Development and Validation of an Index to Measure and Quantify Pet-Related Barriers to Healthcare Access and Utilization.

Issues such as inadequate transportation, language barriers, being uninsured, and living in geographic locations with poor service availability can prevent people from accessing necessary healthcare. In addition, approximately 60% of the US population has pets, which can also create barriers to healthcare that are related to pet caregiving responsibilities and concerns about pet welfare, particularly when they have inadequate social and economic resources. This study introduces a new index to measure pet-related barriers to healthcare: the Pet-Related Barriers to Healthcare Index (PRBH). We first describe the development of the index based on previous literature and expert consultation. Next, we evaluate the psychometric properties of the index in a sample of 219 pet-owning people with HIV in Florida. We use three validation approaches: 1) confirmatory factor analysis to test the hypothesized two-factor structure of the PRBH measure and to compare the fit of this model with alternative models, 2) assessment of construct validity for the PRBH factors with validated measures of commitment to pets, comfort derived from pets, and social support from people, and 3) latent class analysis to identify underlying patterns of endorsement of items. Additionally, we assessed differences in index scores by sociodemographic characteristics. Our results indicate that 1) a modified 2-factor model that split items based on item phrasing fit the data best: one factor measured previously experienced barriers, while the other factor measured anticipated future barriers. This factor structure was further supported by the results of the latent class analysis; 2) Poorer social support from people was associated with higher endorsement of both factors; and 3) Twenty percent of the participants were characterized by high endorsement of the index items. The use of the PRBH in research and clinical settings is an important step in standardizing the quantification of this construct, identifying populations most at risk for pet-related barriers to their healthcare and moving toward systematized support services for those groups and their animal companions.