Barriers to Access to Care Evaluation Scale - Proxy Report (BACE-PR): Evidence of Reliability and Validity for Caregivers Reporting on Children and Adolescents with Mental Health Concerns in Greece
Year: 2025
Type: article
Abstract: To improve access to mental health care for children and adolescents, it is necessary to identify the barriers faced by their caregivers. The aim of this study is to identify these barriers in Greece and to investigate the reliability and validity of the modified version of the Barriers to Access to Care Evaluation scale (BACE) - the BACE Proxy Report (BACE-PR). A total of 265 caregivers who reported that their offspring had mental health difficulties completed the BACE-PR. Descriptive statistics were used to identify the major barriers to accessing care. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were used to investigate the factor structure of the instrument. Item parameters were assessed via Item Response Theory. Interpretability was assessed by linking summed scores to IRT-based scores. Caregivers reported care costs, their willingness to resolve problems on their own, and their own concern that their children might be seen as weak, as the major barriers to services access. Obsessive compulsive symptoms and self-harm were the conditions for which caregivers reported the highest level of barriers. EFA and CFA suggested that a one-factor solution fit the data well (RMSEA = 0.048, CFI = 0.991, TLI = 0.990). Internal consistency was found to be high (ω = 0.96). Average z-scores provided five meaningful levels of caregivers' perceived barriers compared to the national average. Caregivers face a variety of barriers to access mental health care for their children, and this could partly explain the treatment gap in the Greek mental health sector. Our study provides evidence for the reliability and validity of the BACE-PR scale, which can aid to identify caregiver-perceived barriers and to design interventions to improve access to mental health care.
Authors: Konstantinos Kotsis, Graham Thornicroft, Julia Luiza Schafer, Aspasia Serdari, Maria Basta, Caio Borba Casella, Lauro Estivalete Marchionatti, Mauricio Scopel Hoffmann, Alexandra Tzotzi, Andromachi Mitropoulou, André Simioni, Katerina Papanikolaou, Anastasia Koumoula, Giovanni Abrahão Salum
Institutions: University of Ioannina, Stavros Niarchos Foundation, Child Mind Institute, King's College London, Democritus University of Thrace, University of Crete, Universidade Federal do Rio Grande do Sul, Universidade Federal de Santa Maria, London School of Economics and Political Science, National and Kapodistrian University of Athens, Children's Hospital Agia Sophia
Language: English
Subfield: Social Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: hybrid
Estimated APC paid: $3,790
OpenAlex ID: W4413505795