Year of Award


Document Type


Degree Type

Doctor of Philosophy (PhD)

Degree Name

Clinical Psychology

Department or School/College

Department of Psychology

Committee Chair

Jennifer A. Waltz

Commitee Members

Duncan Campbell, Christine Fiore, Holly Schleicher, Kirsten Murray


Assessment, Clinical Psychology, Mental Health, Nonadherence, Noncompliance, Primary Care


University of Montana


Decades of research demonstrate that people’s behavior has a tremendous influence on their overall health (e.g., DSHHS, 2014; Kokkinos, 2012; Segerstrom & Miller, 2004; Willet et al., 2006). Nonadherence to clinical recommendations is a common obstacle in healthcare (DiMatteo, 2004b), which is associated with worse health outcomes (DiMatteo, Giordani, Lepper, & Croghan, 2002). Behavioral health professionals (BHPs) are often involved in assessing and addressing nonadherence; however, there is a lack of standardization in how it is approached. Relatedly, there is no extant tool designed to help primary care BHPs efficiently identify barrier to adherence across diverse treatment targets. Such a tool may help BHPs and patients to more effectively identify and address adherence barriers, which could improve intervention efforts and health outcomes. The purpose of this study was to create, explore the feasibility of, and refine such a tool, which we called the Barrier Identification Tool (BIT). The main research questions of this project were: 1) What are behavioral health professionals’ reactions to using the BIT in an integrated primary care setting?, and 2) What feedback do these providers have regarding the BIT that could lead to its change or improvement? The BIT was adapted from the Missing Links Analysis, a Dialectical Behavior Therapy (DBT) tool designed to help therapists and patients address nonadherence and craft appropriate interventions (Linehan, 2015). 14 primary care BHPs completed the study, which consisted of participation in an orientation to the BIT, using the tool for 5-6 weeks, and completing a semi-structured interview and three surveys (Demographics and Professional Experience Survey, Quantitative Questions for BIT Feasibility Study, and Integrated Practice Assessment Tool). 11 of these individuals were included in final data analysis due to reaching saturation. Qualitative data was analyzed using a generic qualitative approach incorporating qualitative content analysis (conventional) and elements of phenomenology. On the whole, qualitative and quantitative data suggests that using the BIT in integrated primary care settings is feasible and providers seemed to find it useful. Participants reported being able to use the tool in a number of ways for various patient concerns with positive results (e.g., improved communication with patients, more thorough assessment, reported patient changes). Participants also reported some challenges using the BIT, such as its formal language and readability. Feedback on the tool was incorporated to create revised versions of the BIT in an effort to improve the effectiveness of the original tool. Implications, limitations, and directions for future research are discussed.



© Copyright 2021 Jacob Harrison Bloch