The CRBS was psychometrically-validated in a sample of 2636 cardiac inpatients from 11 hospitals in Ontario, Canada (Shanmugasegaram et al. 2012). Participants were followed for one year, and assessment of CR use established some enrolled and some did not. Upon factor analysis of CRBS item scores at one year, four factors were extracted; all factors were internally consistent and well-defined by the items. The first factor reflected perceived need/ healthcare factors. The second factor reflected logistical factors such as distance and cost. The third factor reflected work/time conflicts. The fourth factor reflected comorbidities/functional status (see below). Internal consistency was acceptable (see Table below).
Three-week re-test reliability was established in a subsample of 200 of these participants, with an intra-class correlation coefficient of 0.64.
Moreover, criterion validity was demonstrated in the cohort, given the significant associations between CRBS total and subscale scores with CR use (p<.001).
To establish convergent validity, the CR Enrolment Obstacles scale (Fernandez et al. 2008) and Beliefs About CR scales (Cooper et al. 2007) were administered along with the CRBS at the one-year assessment; again, significant associations were observed in the expected direction.
Construct validity is shown given studies showing significant sex, age, geographic and socioeconomic (patient level, and national level) differences in CRBS scores.
In terms of responsiveness, the CRBS has been administered in several samples across the cardiac care continuum, with significant changes in barrier ratings reported (Winnige et al. 2021).
Cross-cultural validity of the scale is demonstrated through the 17 translations of the scale (see https://sgrace.info.yorku.ca/cr-barriers-scale/crbs-instructions-and-languages-translations/), and the corresponding administration in 25+ countries.
CRBS Items by Subscale:
Perceived need/health care factors
1) I didn’t know about cardiac rehab (e.g., doctor didn’t tell me about it)
2) I don’t need cardiac rehab (e.g., feel well, heart problem treated, not serious)
3) I already exercise at home, or in my community
4) My doctor did not feel it was necessary
5) Many people with heart problems don’t go, and they are fine
6) I can manage my heart problem on my own
7) I think I was referred, but the rehab program didn’t contact me
8) It took too long to get referred and into the program
9) I prefer to take care of my health alone, not in a group
Logistical factors
1) Distance (e.g., not located in your area, too far to travel)
2) Cost (e.g., parking, gas)
3) Transportation problems (e.g., access to car, public transportation)
4) Family responsibilities (e.g., caregiving)
5) Severe weather
Work/time conflicts
1) Travel (e.g., holidays, business, cottage)
2) Time constraints (e.g., too busy, inconvenient class time)
3) Work responsibilities
Comorbidities/functional status
1) I find exercise tiring or painful
2) I don’t have the energy
3) Other health problems prevent me from going (specify: _____)
4) I am too old
All four subscales of the CRBS were internally-consistent:
| Subscale | Cronbach’s α |
|---|---|
| Health care factors | .89 |
| Logistical factors | .88 |
| Work/time conflicts | .71 |
| Comorbidities/functional status | .83 |
