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Powerlessness Regarding Health-Service Barriers: Construction of an Instrument
Joan Dolce Dunn, DNS, RN, CS
PURPOSE. The purpose of the study was to develop a scale to calculate college students' powerlessness regarding health service barriers (PHSB).
METHODS. Scale items were generated to represent two domains of interest: powerlessness and college students' powerlessness regarding health service barriers. The final 20-item instrument was subjected to multiple measures of validity with college students and panels of nurse experts in the area of nursing diagnosis. Reliability was assessed by two samples (n = 92 and n = 33) of college-age students. A final administration was conducted with 197 college students.
FINDINGS. The PHSB scale was determined to be an accurate and consistent measure. CONCLUSIONS. This instrument will provide a reliable and valid measure to conduct research. Key words: Barriers, health, health service, powerlessness, scale Joan Dolce Dunn, DNS, RN, CS, is Associate Professor, College of Nursing, Niagara University, Niagara Falls, NY. Because perceived powerlessness has been recognized as an internal factor that influences health-seeking behavior (Miller, 1983,1984,1992), and recognizing that college students have multidimensional health needs for which they do not obtain health services, the author hypothesized a relationship between the two. This study reports the research to construct a valid and reliable instrument to measure the quantity of perceived powerlessness regarding health-service barriers in college students for use in studying health-seeking behaviors. Background The literature substantiates that barriers to healthservice utilization not only exist, but also are unique among adolescents (Dougherty et al., 1992; Melnyk, 1990). Young people express an aversion to seeking medical attention and have behaviors of denial, avoidance, and a strong antipathy toward seeking medical services (Dunn, 1990; Resnick, Blum, & Hedin, 1980). These avoidance behaviors are strikingly reminiscent of the characteristics proposed by nurse theorists to define the concept of powerlessness. Miller (1984, 1992), who contributed significantly to the study of powerlessness as it relates to nursing, noted that perceived powerlessness, or a perceived lack of control over a health situation, will lead to apathy, withdrawal, diminished patient-initiated interaction, and nonparticipation in care or decision making. Seeman and Evans (1962), Pender (1996), and Pender and Pender (1986) agreed that reduced utilization of healthcare services, behavioral inhibition, alienation, and lower motivation are associated with...