Psychometric Analysis of the German Version of the Barriers to Healthcare Checklist-Short Form

Authors

• Judith Peth, University Medical Center Hamburg-Eppendorf, Hamburg
• Nicole David, University Medical Center Hamburg-Eppendorf, Hamburg
• Sophia Duckert, University Medical Center Hamburg-Eppendorf, Hamburg
• Petia Gewohn, University Medical Center Hamburg-Eppendorf, Hamburg
• Daniel Schottle, University Medical Center Hamburg-Eppendorf, Hamburg
• Pascal Rahlff, University Medical Center Hamburg-Eppendorf, Hamburg
• Alexander Konnopka, University Medical Center Hamburg-Eppendorf, Hamburg
• Hannah Konig, University Medical Center Hamburg-Eppendorf, Hamburg
• Kai Vogeley, University of Cologne, Cologne
• Christina Nicolaidis, Portland State UniversityFollow
• Dora M. Raymaker, Portland State UniversityFollow
• Holger Schulz, University Medical Center Hamburg-Eppendorf, Hamburg

Published In

Autism in Adulthood

Document Type

Article

Publication Date

4-23-2026

Subjects

Autism spectrum, health care, adults, questionnaire

Abstract

Background: Autistic people face multiple barriers to health care. To recognize specific barriers in a standardized way, autistic people, health care providers, and researchers need a suitable measure. The Academic Autistic Spectrum Partnership in Research and Education successfully developed the Barriers to Healthcare Checklist— Short Form (BHC-SF). It remains unclear whether (1) a German version of the BHC-SF performs well in terms of psychometric properties and (2) the BHC-SF consists of multiple constructs (i.e., assessing structural validity). Methods: We created a translated and culturally adapted version of the 17-item BHC-SF and used it with 345 autistic people in Germany. Psychometric analyses included calculations to test for internal consistency reliability (Cronbach’s a) and construct validity (i.e., a priori hypothesis tests for correlations with previous treatment termination and statements about barriers to health care in terms of lack of knowledge, participation, autism-specific needs, lack of services, access/financing and collaboration). We conducted an exploratory factor analysis (EFA) to investigate the presence of BHC-SF subscales (i.e., structural validity) and performed reliability and validity calculations where appropriate.

Results: The average BHC-SF total score was mean = 8.05 (standard deviation = 4.05), with more barriers for persons who identified as female compared with males. The BHC-SF total score revealed good internal consistency reliability (Cronbach’s a = 0.82). The assessment of construct validity mainly supported the hypothesized associations. The EFA identified four BHC-SF subscales, for which we found lower psychometric support with respect to internal consistency reliability and construct validity.

Conclusions: The German version of the BHC-SF demonstrates good internal consistency reliability and construct validity. We identified four different constructs underlying the BHC-SF. The derived subscales need further psychometric testing. Use of the BHC-SF total score could potentially help health care providers and researchers systematically identify and address barriers to health care for autistic patients.

Rights

Copyright (c) 2026 The Authors

This work is licensed under a Creative Commons Attribution 4.0 International License.

DOI

10.1177/25739581261441229

Persistent Identifier

https://archives.pdx.edu/ds/psu/44678

Citation Details

Peth, J., David, N., Dückert, S., Gewohn, P., Schöttle, D., Rahlff, P., Konnopka, A., König, H., Vogeley, K., Nicolaidis, C., Raymaker, D. M., & Schulz, H. (2026). Psychometric Analysis of the German Version of the Barriers to Healthcare Checklist—Short Form. Autism in Adulthood.