Breaking the Barriers: Development and Psychometric Validation of the Physical Activity Barriers Scale for Oncology Patients
DOI:
https://doi.org/10.12775/JEHS.2026.94.74009Keywords
cancer, physical activity, barriers to exercise, psychometric validation, questionnaire development, oncology rehabilitationAbstract
Physical activity is an essential component of comprehensive oncological care due to its beneficial effects on physical functioning, psychological well-being, quality of life, and long-term health outcomes. Despite international recommendations, most cancer patients do not achieve recommended levels of physical activity. This may be explained by complex biological, psychological, social, and organizational barriers. However, no standardized multidimensional instrument specifically designed for oncology populations is currently available. The aim of this study was to develop and validate the Physical Activity Barriers Scale for Oncology Patients (PABSOP), a multidimensional instrument for assessing barriers to physical activity among cancer patients. Material and methods. A methodological validation study was conducted according to COSMIN recommendations. The development process included a literature review, expert evaluation, cognitive interviews, pilot testing, and psychometric validation. A total of 342 adult oncology patients participated. Structural validity was assessed using exploratory and confirmatory factor analyses, reliability using Cronbach's alpha, McDonald's omega, and test–retest analysis, while convergent validity was evaluated through correlations with physical activity, fatigue, quality of life, self-efficacy, psychological distress, and social support. Item Response Theory analysis was also performed. Results. The analyses confirmed a six-factor structure explaining 68.4% of the total variance. The model demonstrated good fit indices (CFI = 0.958, TLI = 0.952, RMSEA = 0.051, SRMR = 0.046). Internal consistency was excellent (a = 0.95; w = 0.96), and test–retest reliability was high (ICC = 0.89). Correlations with external measures supported convergent validity.
References
Azemmour, Y., Boutayeb, S., Beddaa, H., & Errihani, H. (2022). Physical activity in cancer care: barriers and interventions. The Pan African medical journal, 43, 131. https://doi.org/10.11604/pamj.2022.43.131.31743
Bandura A. (2004). Health promotion by social cognitive means. Health education & behavior : the official publication of the Society for Public Health Education, 31(2), 143–164. https://doi.org/10.1177/1090198104263660
Bergerot, C. D., Bergerot, P. G., Philip, E. J., Ferrari, R., Peixoto, R. M., Crane, T. E., Schmitz, K. H., & Soto-Perez-de-Celis, E. (2024). Enhancing Cancer Supportive Care: Integrating Psychosocial Support, Nutrition, and Physical Activity Using Telehealth Solutions. JCO global oncology, 10, e2400333. https://doi.org/10.1200/GO-24-00333
Brawley, L. R., Rejeski, W. J., & King, A. C. (2003). Promoting physical activity for older adults: the challenges for changing behavior. American journal of preventive medicine, 25(3 Suppl 2), 172–183. https://doi.org/10.1016/s0749-3797(03)00182-x
Campbell, K. L., Winters-Stone, K. M., Wiskemann, J., May, A. M., Schwartz, A. L., Courneya, K. S., Zucker, D. S., Matthews, C. E., Ligibel, J. A., Gerber, L. H., Morris, G. S., Patel, A. V., Hue, T. F., Perna, F. M., & Schmitz, K. H. (2019). Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Medicine and science in sports and exercise, 51(11), 2375–2390. https://doi.org/10.1249/MSS.0000000000002116
Chan, A., Ports, K., Neo, P., Ramalingam, M. B., Lim, A. T., Tan, B., Hart, N. H., Chan, R. J., & Loh, K. (2022). Barriers and facilitators to exercise among adult cancer survivors in Singapore. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 30(6), 4867–4878. https://doi.org/10.1007/s00520-022-06893-y
Clifford, B. K., Mizrahi, D., Sandler, C. X., Barry, B. K., Simar, D., Wakefield, C. E., & Goldstein, D. (2018). Barriers and facilitators of exercise experienced by cancer survivors: a mixed methods systematic review. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 26(3), 685–700. https://doi.org/10.1007/s00520-017-3964-5
Cormie, P., Zopf, E. M., Zhang, X., & Schmitz, K. H. (2017). The Impact of Exercise on Cancer Mortality, Recurrence, and Treatment-Related Adverse Effects. Epidemiologic reviews, 39(1), 71–92. https://doi.org/10.1093/epirev/mxx007
Doughty, H. C., Hill, R. A., Riley, A., Midgley, A. W., Patterson, J. M., Boddy, L. M., Rogers, S. N., Maden, M., & Williams, N. H. (2023). Barriers to and facilitators of physical activity in adults living with and beyond cancer, with special emphasis on head and neck cancer: a systematic review of qualitative and mixed methods studies. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 31(8), 471. https://doi.org/10.1007/s00520-023-07925-x
DeVellis, R.F. and Thorpe, C.T. (2021) Scale Development: Theory and Applications. Sage Publications, Thousand Oaks.
Engel G. L. (1977). The need for a new medical model: a challenge for biomedicine. Science (New York, N.Y.), 196(4286), 129–136. https://doi.org/10.1126/science.847460
Gildea, G. C., Spence, R. R., Jones, T. L., Turner, J. C., Macdonald, E. R., Hayes, S. C., & Sandler, C. X. (2023). Barriers, facilitators, perceptions and preferences influencing physical activity participation, and the similarities and differences between cancer types and treatment stages - A systematic rapid review. Preventive medicine reports, 34, 102255. https://doi.org/10.1016/j.pmedr.2023.102255
Hu, L., Bentler, P. M., & Hu, L. (2009). Cutoff Criteria for Fit Indexes in Covariance Structure Analysis: Conventional Criteria versus New Alternatives Cutoff Criteria for Fit Indexes in Covariance Structure Analysis: Conventional Criteria versus New Alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6, 1-15.
https://doi.org/10.1080/10705519909540118
Inayama, Y., Yamaguchi, K., Mizuno, K., Tanaka-Mizuno, S., Koike, A., Higashiyama, N., Taki, M., Yamanoi, K., Murakami, R., Hamanishi, J., Yoshida, S., Mandai, M., & Kawakami, K. (2025). Changes in Physical Activity Across Cancer Diagnosis and Treatment Based on Smartphone Step Count Data Linked to a Japanese Claims Database: Retrospective Cohort Study. JMIR cancer, 11, e58093. https://doi.org/10.2196/58093
Ligibel, J. A., Bohlke, K., May, A. M., Clinton, S. K., Demark-Wahnefried, W., Gilchrist, S. C., Irwin, M. L., Late, M., Mansfield, S., Marshall, T. F., Meyerhardt, J. A., Thomson, C. A., Wood, W. A., & Alfano, C. M. (2022). Exercise, Diet, and Weight Management During Cancer Treatment: ASCO Guideline. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 40(22), 2491–2507. https://doi.org/10.1200/JCO.22.00687
Lloret-Segura, S., Ferreres-Traver, A., Hernández-Baeza, A., & Tomás-Marco, I. (2014). Exploratory item factor analysis: A practical guide revised and updated. Anales de Psicología, 30(3), 1151–1169. https://doi.org/10.6018/analesps.30.3.199361
Mayer, R. S., & Engle, J. (2022). Rehabilitation of Individuals With Cancer. Annals of rehabilitation medicine, 46(2), 60–70. https://doi.org/10.5535/arm.22036
Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation science : IS, 6, 42. https://doi.org/10.1186/1748-5908-6-42
Mishra, S. I., Scherer, R. W., Geigle, P. M., Berlanstein, D. R., Topaloglu, O., Gotay, C. C., & Snyder, C. (2012). Exercise interventions on health-related quality of life for cancer survivors. The Cochrane database of systematic reviews, 2012(8), CD007566. https://doi.org/10.1002/14651858.CD007566.pub2
Misiąg, W., Piszczyk, A., Szymańska-Chabowska, A., & Chabowski, M. (2022). Physical Activity and Cancer Care-A Review. Cancers, 14(17), 4154. https://doi.org/10.3390/cancers14174154
Mokkink, L. B., Terwee, C. B., Patrick, D. L., Alonso, J., Stratford, P. W., Knol, D. L., Bouter, L. M., & de Vet, H. C. (2010). The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 19(4), 539–549. https://doi.org/10.1007/s11136-010-9606-8
Schmitz, K. H., Campbell, A. M., Stuiver, M. M., Pinto, B. M., Schwartz, A. L., Morris, G. S., Ligibel, J. A., Cheville, A., Galvão, D. A., Alfano, C. M., Patel, A. V., Hue, T., Gerber, L. H., Sallis, R., Gusani, N. J., Stout, N. L., Chan, L., Flowers, F., Doyle, C., Helmrich, S., … Matthews, C. E. (2019). Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer. CA: a cancer journal for clinicians, 69(6), 468–484. https://doi.org/10.3322/caac.21579
Sechrist, K. R., Walker, S. N., & Pender, N. J. (1987). Development and psychometric evaluation of the exercise benefits/barriers scale. Research in nursing & health, 10(6), 357–365. https://doi.org/10.1002/nur.4770100603
Siegel, R. L., Giaquinto, A. N., & Jemal, A. (2024). Cancer statistics, 2024. CA: a cancer journal for clinicians, 74(1), 12–49. https://doi.org/10.3322/caac.21820
Soong, R. Y., Low, C. E., Ong, V., Sim, I., Lee, C., Lee, F., Chew, L., Yau, C. E., Lee, A. R. Y. B., & Chen, M. Z. (2025). Exercise Interventions for Depression, Anxiety, and Quality of Life in Older Adults With Cancer: A Systematic Review and Meta-Analysis. JAMA network open, 8(2), e2457859. https://doi.org/10.1001/jamanetworkopen.2024.57859
Stout, N. L., Santa Mina, D., Lyons, K. D., Robb, K., & Silver, J. K. (2021). A systematic review of rehabilitation and exercise recommendations in oncology guidelines. CA: a cancer journal for clinicians, 71(2), 149–175. https://doi.org/10.3322/caac.21639
Subburaj, J., & Sharma, K. (2023). Development, translation, and psychometric evaluation of a questionnaire designed to explore knowledge, barriers, facilitators, and preferences to physical exercise in cancer survivors. Cancer Survivorship Research & Care, 1(1). https://doi.org/10.1080/28352610.2023.2287231
Wagle, N. S., Nogueira, L., Devasia, T. P., Mariotto, A. B., Yabroff, K. R., Islami, F., Jemal, A., Alteri, R., Ganz, P. A., & Siegel, R. L. (2025). Cancer treatment and survivorship statistics, 2025. CA: a cancer journal for clinicians, 75(4), 308–340. https://doi.org/10.3322/caac.70011
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Tomasz Jurys, Mateusz Grajek
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 59
Number of citations: 0
