include intrapersonal, interpersonal, and environmental barriers. Examples of barriers include being too tired, having other responsibilities, and lack of transportation. Responses are scored from 1 (never) to 4 (routinely). Scores range from 18-72. Higher scores indicate greater perceived barriers.
Scale and Scoring
Barriers to Health Promoting Activities for Disabled Persons Scale (BHADP)
People sometimes have problems doing what they want to do to stay healthy. Please circle the number that best indicates how much each of these problems keeps you from taking care of your health.
- 1 = Never
- 2 = Sometimes
- 3 = Often
- 4 = Routinely
|1.||Lack of convenient facilities||1 2 3 4|
|2.||Too tired||1 2 3 4|
|3.||Lack of transportation||1 2 3 4|
|4.||Feeling what I do doesn’t help||1 2 3 4|
|5.||Lack of money||1 2 3 4|
|6.||Impairment||1 2 3 4|
|7.||No one to help me||1 2 3 4|
|8.||Not interested||1 2 3 4|
|9.||Lack of information||1 2 3 4|
|10.||Embarrassment about my appearance1||1 2 3 4|
|11.||Concern about safety||1 2 3 4|
|12.||Lack of support from family/friends||1 2 3 4|
|13.||Interferes with other responsibilities||1 2 3 4|
|14.||Lack of time||1 2 3 4|
|15.||Feeling I can’t do things correctly||1 2 3 4|
|16.||Difficulty with communication||1 2 3 4|
|17.||Bad weather||1 2 3 4|
|18.||Lack of help from health care professionals||1 2 3 4|
- Total score = Sum of scores for each item
- Score range: 18 – 72
- Higher scores indicate greater barriers
- There are not reverse scored items
Reliability and Validity Evidence
- Reliability and Validity in a Sample of Persons with Disabilities: BHADP was tested with a sample of 135 persons reporting 23 disabling conditions, recruited through two independent living centers. Average age was 36 years, and 62% were Anglo-American, and 56% were male.
- Reliability: Internal reliability for this sample was .82. Item-total correlations ranged from .25 to .59.
- Factor Analysis: Principal-components factor analysis using a Varimax rotation resulted in a three-factor solution that accounted for 48% of variance. All items loaded on one of three factors at the level of .38 or above. Three subscales, a Motivation Subscale, Impairment Subscale and Other External Subscale were examined for internal consistency. Because the latter two subscales contained so few items, they were combined to create a nine-item External Barriers subscale. Cronbach’s alpha coefficients of .80 and .69 were obtained, respectively, for the Motivation Subscale and the External Barriers Subscale. The correlation between the two subscales was .57.
- Validity: Low correlations were obtained for the total BHADP, Motivation, and External subscales and the Marlowe-Crowne Social Desirability Scale (r = -.21, -.24, -.15). Moderate correlations were obtained with Sherer’s General Self Efficacy scale (r = -.48), the Stress Management Scale (r = -.35), and the Self Actualization Scale (r = -.36) and total BHADP scores. BHADP scores were positively correlated with two subscales of the Multidimensional Health Locus of Control Scale: Powerful Others and Chance Locus of Control (r =.25 and r = .22, respectively) and negatively correlated with the Internal Locus of Control subscale (r = -.10). The pattern of correlations for the Motivation and External Barriers subscales was similar: In all but two cases correlations were higher between health measures and the Motivation Subscale than with the External Barriers Subscale. Only with the Perceived Heath Status Scale and the Internal and External Locus of Control Subscales were correlations higher with the External Barriers Subscale.
- Validity in non-disabled sample: A comparison group approach was used to contrast scores of the disabled sample and non-disabled individuals. Data were collected at two health screenings, one sponsored by a high-tech employer and the other at a local health department. The average age of the sample (n=144) was 37, 35% were male, and 90% were Anglo-American. Cronbach’s alphas of .74, .71, and .56 were obtained for the total BHADP, Motivation, and External Barriers subscales, respectively for the non-disabled sample. Lower item-total correlations were observed for the non-disabled sample than the disabled sample. T-tests revealed that the non-disabled group scored significantly lower than the disabled sample on the total BHADP (t = 8.45, df = 269, p < .001), the Motivation Subscale (t = 5.71, df = 272, p < .001), and the External Barriers Subscale (t = 9.01, df = 271, p < .001). These results indicate that the BHADP discriminates between disabled and non-disabled persons in terms of barriers to health promotion.
- Reliability Estimates in Other Samples: The BHADP has been used with a wide variety of populations. In a study with samples of persons with MS (n=557), post polio syndrome (n=1,730), and a control group (n=423) internal consistency reliability (Cronbach’s alpha) ranged from .84 -.87.
- Becker, H., Stuifbergen, A.K., & Sands, D. (1991). Development of a scale to measure barriers to health promotion activities among persons with disabilities. American Journal of Heath Promotion 5(6), July/August, 449-454.
- Becker, H., Stuifbergen, A., Lee, H., & Kullberg, V. (In Press). The reliability and validity of PROMIS cognitive abilities and cognitive concerns scales among people with multiple sclerosis, International Journal of MS Care, NIHMS457532.
- Chung-Yi, C., Torkelson Lynch, R., Chan, F., & Rose, L. (2012) The health action process approach as a motivational model of dietary self-management for people with multiple sclerosis: A path analysis. Rehabilitation Counseling Bulletin 56(1): 48-61.
- Stuifbergen, A.K., Seraphine, A., Harrison, T., & Adachi, E. (2005). An explanatory model of health promotion and quality of life for person with post-polio syndrome. Social Science and Medicine 60, 383-393.
- Becker, H. & Stuifbergen, A.K. (2004). What makes it so hard? Barriers to health promotion experienced by people with multiple sclerosis and polio. Family and Community Health 27(1), 75-83.
- Warms, C.A., Belza, B.L., Whitney, J.D., Mitchell, P.H., & Stiens, S.A. (2004)
Lifestyle physical activity for individuals with spinal cord injury: A pilot study. American Journal of Health Promotion 18 (4), 288-291.
- Stuifbergen, A.K., Becker, H., Blozis, S., Timmerman, G., & Kullberg, V. (2003). A randomized clinical trial of a wellness intervention for women with multiple sclerosis. Archives Physical Medicine and Rehabilitation 84, 467-476.
- Harrison, T. & Stuifbergen, A.K. (2001). Barriers that further disablement: A study of survivors of polio. Journal of Neuroscience Nursing, 33(3), 160-166.
- Stuifbergen, A.K., Seraphine, A. & Roberts, G. (2000). An explanatory model of health promotion and quality of life in chronic disabling conditions. Nursing Research 49(3), 122-129.
- Becker, H., Stuifbergen, A.K., Ingalsbe, K., & Sands, D. (1989). Health promoting attitudes and behaviors among persons with disabilities. Int. J. Rehab. Research 12(3), 235-250.
The BHADP is free to the public and does not require permission to be used, but should not be sold. The authors ask that the source of the SRAPH be cited in research publications: Becker, H., Stuifbergen, A.K., & Sands, D. (1991). Development of a scale to measure barriers to health promotion activities among persons with disabilities. American Journal of Heath Promotion 5(6), July/August, 449-454. Potential users of the BHADP are cautioned that this instrument was intended for application to persons with disabilities. As a result, when it is used with non-impaired adults, BHADP scores have a "ceiling effect." Users should be aware that any modification of the BHADP might alter its reliability and validity, which would consequently need to be reassessed. For questions, email Heather Becker, PHD.