Abstract
PURPOSE: The purpose of this study was to identify and test the factor structure of the Agricultural Producer Barriers to Care Scale (APBCS), which assesses barriers to engaging with health care in rural US farmers. METHODS: Respondents (n = 1045) completed an online survey that was distributed digitally and in-person by researchers and community partners at farming events and via farm-related social media. Exploratory and Confirmatory Factor Analysis were used to assess the underlying factor structure of the APBCS, and McDonald's omega coefficients were calculated to test the reliability of each factor and the instrument as a whole. Data analysis was conducted in SPSS 28.0 and MPlus Version 7.4. FINDINGS: The exploratory factor analysis (n = 689) indicated a four-factor structure for the APBCS with domains of (i) formal health care challenges, (ii) cultural barriers to help-seeking, (iii) stigma, and (iv) resilience, which explained 38.408% of the overall variance. The confirmatory factor analysis (n = 231) found that a three-factor structure, where questions from "cultural barriers to help seeking" were applied to factors for stigma and resilience, was a better fit for the model than the four-factor model hypothesized by the EFA. The final APBCS showed reliability within each domain, and across the full three-factor scale. CONCLUSION: The APBCS is a promising tool that shows high internal consistency and could inform researchers and practitioners about the structural and cultural barriers to engaging with health care in agricultural producers living in the United States.