Perceived benefits of and barriers to health behaviors have been investigated by numerous researchers using a variety of frameworks. The two concepts are closely tied in the HBM and are included in the same text box with a singular arrow impacting health behaviors (see Figure 1, Chapter One). Using the value expectancy premise, the benefits are the positively viewed factors, which are offset by the barriers, which are the negatively viewed factors, and the tipping point between the two factors results in the likelihood of action. Because of this close relationship, studies examining these concepts are reported together, even though they are measured by different instruments.
2.3.4.1 Perceived Benefits and Perceived Barriers of a Healthy Diet
Few tools have been constructed to measure the perceived benefits of a healthy diet; however, two questions were used by Glanz et al. (1993) in their construction of a tool to measure psychosocial factors related to eating behavior in a population of adults. These two questions were added together to the diet barriers scale to construct a measure of perceived barriers and benefits to a healthy diet. Glanz et al. (1993) did not find predictive value in perceived benefits of a healthy diet at a level of p=.05.
The tool constructed by Milligan et al. (1997) to measure perceived barriers to a healthy diet is a 16-item, 6-point Likert scale. It asks participants to rate their perception of the importance of potential barriers to following a healthy diet. Using this tool, the authors were able to identify barriers to a healthy diet reported by a group of 18-year-old individuals. These barriers included lack of will power, lack of time, and lack of knowledge about the energy content of foods. Significant gender differences in the barriers were also identified. Items that were perceived as greater barriers by women included using food as treats, difficulty sticking to a diet, and difficulty choosing healthy foods when out with friends. The perceived barriers identified in this study were not related to the eating behavior of the participants with one exception. The scores of the healthy diet barriers scale were examined in relation to self-reported level of fat intake, using a cut point of >30% fat intake by gender. The following barriers were significant predictors (p<.05). Males who reported more home food control consumed less fat, while those reporting less willpower and less availability of healthy lunch food were more likely to consume greater than 30% of energy intake from fat. Females who reported more knowledge of reduction of fat and sugar consumed less fat, while those reporting less planning time for diet
described in relation to barriers to a healthy diet. A report of the relationships between perceived barriers to a healthy diet and self-reports of dairy, protein rich, and nutrient poor food may have been informative.
This study examined the perceived benefits of and barriers to eating a healthy diet using the two instruments discussed above (Glanz et al., 1993; Milligan et al., 1997). The results determined whether benefits and barriers are related to eating behavior in college women.
2.3.4.2 Perceived Benefits and Perceived Barriers of Physical Activity
Myers and Roth (1997) used the Transtheoretical Model to examine perceived benefits of and barriers to exercise in 432 college students. The findings suggest that benefits of and barriers to exercise are complex and multidimensional concepts. Their tool, the Benefits and Barriers to Exercise Questionnaire, contained 48 Likert scale items constructed from results of preliminary surveys of both exercisers and non-exercisers who were asked to list three benefits and three barriers associated with exercise. They also examined current literature to ensure inclusion of pertinent domains. The results were not effective in producing a parsimonious tool for use in prediction of exercise behaviors as measured by an exercise participation questionnaire. There were no significant differences in minutes exercised between subjects in the precontemplation and contemplation stages of exercise (p>.05) or between the participants in the action and maintenance stages (p>.05). It is likely the tool used to measure exercise benefits and barriers was not successful in accurately capturing these latent variables. A more exhaustive exploration of factors related to physical activity, such as the use of nominal group technique in active and non-active college students used in this study, can aid in revealing a more precise understanding of perceived benefits of and barriers to physical activity in this population.
Another tool used to measure exercise benefits and barriers is the Exercise Benefits/Barriers Scale (EBBS), a 43-item, 4-point Likert scale developed by Sechrist et al. (1987). Jones and Nies (1996) used the EBBS and found significant relationship between reported exercise levels and perceived benefits of and barriers to exercise (p<0.001) in a group of African American women. Grubbs and Carter (2002) used the tool to compare perceived benefits of and barriers to reported exercise behaviors in 147 college undergraduates (ages 18-24) in a large southern university. This sample was also predominately female (82%), with a mean age of 19.9 years. The study compared EBBS responses of regular exercisers versus those who did not exercise regularly. Mean scores for the benefits scale were higher in the exercisers (M=3.28,
SD=0.38) versus the non-exercisers (M=2.94, SD=0.36, p<.001). Mean barriers scores were
higher in the non-exercisers (M=3.18, SD=.38) versus the exercisers (M=2.80, SD=0.32, p<.001). The report of the findings does not clearly describe how the exercise habits were measured other than by self-report, with six of the participants not completing the measure. No discussion of demographic comparisons between those completing the exercise measure and those not completing the measure was provided. This is a limiting factor in the study as there may be an inherent characteristic (e.g., they do not want to admit to not exercising), which could bias the benefits and barriers comparison results. Brown (2005) used the EBBS in a sample of 398 college students and found that only benefits were able to significantly predict levels of physical activity (p<.05).
This study examined the perceived benefits of and barriers to physical activity using the EBBS. The findings determined whether benefits and barriers are related to physical activity in college women.
In summary, insight into the strength of the relationship between the perceptions of benefits and barriers and the health behaviors of eating behavior and physical activity in a group of emerging adult women is needed. While benefits of and barriers to action are a mainstay of the HBM, it is possible that in emerging adults the effects are not consistent with findings in other populations.