Measuring barriers to home bowel cancer screening in rural Australia: Development and validation of a survey instrument

OBJECTIVE: This study aimed to develop and psychometrically validate an adapted version of the Barriers to Home Bowel Cancer screening Scale relevant to rural communities. METHODS: A combined scale assessing general and "rural-specific" barriers to bowel screening was developed and presented via a cross-sectional online survey to 526 screening-eligible Australians (78% rural). Participants rated the extent to which each barrier would deter them from participating in at-home bowel cancer screening. Exploratory factor analysis identified latent screening barriers among rural participants (n=416), and a multi-group confirmatory factor analysis examined the equivalence of the identified factor structure across rural and non-rural participants. RESULTS: Six key barrier types emerged: (i) travel and access, (ii) concerns about the postal service, (iii) practical difficulties, (iv) avoidance, (v) limited time and resources and (vi) privacy of health information. There were no significant differences in barrier endorsement between rural and non-rural areas. CONCLUSIONS: The adapted scale is suitable for use in populations irrespective of geographical location. IMPLICATIONS FOR PUBLIC HEALTH: Interventions targeting rural and non-rural participants should aim to address forgetting and procrastination and coping self-efficacy and mitigate fear-based avoidance.