Graduation Year


Document Type




Degree Granting Department

Community and Family Health

Major Professor

Oliver Massey, PhD

Committee Member

Kristen Wells, PhD, MPH

Committee Member

Carla Vandeweerd, PhD

Committee Member

Richard Roetzheim, MD, MSPH


barriers to care, cancer screening, reliability, self-efficacy, validity


There is a dearth of validated self-efficacy (SE) measures in the field of preventive oncology. The objective of this study is to describe the development and validation of a measure to assess patients' perceived ability to obtain the recommended care following an abnormality suspicious for breast cancer. Guided by a social cognitive theory framework, a 51-item measure was developed to explore perceived capability to obtain follow up care under a number of barriers. A multi-step process was utilized to assess the instrument's psychometric properties. First, cognitive validity assessments with experts were conducted, and these aided in the wording refinement of several items. An exploratory factor analysis was performed, and a 4-factor solution emerged containing factors related to barriers to care such as costs, transportation, structural and communication barriers. Reliability analyses were conducted for the total scale and subscales. Then, relationships between theoretically-related constructs were explored to assess convergent validity (self-efficacy and outcome expectations, perceived control), and divergent validity (self-efficacy and depression). Findings provide evidence of both convergent and discriminant validity. This multi-step process aided in the reduction of the scale to 12 validated and reliable items.