Preliminary Psychometric Properties of the Barriers to Care Questionnaire among Adults with Traumatic Brain Injury

Research Objectives: The Barriers to Care Questionnaire (BCQ) is a measure of healthcare access and quality containing 5 subscales (pragmatics, skills, marginalization, expectations, and knowledge/beliefs) developed for parents of children with chronic health conditions. The objective of this study was to examine the internal consistency and construct validity of a modified version of the BCQ for adult self-report (BCQ-ASR) in a sample of individuals with history of Traumatic Brain Injury (TBI).

Design: Cross-sectional

Setting: Online survey

Participants: 311 individuals with a history of TBI between the ages of 18-79 (M=44.0, SD=16.4). Females comprised 40% of the sample which included individuals identifying as Non-Hispanic White (34.7%), Non-Hispanic Black (35.4%), and Hispanic (29.9%).

Interventions: Not Applicable

Main Outcome Measures: Abbreviated Ohio State University TBI Identification Self-Administered-Brief determined severity of worst lifetime TBI and age of injury. The BCQ was modified for adult self-report by removing pediatric references (i.e., “child-friendly” “your child’s care”) and increasing the frame of reference in the instructions from “the past 3 months” to “the past 12 months” to provide a wider window of experience.

Results: The resulting BCQ-ASR demonstrated excellent internal consistency for the overall measure (Cronbach’s alpha=0.9) and each of its subscales (Cronbach’s alphas>0.8). Confirmatory factor analysis demonstrated acceptable fit for the 5-factor structure of the original measure (CFI=0.929, RMSEA=0.066, 90%CI: 0.061, 0.071). Significantly lower scores on the BCQ-ASR, indicating poorer healthcare access and quality, were found for individuals living in counties with a lower density of hospitals per million residents [F(1,309)=5.8, p=0.017] and for those with moderate-to-severe TBI vs. mild controlling for time since injury [F(1,308)=5.0, p=0.026].

Conclusions: The BCQ-ASR demonstrated preliminary evidence of reliability and construct validity with expected relationships with area resources and TBI severity. Further study should assess convergent validity of individual subscales and their utility in identifying modifiable barriers to healthcare access after TBI.

Author(s) Disclosures: Authors have no conflicts of interest to disclose.