Help-seeking perceived norm is a frequently studied help-seeking perception construct and is incorporated into certain medical/health/social scientific theories used to studying health services treatment access. When studying the behavior of seeking help from a mental health professional, “perceived norm” is shorthand for “perceived norm related to seeking help from a mental health professional.”

A variety of ad hoc measures of help-seeking perceived norm have been used by scholars over time. See Dr. Hammer’s Publications page for such articles (e.g., Hammer, Perrin, & Spiker, 2021; Spiker, Berney, Hammer, & Jensen, 2020; Spiker, Hammer & Parnell, 2019, Hammer, Spiker, & Perrin, 2019, Hammer, Parent, & Spiker, 2018; Hammer & Vogel, 2013). These measures vary in the degree to which they assess injunctive versus descriptive elements of perceived norm. These measures are generally adapted from Ajzen’s (2006; revised 2019) subjective norms measure template for scholars wanting to construct direct measures for a Theory of Planned Behavior Questionnaire.

In October 2024, Hammer and colleagues (2024) published psychometric evidence of reliability and validity for a battery of mental health help seeking measures, including measures of the constructs of perceived norm: injunctive and perceived norm: descriptive. A copy of those measures can be found in the supplemental material associated with that 2024 article. We welcome users to use/adapt those measures.

Alternatively, below is a similar 6-point Likert perceived norm measure that we recommend, which has also been adapted from Ajzen’s (2006; revised 2019) subjective norms measure template and refined over time by our research team. The first three items of this measure assess the injunctive element of perceived norm and the last three items assess the descriptive element of perceived norm.

The instructions for this measure can be included immediately before the six items, if it this measure is the only IBM-HS intention/mechanism measure being included on your survey. However, if you are administering multiple IBM-HS intention/mechanism measures, then it is permissible to include these instructions at the start of the survey block containing the IBM-HS measures, as the instructions are the same for all IBM-HS intention/mechanism measures. Please note that this version of the measure assumes that the researcher is (1) administering this measure to a sample containing respondents with varying current levels of mental health distress including some respondents experiencing very little distress and thus have no real need to seek professional mental health care, thereby necessitating that the measure items are framed conditionally/hypothetically (e.g., “If I had a mental health concern…”) and (2) not opting to use a clinical vignette design in which respondents are asked to imagine, for the purposes of responding to the IBM-HS measure items, that they were experiencing the symptoms and functional impairments described in a clinical vignette scenario provided to them in the start-of-survey instructions. If either 1 or 2 is not true, then the wording of the instructions and the items would need to be adjusted accordingly. Furthermore, like the default version of the MHSIS and MHSAS, this version of this perceived norm measure does not specify time (e.g., “seeking help in the next 3 months”), so researchers who wish to specify a time frame should do so within each item of this measure like they would for all IBM-HS intention/mechanism measures. For more information, please refer to Steps 2 and 6 on the IBM-HS Mixed-Method Protocol page and IBM-HS Measurement Guidelines page.

Mental Help Seeking Perceived Norm Scale
INSTRUCTIONS: For the purposes of this survey, “mental health professionals” include psychologists, psychiatrists, clinical social workers, and counselors. Likewise, “mental health concerns” include issues ranging from personal difficulties (e.g., loss of a loved one) to mental illness (e.g., anxiety, depression). Please select the response that best represents your opinion.

  1. If I had a mental health concern, most people who are important to me would think that ____ seek help from a mental health professional. [This item is rated on a Likert-type scale from 1 (I should not) to 6 (I should)]
  2. If I had a mental health concern, most people would expect me to seek help from a mental health professional. [This item is rated on a Likert-type scale from 1 (Completely false) to 6 (Completely true)]
  3. If I had a mental health concern, most people who are important to me would want me to seek help from a mental health professional. [This item is rated on a Likert-type scale from 1 (Strongly disagree) to 6 (Strongly agree)]
  4. Most people who are important to me would seek help from a mental health professional, if they were experiencing a mental health concern. [This item is rated on a Likert-type scale from 1 (Completely false) to 6 (Completely true)]
  5. The people in my life whose opinions I value would_____ from a mental health professional, if they were experiencing a mental health concern. [This item is rated on a Likert-type scale from 1 (Not seek help) to 6 (Seek help)]
  6. Most people I know would seek help from a mental health professional, if they were experiencing a mental health concern. [This item is rated on a Likert-type scale from 1 (Completely false) to 6 (Completely true)]

To cite this measure using APA-style:

Hammer, J. H. (n.d.). Mental Help Seeking Perceived Norm Scale. Retrieved [Month] [Date], [Year], from https://helpseekingresearch.com/measures/perceived-norm/

This Mental Help Seeking Perceived Norm Scale assesses perceived norm in a manner consistent with the definition of perceived norm specified by the Integrated Behavioral Model of Mental Health Help Seeking (IBM-HS).

Because the earlier reasoned action tradition theories (i.e., Theory of Reasoned Action, Theory of Planned Behavior) use the term “subjective norm” and do not provide strict guidance on the degree to which subjective norm items must assess injunctive versus descriptive norm elements, this Mental Help Seeking Perceived Norm Measure is also appropriate for measuring “subjective norm”. However, we recommend that help seeking researchers use the IBM-HS and operationalize this measured construct as “perceived norm”.

The two elements (i.e., injunctive and descriptive) of perceived norm may be best operationalized as either (a) two separate latent factors or (b) two inseparable facets of the same latent factor, depending on the measure, population, and sample in question. Thus, users are encouraged to use factor analysis to verify the dimensionality (and reliability) of this six-item set in their sample before committing to a given modeling and scoring strategy. In other words, it may be best to create one mean score that averages the scores across all six items to measure overall perceived norm, or it may be best to create two mean scores, one that averages the scores across the first three items to measure perceived norm: injunctive and one that averages the scores across the last three items to measure perceived norm: descriptive.