Table 2 - Supplementary
Summary of More Commonly Reported Barriers to Seeking Treatment for Gambling Problems: Further Information
Category of Barrier / Studies reporting this category of barrier / Method of collecting barriers information / Sample study results with regard to this category of barrier*Desire to handle problems themselves and/or the belief in ability to do so / Hodgins & el-Guebaly, 2000 / Closed-ended; Likert scale (0 to 5) / 82% of all gamblers endorsed desire to handle problem on own (mean importance rating 4.1)
Nova Scotia Department of Health, 2001 / Open-ended / 60% of problem VLT players who had not used treatment stated they could stop on own/ no need for help
Tremayne et al., 2001 / Closed-ended; checklist / 60.7% of problem gamblers who had not sought help cited belief in ability to solve problem themselves
Boughton & Brewster, 2002 / Closed-ended; checklist / 73% of concerned female gamblers cited belief that one should be able to make changes on one’s own
Tavares et al., 2002 / Closed-ended; Likert scale (0 to 4) / Correlation between “chasing of losses/ efforts for self-control” factor (which included item on attempting to cut down by oneself) & years of problem gambling significant at p=0.032 for pathological gamblers in treatment
Mansley et al., 2004 / Focus group discussion / Gamblers mentioned self-sufficiency; no % given
McMillen et al., 2004 / Semi-structured interviews / Problem gamblers mentioned pride and self-reliance; no % given
Nova Scotia Office of Health Promotion, 2004 / Unclear if barriers questions were closed-ended or open-ended / Problem gamblers cited the belief that they have to overcome the problem by themselves; no % given
Evans & Delfabbro, 2005 / Closed-ended; Likert scale (0 to 4) / Problem gamblers gave mean score of 3.04 to belief in ability to control gambling by themselves
Nett & Schatzmann, 2005 / Unclear if barriers questions were closed-ended or open-ended / Problem gamblers cited over-confidence in being able to make change by oneself; no % given
Doiron, 2006 / Open-ended / 25.0% of respondents (gamblers or not) who would not seek help cited desire to deal with gambling problem by themselves
Volberg et al., 2006 / Closed-ended; checklist / 21.3% of male and 10.3% of female problem/ pathological gamblers who had not sought help cited a combined category of belief that they should handle the problem by themselves and shame/ embarrassment;
6.9% of male and 8.3% of female problem/pathological gamblers who had not sought help said they had stopped on own or with help of family/friends
ACNielsen, 2007 / Closed-ended / 30% of problem gamblers who did not seek help said it was because they thought they could deal with the problem on their own; this was the second most frequently mentioned barrier
Pulford et al., 2009a / Open-ended / 10% of gamblers who had sought help for their own gambling problem and 35% of gamblers who had not sought help named desire for self-resolution or pride as a barrier
Closed-ended; checklist / 69% of gamblers who had sought help for their own gambling problem and 49% of gamblers who had not sought help named desire for self-resolution or pride as a barrier
Hodgins et al., under review / Closed-ended; Likert scale (1 to 5) / Problem gamblers gave mean score of 4.00 to desire to deal with gambling problem by themselves; this was most important reason for not seeking formal treatment
Issues of shame, secrecy, embarrassment, pride and fear of stigma / Hodgins & el-Guebaly, 2000 / Closed-ended; Likert scale (0 to 5) / 59% of non-resolved gamblers endorsed embarrassment/pride;
53% of all gamblers rated stigma as at least moderately important
Nova Scotia Department of Health, 2001 / Open-ended / 12% of problem VLT players who had not used treatment cited embarrassment/ shame
Tremayne et al., 2001 / Closed-ended; checklist / 7.5% of problem gamblers who had not sought help cited embarrassment
Boughton & Brewster, 2002 / Closed-ended; checklist / 34% of concerned female gamblers cited fear of being criticized or judged
Tavares et al., 2002 / Closed-ended; Likert scale (0 to 4) / Correlation between “shame and secrecy” factor & years of problem gambling significant at p=0.026 for pathological gamblers in treatment
Cooper, 2001 & 2004 / Closed-ended; checklist / 61.5% of problem gamblers who had avoided face-to-face self-help group cited concern about opinions of others
Mansley et al., 2004 / Focus group discussion / Gamblers mentioned stigma, embarrassment, shame; no % given
McMillen et al., 2004 / Semi-structured interviews / Many of the problem gamblers mentioned shame; no % given
Nova Scotia Office of Health Promotion, 2004 / Unclear if barriers questions were closed-ended or open-ended / Problem gamblers cited privacy concerns and embarrassment; no % given
Rockloff & Schofield, 2004 / Closed-ended; Likert scale (1 to 5); factor analysis / General population respondents gave mean score of 2.32 to belief that people with gambling problems lack self control
Evans & Delfabbro, 2005 / Open-ended / 24.4% of problem gamblers cited embarrassment/ stigma/ shame/ pride
Closed-ended; Likert scale (0 to 4) / Problem gamblers gave mean score of 3.21 to not wanting close others to find out about gambling problem
Nett & Schatzmann, 2005 / Unclear if barriers questions were closed-ended or open-ended / Problem gamblers cited pride; no % given
Doiron, 2006 / Open-ended / 19.4% of respondents (gamblers or not) who would not seek help cited embarrassment
Volberg et al., 2006 / Closed-ended; checklist / 21.3% of male and 10.3% of female problem/ pathological gamblers who had not sought help cited a combined category of shame/ embarrassment and belief that problem should be handled by self
Piquette-Tomei et al., 2007 / Unclear if barriers questions were closed-ended or open-ended / Female gamblers in treatment cited shame/ guilt as a “main barrier”; no % given
Pulford et al., 2009a / Open-ended / 11% of gamblers who had sought help for their own gambling problem and 32% of gamblers who had not sought help named shame as a barrier
Closed-ended; checklist / 62% of gamblers who had sought help for their own gambling problem and 52% of gamblers who had not sought help named shame as a barrier
Hodgins et al., under review / Closed-ended; Likert scale (1 to 5) / Problem gamblers gave mean score of 3.1 to embarrassment/ pride
Not acknowledging problems associated with gambling/ minimization of such problems / Hodgins & el-Guebaly, 2000 / Closed-ended; Likert scale (0 to 5) / 61% of non-resolved gamblers endorsed no problem/ no help needed;
50% of all gamblers rated this item as at least moderately important
Nova Scotia Department of Health, 2001 / Open-ended / 12% of problem VLT players who had not gone for treatment cited “problem not bad enough for external intervention”
Boughton & Brewster, 2002 / Closed-ended; checklist / 46% of concerned female gamblers cited belief that treatment is only for very serious problems
Tavares et al., 2002 / Closed-ended; Likert scale (0 to 4) / Correlation between “lack of readiness to change” factor (which included item on not caring about gambling problems) & years of problem gambling significant at p=0.085 for pathological gamblers in treatment
Ladouceur et al., 2004 / Unclear how barriers information was obtained / “Main reason” for not seeking help among adolescent pathological gamblers was absence of perception of problem
Mansley et al., 2004 / Focus group discussion / Gamblers mentioned feeling that there was no problem or the problem was not bad enough; no % given
McMillen et al., 2004 / Semi-structured interviews / Problem gamblers mentioned denial or ambivalence about whether there was a problem; no % given
Rockloff & Schofield, 2004 / Closed-ended; Likert scale (1 to 5); factor analysis / General population respondents gave mean score of 3.86 to belief that gambling treatment is only for those with serious problems
Evans & Delfabbro, 2005 / Open-ended / 16.7% of problem gamblers cited denial/ not wanting to admit problem
Closed-ended; Likert scale (0 to 4) / Problem gamblers gave mean score of 2.20 to denial of having a gambling problem
Nett & Schatzmann, 2005 / Unclear if barriers questions were closed-ended or open-ended / Problem gamblers cited denial of gambling problems; this emerged as most important barrier but no % given
Volberg et al., 2006 / Closed-ended; checklist / 8.1% of male and 16.7% of female problem/ pathological gamblers who had not sought help cited denial
ACNielsen, 2007 / Closed-ended / 53% problem gamblers who did not seek help said it was because they did not have a problem; this was the most frequently mentioned reason
Piquette-Tomei et al., 2007 / Unclear if barriers questions were closed-ended or open-ended / Female problem gamblers in treatment mentioned lack of recognition of problem as a “main barrier”; no % given
Pulford et al., 2009a / Open-ended / 10% of gamblers who had sought help for their own gambling problem and 34% of gamblers who had not sought help said they believed there was no problem and they did not need help
Closed-ended; checklist / 32% of gamblers who had sought help for their own gambling problem and 53% of gamblers who had not sought help said they believed there was no problem and they did not need help
Hodgins et al., under review / Closed-ended; Likert scale (1 to 5) / Problem gamblers gave mean score of 2.1 to the belief they had no problem
Concerns about treatment itself (e.g., lack of knowledge about what treatment entails; fear of failing at treatment; doubts about the quality or efficacy of treatment or providers; worries about confidentiality and anonymity in treatment settings; worries about discrimination or insensitivity in treatment programs) / Hodgins & el-Guebaly, 2000 / Closed-ended; Likert scale (0 to 5) / 24% of all gamblers endorsed negative attitudes towards treatment as at least moderately important
Nova Scotia Department of Health, 2001 / Open-ended / 16% of problem VLT players who had not gone for treatment cited doubts about value of services
Boughton & Brewster, 2002 / Closed-ended; checklist / 41% of concerned female gamblers cited lack of knowledge about what to expect from treatment
Tavares et al., 2002 / Closed-ended; Likert scale (0 to 4) / Correlation between “lack of readiness to change” factor (which contained items on fear of failing at treatment and belief that treatment required more effort than was possible) & years of problem gambling significant at p=0.085 for pathological gamblers in treatment
Cooper, 2001 & 2004 / Closed-ended; checklist / 35.9% of problem gamblers who had avoided face-to-face self-help group cited worries about confidentiality
Mansley et al., 2004 / Focus group discussion / Gamblers mentioned bad experiences in past with treatment and worries about qualifications/ intentions of helpers; no % given
McMillen et al., 2004 / Semi-structured interviews / Problem gamblers mentioned bad experiences in past with services and counselors; no % given
Nova Scotia Office of Health Promotion, 2004 / Unclear if barriers questions were closed-ended or open-ended / Problem gamblers cited belief that available help would not work; no % given
Rockloff & Schofield, 2004 / Closed-ended; Likert scale (1 to 5); factor analysis / General population respondents gave mean score of 1.88 to the statement that they had no idea what happens in gambling treatment
Evans & Delfabbro, 2005 / Open-ended / 11.1% of problem gamblers cited dissatisfaction with treatment services
Nett & Schatzmann, 2005 / Unclear if barriers questions were closed-ended or open-ended / Problem gamblers cited inadequate knowledge among professionals and belief that professional help provides no benefit; no %’s given
Doiron, 2006 / Open-ended / 11.1% of respondents (gamblers or not) who would not seek help cited lack of confidence in treatment
Volberg et al., 2006 / Closed-ended; checklist / 11.3% of male and 7.4% of female problem/ pathological gamblers who had not sought help cited belief that treatment would not work
Pulford et al., 2009a / Open-ended / 2% of gamblers who had sought help for their own gambling problem and 3% of gamblers who had not sought help reported bad experiences in the past with gambling help
Closed-ended; checklist / 14% of gamblers who had sought help for their own gambling problem and 56% of gamblers who had not sought help reported bad experiences in the past with gambling help
Hodgins et al., under review / Closed-ended; Likert scale (1 to 5) / Problem gamblers gave mean score of 2.2 to negative attitudes about treatment
Lack of knowledge about treatment options or availability; difficulty finding information about treatment services / Hodgins & el-Guebaly, 2000 / Closed-ended; Likert scale (0 to 5) / 55% of all gamblers endorsed ignorance of treatment/ availability as at least moderately important
Tremayne et al., 2001 / Closed-ended; checklist / 13.1% of problem gamblers who had not sought help said they did not know where to go
Boughton & Brewster, 2002 / Closed-ended; checklist / 38% of concerned female gamblers cited lack of knowledge about available services
McMillen et al., 2004 / Semi-structured interviews / Problem gamblers mentioned difficulty finding information about helping services; no % given
Nova Scotia Office of Health Promotion, 2004 / Unclear if barriers questions were closed-ended or open-ended / Problem gamblers cited lack of knowledge about available help; no % given
Rockloff & Schofield, 2004 / Closed-ended; Likert scale (1 to 5); factor analysis / General population respondents gave mean score of 3.27 to knowledge of gambling treatment options in their community
Evans & Delfabbro, 2005 / Open-ended / 24.2% of problem gamblers cited “other” barriers, including lack of knowledge of services
Nett & Schatzmann, 2005 / Unclear if barriers questions were closed-ended or open-ended / Problem gamblers cited lack of knowledge about what professional help was available; no % given
Doiron, 2006 / Open-ended / 5.6% of respondents (gamblers or not) who would not seek help cited insufficient knowledge about available services
Volberg et al., 2006 / Closed-ended; checklist / 4.4% of male and 7.4% of female problem/ pathological gamblers who had not sought help said they did not know about treatment
Pulford et al., 2009a / Open-ended / 1% of gamblers who had sought help for their own gambling problem and 6% of gamblers who had not sought help said they were unaware of treatment being available
Closed-ended; checklist / 14% of gamblers who had sought help for their own gambling problem and 43% of gamblers who had not sought help said they were unaware of treatment being available
Hodgins et al., under review / Closed-ended; Likert scale (1 to 5) / Problem gamblers gave mean score of 2.6 to issues associated with availability of treatment
Practical issues around attending treatment (e.g., cost; lack of time, including having to take time off work; transportation) / Hodgins & el-Guebaly, 2000 / Closed-ended; Likert scale (0 to 5) / 23% of non-resolved gamblers cited cost
Boughton & Brewster, 2002 / Closed-ended; checklist / 34% of concerned female gamblers cited time constraints
Tavares et al., 2002 / Closed-ended; Likert scale (0 to 4) / Correlation between “lack of practical resources” factor & years of problem gambling not significant among pathological gamblers in treatment
Cooper, 2001 & 2004 / Closed-ended; checklist / 51.3% of problem gamblers who had avoided face-to-face self-help group said that attendance was inconvenient
Mansley et al., 2004 / Focus group discussion / Gamblers mentioned time and financial barriers; no % given
McMillen et al., 2004 / Semi-structured interviews / Problem gamblers mentioned cost of professional help; no % given
Nova Scotia Office of Health Promotion, 2004 / Unclear if barriers questions were closed-ended or open-ended / Problem gamblers cited inconvenience; no % given
Rockloff & Schofield, 2004 / Closed-ended; Likert scale (1 to 5); factor analysis / General population respondents gave mean score of 3.08 to likelihood of someone having to take time off work to get gambling treatment
Nett & Schatzmann, 2005 / Unclear if barriers questions were closed-ended or open-ended / Problem gamblers cited lack of treatment options for gambling problems (which was defined as an objective barrier); no % given
Volberg et al., 2006 / Closed-ended; checklist / 7.5% of male and 3.9% of female problem/ pathological gamblers who had not sought help cited financial barriers (e.g., cost of treatment)
Pulford et al., 2009a / Open-ended / 4% of gamblers who had sought help for their own gambling problem and 7% of gamblers who had not sought help had issues with the time and/or location of helping services
Closed-ended; checklist / 22% of gamblers who had sought help for their own gambling problem and 42% of gamblers who had not sought help had issues with the time and/or location of helping services
Hodgins et al., under review / Closed-ended; Likert scale (1 to 5) / Problem gamblers gave mean score of 2.2 to cost of treatment
Pressure from others to continue gambling or lack of support to make a change / Boughton & Brewster, 2002 / Closed-ended; checklist / 18% of concerned female gamblers cited lack of support/ encouragement
Mansley et al, 2004 / Focus group discussion / Gamblers mentioned the role of pressure and support from others (but this could have been meant as a motivator and not a barrier); no % given
McMillen et al., 2004 / Semi-structured interviews / Problem gamblers mentioned lack of support for efforts to change; no % given
Evans & Delfabbro, 2005 / Open-ended / 6.7% of gamblers cited pressure from family or others to keep gambling
Volberg et al., 2006 / Closed-ended; checklist / 0.6% of male and 1.0% of female problem/ pathological gamblers who had not sought help cited family objections
Piquette-Tomei et al., 2007 / Unclear if barriers questions were closed-ended or open-ended / Female problem gamblers in treatment cited influence of partners as a main reason; no % given
Pulford et al., 2009a / Open-ended / 1% of gamblers who had sought help for their own gambling problem and 1% of gamblers who had not sought help felt pressured by others to keep gambling
Closed-ended; checklist / 28% of gamblers who had sought help for their own gambling problem and 46% of gamblers who had not sought help felt pressured by others to keep gambling
Not wanting to stop or to give up benefits of gambling (e.g., financial benefits including hopes for “the big win”, friendships, an enjoyable activity) / Boughton & Brewster, 2002 / Closed-ended; checklist / 59% of concerned female gamblers cited hopes for the “Big Win”
Tavares et al., 2002 / Closed-ended; Likert scale (0 to 4) / Correlation between “chasing of losses/ effort for self-control” factor (which included item on expecting to win back losses) & years of problem gambling significant at p=0.032 among pathological gamblers in treatment
Mansley et al., 2004 / Focus group discussion / Gamblers mentioned concern about losing friends or enjoyable activities; no % given
Evans & Delfabbro, 2005 / Open-ended / 6.7% of problem gamblers said they did not want to stop/ they lacked willpower
Closed-ended; Likert scale (0 to 4) / Problem gamblers gave mean score of 2.96 to statement that gambling would help them deal with financial problems.
Volberg et al., 2006 / Closed-ended; checklist / 26.3% of male and 36.3% of female problem/ pathological gamblers who had not sought help said they did not want to stop gambling
Pulford et al., 2009a / Open-ended / 3% of gamblers who had sought help for their own gambling problem volunteered that reluctance to give up the emotional benefit of gambling was the most important barrier to seeking treatment
Difficulty in sharing problems or talking about personal issues / Hodgins & el-Guebaly, 2000 / Closed-ended; Likert scale (0 to 5) / 49% of all gamblers endorsed “inability to share problems” as at least moderately important
Boughton & Brewster, 2002 / Closed-ended; checklist / 49% of concerned female gamblers endorsed a safety category that included dislike of talking about oneself
Cooper, 2001 and 2004 / Closed-ended; checklist / 46.2% of problem gamblers who had avoided face-to-face self-help group cited discomfort in revealing personal information
Mansley et al., 2004 / Focus group discussion / Gamblers mentioned difficulty talking about personal issues; no % given
Rockloff & Schofield, 2004 / Closed-ended; Likert scale (1 to 5); factor analysis / General population respondents gave mean score of 3.06 to not liking to talk about their personal life with others
Hodgins et al., under review / Closed-ended; Likert scale (1 to 5) / Problem gamblers gave mean score of 3.0 to difficulty sharing personal information
*If there are several study results that would be relevant, the strongest (e.g., items cited by the highest proportion of respondents; items most clearly belonging to the category of barrier in question) were included in the table.