Abstract
BACKGROUND: Measuring healthcare access barriers is crucial for improving service equity. However, existing tools often lack a holistic, process-integrated approach. This study addresses this gap by developing and validating the Healthcare Access Barriers Scale (HABS), a new instrument that holistically assesses barriers before, during, and after medical visits. METHODS: A cross-sectional survey was conducted among 2,009 Shanghai residents. HABS was developed based on Penchansky and Thomas's Theory of Access and Saurman's modification. Exploratory and confirmatory factor analyses (EFA, CFA) were used to assess its structure. Reliability and validity were tested using Cronbach's alpha and model fit indices. RESULTS: EFA and CFA supported a six-factor structure of the HABS, corresponding to six key dimensions of access barriers: unawareness, unavailability, inaccessibility, inadaptability, unaffordability, and unacceptability. The HABS demonstrated strong reliability (Cronbach's α = 0.974) and a good fit for the six-factor model (CFA: Comparative Fit Index [CFI] = 0.937, Tucker-Lewis Index [TLI] = 0.930, Root Mean Square Error of Approximation [RMSEA] = 0.069). The two most pronounced barriers were financial constraints (mean of unaffordability dimension = 3.26) and lack of awareness (unawareness = 3.19), highlighting cost burdens and health literacy gaps in this population. CONCLUSIONS: The HABS is a valid and reliable instrument for measuring perceived healthcare access barriers in urban populations, offering a more holistic, process-integrated assessment by capturing obstacles across the full continuum of care - before, during, and after healthcare visits. This unified scale can facilitate assessment of systematic barriers, comparisons across settings, and identification of target areas for intervention. Future use of the HABS may inform policies and programs aimed at improving access to health services and equity.