Shively M (VA San Diego Healthcare System)
McKibbin C (University of California San Diego)
Kodiath M (VA San Diego Healthcare System)
Smith TL (VA San Diego Healthcare System and University of California San Diego)
Glaser D (VA San Diego Healthcare System)
To assess the psychometric properties of a readiness to change (RTC) questionnaire, examine the level of RTC in veterans with heart failure, and evaluate the effect of a behavioral management intervention for heart failure on RTC.
Design: Secondary analyses from clinical trial data. Setting: Single site, VA San Diego Healthcare System. Sample: 116 outpatients with heart failure were stratified by functional status and randomly assigned to usual care (n=58) or usual care plus a 4-month behavioral management intervention (n=58) (Shively et al., 2004, in press). Intervention: The behavioral management program had 4 group classes and 3 follow-up phone calls. Participants selected and implemented specific goals related to healthier diet, exercise, smoking cessation, and social/interpersonal activities. Instrument: An adapted version of the Pain Stages of Change Questionnaire (Kerns et al., 1997) consisted of 20 items and 4 subscales (range 5-25): precontemplation, contemplation, action, maintenance. Dependent Variable: RTC was assessed at baseline and post-intervention (4-months). Data Analyses: The instrument structure was evaluated with baseline data using principal components analysis. The factor structure based on Kerns et al. (1997) was retained for subsequent analyses. Subscale internal consistency reliabilities were examined. To evaluate the intervention effect on stage of change, a 2 (group) by 4 (stage) by 2 (time) mixed-model ANOVA was done.
Principal components analysis suggested a 6-factor structure, which somewhat corresponded to the 4 theoretical stages. Action and maintenance items formed 2 factors while other items loaded across factors. Four of the factors accounted for 55.9% of the total variance. Maintenance and action accounted for 26.1% and 13.2% of the variance, respectively. Scale reliabilities ranged from .58-.81. The intervention group showed significant increases in both action and maintenance at 4 months compared to the usual care group (F = 2.94, p = .04).
The use of this RTC measure in heart failure shows some promise, but results regarding factor structure and sensitivity to change are preliminary. Further construct development, measurement alternatives, and psychometric evaluation in heart failure are needed.
With revision, this instrument may be used to evaluate RTC in patients with heart failure and may be applied in the evaluation of chronic illness self-management outcomes.