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

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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. https://doi.org/10.1177/25739581261441229

Publication date: 23 Apr 2026 Added to AutiHub: 6 Jul 2026 Type: Article Article language: English
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Authors

Publication authors
12
Publication authors identified as autistic
1 / 12 (8.3%)
  1. Judith Peth
  2. Nicole David
  3. Sophia Dückert
  4. Petia Gewohn
  1. Daniel Schöttle
  2. Pascal Rahlff
  3. Alexander Konnopka
  4. Hannah König
  1. Kai Vogeley
  2. Christina Nicolaidis
  3. Dora M Raymaker *
  4. H Schulz

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 α) 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 α = 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.

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These indicators describe the cited bibliography imported for this publication. Cited-reference metrics use the cited-reference total as denominator. Cited-author metrics state whether they use all cited-author occurrences or only occurrences linked to authors already integrated in the AutiHub database. They use cached links between cited authors and authors integrated in the AutiHub database. Last computed: 16 Aug 2026 11:31.

Cited references
66
Total cited references integrated for this publication.
Cited references with an identified autistic author
9 / 66 (13.6%)
Cited author occurrences identified as autistic
28 / 395 (7.1%)
Among occurrences linked to AutiHub author records: 28 / 197 (14.2%). Distinct cited authors identified as autistic: 11 / 304 (3.6%).
Cited author occurrences linked to AutiHub author records
197 / 395 (49.9%)
Distinct linked cited authors: 113 / 304 (37.2%)
Linked cited-author occurrences not identified as autistic
169 / 197 (85.8%)
Among linked cited-author occurrences only. Across all cited-author occurrences: 169 / 395 (42.8%). Distinct linked cited authors not identified as autistic: 102 / 113 (90.3%).
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