Barriers to Specialty Alcohol Treatment Scale

Abstract

The Barriers to Specialty Alcohol Treatment (BSAT) Scale, developed by Pinedo et al. (2023), is designed to identify and measure the reasons individuals with alcohol use disorder (AUD) may not seek or utilize specialty alcohol treatment. The development of the preliminary BSAT was informed by the Theory of Planned Behavior (TPB; Ajzen, 1985) and Ajzen’s recommendations for measuring TPB components (Ajzen, 2002). Extensive formative work (Pinedo et al., 2019, 2020, 2018; Rogers et al., 2019) and a comprehensive literature review contributed to the creation of an initial pool of 45 items. All items were translated into Spanish by native Spanish speakers using standard back-translation procedures (Douglas & Craig, 2007). Data were collected from an online national sample of White and Latino adults diagnosed with a recent AUD. Through a combination of exploratory and confirmatory factor analyses, a final model comprising 36 items across seven distinct factors was identified and validated. The study also reported on the scale’s reliability and measurement invariance. The BSAT Scale typically takes about 13 minutes to complete.

Keywords

Alcohol Use Disorder; Cultural Factors; Health Disparities; Immigration-Related Concerns; Latinos; Logistical Issues; Low Perceived Social Support; Low Perceived Treatment Efficacy; Low Problem Recognition; Recovery Goals; Specialty Treatment; Theory of Planned Behavior; Treatment Barriers; Whites

Authors

Pinedo, M.; Castro, Y.; Gilbert, P. A.; Caetano, R.; Zemore, S. E.

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Purpose

The BSAT Scale was developed specifically to assess barriers to specialty alcohol treatment among White and Latino individuals diagnosed with an alcohol use disorder (AUD).

Validity

No data is Available

Reliability

Internal Consistency: The internal consistency for each subscale of the BSAT Scale was assessed using Cronbach’s alpha, with values ranging from 0.82 to 0.93, indicating good to excellent reliability.

Factor Analysis

Exploratory/Confirmatory Factor Analysis: The initial model, derived from exploratory factor analysis (EFA), comprised 39 items distributed across seven factors. While three of the four fit indices for this model were slightly below the minimum cut-off values (RMSEA = 0.05, CFI = 0.93, TLI = 0.92, SRMR = 0.05), subsequent model trimming procedures led to the removal of an additional three items, resulting in the final 36-item scale. Notably, items related to family and friend support consistently loaded onto a single factor. Similarly, all 11 items within the perceived control domain converged onto a single factor, which was identified as logistical barriers.

Measurement Invariance: The measurement invariance of the English version of the BSAT was examined in two contexts: first, across White and Latino participants who completed the scale in English, and second, across the English and Spanish versions within the Latino sample. In both sets of invariance tests, the results supported configural and metric invariance, suggesting that the underlying factor structure and factor loadings are consistent across groups and language versions. However, scalar invariance was not supported (White vs. Latino: χ2diff [36,846] = 94.82, p < 0.0001; English vs. Spanish: χ2diff [36, 600] = 61.65, p = 0.005). This implies that while the conceptual meaning of the constructs and the strength of the item-factor relationships are similar, direct comparisons of mean scores across groups or language versions may not be entirely valid.

Instrument: BSAT Scale

Test Type: Original Inventory/Questionnaire

Format: The BSAT Scale consists of statements designed to assess barriers to specialty alcohol treatment. Participants are asked to indicate their level of agreement or disagreement with each statement using a 5-point Likert scale, ranging from (1) “strongly disagree” to (5) “strongly agree,” as a reason for not using specialty alcohol treatment. The administration method is electronic.

Language Available: English, Spanish

Population Group: Human; Male; Female

Age Group: Adulthood (18 years & older), including Young Adulthood (18-29 years), Thirties (30-39 years), Middle Age (40-64 years), and Aged (65 years & older).

Population Details:

• Location: United States

• Respondents: Adults aged 18-74 years with a recent Alcohol Use Disorder (AUD) diagnosis, specifically Latino and White individuals.

Test Methodology: The methodology employed in the development and validation of the BSAT Scale included: Test Reliability, Internal Consistency, Factor Analysis, Confirmatory Factor Analysis, Exploratory Factor Analysis, and Measurement Invariance.

Keywords

Alcohol Use Disorder; Cultural Factors; Health Disparities; Immigration-Related Concerns; Latinos; Logistical Issues; Low Perceived Social Support; Low Perceived Treatment Efficacy; Low Problem Recognition; Recovery Goals; Specialty Treatment; Theory of Planned Behavior; Treatment Barriers; Whites

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Authors

• Pinedo, M.

  • Author ORCID Identifier: No data is Available

  • Affiliation Email addresses: No data is Available

  • Correspondence Address: 2109 San Jacinto Blvd., Stop D3700, Austin, Texas, United States, 78712-1415

  • Affiliation: UT Austin, Kinesiology & Health Education

• Castro, Y.

  • Author ORCID Identifier: No data is Available

  • Affiliation Email addresses: No data is Available

  • Affiliation: UT Austin, Steve Hicks School of Social Work

• Gilbert, P. A.

  • Author ORCID Identifier: No data is Available

  • Affiliation Email addresses: No data is Available

  • Affiliation: University of Iowa, College of Public Health

• Caetano, R.

  • Author ORCID Identifier: No data is Available

  • Affiliation Email addresses: No data is Available

  • Affiliation: Pacific Institute for Research and Evaluation

• Zemore, S. E.

  • Author ORCID Identifier: No data is Available

  • Affiliation Email addresses: No data is Available

  • Affiliation: Alcohol Research Group

Permissions & Fee and Test Year

• Permissions: May be used for Research/Teaching purposes.

• Commercial Use: No

• Fee: No

• Test Year: 2023

References

Pinedo, M., Castro, Y., Gilbert, P. A., Caetano, R., & Zemore, S. E. (2023). Improving assessment of alcohol treatment barriers among Latino and White adults with an alcohol use disorder: Development of the barriers to specialty alcohol treatment scale. Drug and Alcohol Dependence, 248, 1–9. doi:10.1016/j.drugalcdep.2023.109895

Items of the BSAT Scale

The BSAT Scale is a 36-item measure. The items assess barriers across seven factors (subscales), as identified through factor analysis:

• Attitudes toward specialty alcohol treatment:

  • Low problem recognition

  • Recovery goals

  • Low perceived treatment efficacy

  • Cultural factors

  • Immigration-related concerns

• Subjective norms toward specialty alcohol treatment:

  • Low perceived social support

• Perceived control toward specialty alcohol treatment:

  • Logistical barriers

Attitudes toward specialty alcohol treatment

Low problem recognition

• I didn’t think treatment was needed because I could still function (for example, I had a job, provided for my family, took care of my kids, etc.).

• I didn’t feel I had a drinking problem.

• I thought I could stop drinking any time I wanted to.

• I didn’t think I needed treatment because my drinking didn’t interfere with my responsibilities (like paying rent/mortgage, taking care of my kids).

• I didn’t think my problem was serious enough to get treatment.

Recovery goals

• I was afraid of being judged or punished for not wanting to stop drinking completely.

• I was afraid of being judged or punished for using alcohol or drugs again after having quit.

• I was concerned about missing drinking (for example, that I would miss getting drunk, miss my old lifestyle, or have cravings).

• I wanted to reduce my drinking but not stop completely.

Low perceived treatment efficacy

• I didn’t think treatment would work for me because I didn’t think the counselors would understand my drinking or me.

• I didn’t think treatment would be helpful because most counselors lack ‘real world experiences.’

• I didn’t think treatment would be helpful because most counselors have never experienced a problem with alcohol.

• I didn’t think treatment would work for me because alcohol treatment is not effective.

Cultural factors

• I was concerned that treatment counselors might not understand my cultural background.

• I didn’t think I could find a counselor with the same racial/ethnic or cultural background as me.

• Attending an alcohol treatment program is something that is not accepted in my culture.

• It is not common to attend an alcohol treatment program in my culture.

Immigration-related concerns

• I was afraid that using treatment would have negative consequences for my immigration status (for example, having my green card revoked).

• I was afraid that using treatment would have negative consequences for the immigration status of someone in my family (like my parents, children).

• I was concerned about disclosing sensitive information, such as my immigration status.

Subjective norms toward specialty alcohol treatment

Perceived lack of social support

• I didn’t want my friends to judge me for going to treatment.

• I was afraid of being rejected by my friends for going to treatment.

• I was concerned that going to treatment would bring shame to my family.

• I didn’t want my family to judge me for going to treatment.

• I was afraid of being rejected by my family for going to treatment.

Perceived control toward specialty alcohol treatment

Logistical barriers

• My health insurance didn’t cover alcohol treatment.

• I didn’t have time due to other responsibilities (like work, taking care of my family or household).

• I was concerned that treatment would interfere with my home responsibilities (for example, taking care of my children or household).

• I was concerned that treatment would interfere with my work.

• I didn’t want to or couldn’t request time off work to go to treatment.

• The treatment program’s hours were inconvenient.

• The wait time to get an appointment to start treatment was too long.

• I didn’t know where to go for treatment.

• I wasn’t comfortable communicating in English.

• I had no one to take care of my children or couldn’t afford childcare.

• I was concerned that I couldn’t afford to pay for it.

Note: Participants are asked to indicate to what extent they agreed or disagreed with each statement, using a 5-point Likert scale ranging from (1) strongly disagree to (5) strongly agree, as a reason for not using specialty alcohol treatment.