The Readiness Ruler as a measure of readiness to change poly-drug use in drug abusers

Readiness to change is a crucial issue in the treatment of substance use disorders. Experiences with methadone maintenance treatment (MMT) has shown that continuous drug and alcohol use with all its consequences characterize most MMT programs. In a prospective study of drug abusers seeking opiate agonist maintenance treatment in the City of Copenhagen, subjects were administered the Addiction Severity Index, and the Readiness Ruler for each of 11 different licit and illicit drugs by research technicians. Data was collected upon admission to the program and at a 18 month follow-up. Subjects who indicated they wanted to quit or cut down upon admission, reported less drug use at 18 month follow-up, after controlling for severity of drug problems at intake. Subjects who expressed readiness to change their drug use upon admission decreased their drug use. It is concluded that the Readiness Ruler measures a construct related to actual readiness, supporting its use in the clinical context.     

Patients' readiness for dietary change at the beginning of counselling: a transtheoretical model-based assessment

Background The purpose of this study was to explore patients' readiness for dietary change within a theoretical framework of the transtheoretical model. The patients were recently diagnosed to have type 2 diabetes or impaired glucose tolerance. We discuss the theoretical aspects of appropriate dietary counselling strategies from a standpoint of patient‐specific stages of change. Methods The data included 32 audiotaped diabetes counselling sessions with 16 patients conducted by two nurses. The transcribed data was analysed by using deductive content analysis. Results The patients were at different stages of change of diabetes‐affected dietary behaviour. Their stages of change varied in different dietary areas and within certain dietary habits. These stages of change could involve their overall dietary behaviour or some minor aspects of their diets. Conclusions Understanding patient‐specific stages of change orientates health counsellors to use the most appropriate counselling strategies. The transtheoretical framework helps counsellors to perceive the total range of patients' different stages of change and their effect on the implementation of counselling. However, determining patients' stages of change through examining counselling conversations is occasionally difficult. Further qualitative research is called for.     

Evaluating organizational readiness for change: a preliminary mixed-model assessment of an interprofessional rehabilitation hospital

We conducted a Functional Organizational Readiness for Change Evaluation (FORCE) to assess the characteristics of readiness for change across two programs (N=216 employees) in an interprofessional rehabilitation hospital that was about to undergo strategic changes as part of a planned physical merger within the next two years. The study used a mixed-method approach: a quantitative survey, previously validated in a drug rehabilitation setting, followed by key informant interviews to further enlighten survey findings. Statistical analyses identified correlations between demographic variables (age, education and experience) and readiness for change, as well as the prevalence of specific organizational characteristics (motivation for change, access to resources, staff attributes, organizational climate, and exposure/ use of training opportunities) that facilitate or impede change. Findings were intended to better inform the tactics for successful implementation of upcoming initiatives. Much like assessing a patient prior to initiating a treatment, FORCE can serve as a management tool to direct the planning and implementation of changes intended to improve hospital performance.     

Training readiness of public health agencies: a framework for assessment.

The Healthy People 2010 Objectives and the Taskforce on Public Health Workforce Development both have recognized the important roles of state and local agencies in the education and training of their employees. This article describes an initial step in the development of a tool to assess agencies' training readiness using five factors derived from learning organization theory. These factors (resources, policies, learning culture, programs, and leadership) offer a useful framework for further development of a tool to assess training program readiness.     

Synchronizing clinician engagement and client motivation in telephone counseling

Health care increasingly incorporates telephone counseling, but the interactions supporting its delivery are not well understood. The authors' clinical trial of a tailored, nurse-administered smoking cessation intervention for surgical patients included a telephone counseling component and provided an opportunity to describe the interaction dynamics of proactive telephone counseling over the course of 4 months. Tape-recorded telephone counseling calls for 56 consecutively enrolled individuals randomized to the intervention group resulted in a data set of 368 calls, which were transcribed and analyzed using constant comparative methods. The findings revealed varying interaction dynamics depending on the nurse's level of engagement with participants and participants' motivation to stop smoking. The authors identified four interaction dynamics: affirming/working, chasing/skirting, controlling/withdrawing, and avoiding commitment. Shifts in interaction dynamics were common and influenced the provision of support both positively and negatively. The findings challenge many assumptions underlying telephone counseling and suggest strategies to improve its delivery.     

Obesity management in primary care: assessment of readiness to change among 284 family practice patients

BACKGROUND: Most adults in primary care are overweight or obese; two thirds of patients with weight problems have other obesity-related conditions. The study objective was to explore the feasibility of a primary care obesity intervention based on the transtheoretical model (TM) of behavior change and principles of chronic disease (CD) care. METHODS: A prospective study of the initial version of the TM-CD intervention with obese family practice patients (n = 284) yielded cross-sectional data on baseline stage of change for six target behaviors: dietary fat, portion control, vegetable intake, fruit intake, usual physical activity, and planned exercise. The sample consisted of obese patients scheduled for an office visit during times when recruitment and informed consent did not conflict with acute care. RESULTS: Obese patients volunteering for a TM-CD program are in different stages of change for six target behaviors. Preparation was the most frequently reported stage for increased exercise (49%) or activity (34%), decreased dietary fat consumption (44%), and increased portion control (51%). Patients in a particular stage for one behavior were distributed across all five stages for another behavior. Stage of change for five target behaviors was associated with body mass index or waist girth (P < .05) in a manner consistent with stage-of-change theory. CONCLUSIONS: Using the transtheoretical model of behavior change will allow physicians to recognize when obese patients are receptive to specific behavioral interventions.     

Demographic and clinical correlates of client motivation among substance abusers

Understanding the role of motivation in substance abusers' acceptance of treatment is critically important to improving treatment outcomes. To examine this phenomenon a cohort of substance abuse treatment clients was recruited from two treatment programs whose services are funded by a state managed care system. Motivation at treatment entry was examined. Better motivation was consistently associated with severity of substance use. Neither the coercion that accompanies legal system involvement nor self-referral was significantly related to measured levels of motivation. Motivation was not related to alcohol and drug use severity six months later. The severity associated with motivation at treatment entry was, for the most part, not related to clients' success six months later. Implications for social work practice with substance abusers are discussed.     

Journey toward a patient-centered medical home: readiness for change in primary care practices

Context: Information is limited regarding the readiness of primary care practices to make the transformational changes necessary to implement the patient‐centered medical home (PCMH) model. Using comparative, qualitative data, we provide practical guidelines for assessing and increasing readiness for PCMH implementation. Methods: We used a comparative case study design to assess primary care practices’ readiness for PCMH implementation in sixteen practices from twelve different physician organizations in Michigan. Two major components of organizational readiness, motivation and capability, were assessed. We interviewed eight practice teams with higher PCMH scores and eight with lower PCMH scores, along with the leaders of the physician organizations of these practices, yielding sixty‐six semistructured interviews. Findings: The respondents from the higher and lower PCMH scoring practices reported different motivations and capabilities for pursuing PCMH. Their motivations pertained to the perceived value of PCMH, financial incentives, understanding of specific PCMH requirements, and overall commitment to change. Capabilities that were discussed included the time demands of implementation, the difficulty of changing patients’ behavior, and the challenges of adopting health information technology. Enhancing the implementation of PCMH within practices included taking an incremental approach, using data, building a team and defining roles of its members, and meeting regularly to discuss the implementation. The respondents valued external organizational support, regardless of its source. Conclusions: The respondents from the higher and lower PCMH scoring practices commented on similar aspects of readiness—motivation and capability—but offered very different views of them. Our findings suggest the importance of understanding practice perceptions of the motivations for PCMH and the capability to undertake change. While this study identified some initial approaches that physician organizations and practices have used to prepare for practice redesign, we need much more information about their effectiveness.     

Assessing readiness to change of a high fall risk patient: a case report

The case report discusses a patient with an extensive history offalls living in the community. The patient's medical record was analyzed and an informal interview was conducted with the patient to provide an overview of his care provided by the Veterans Health Administration (VHA) Home-Based Primary Care (HBPC) program from June 2008 to February 2011. The report will also apply the transtheoretical model of behavioral change to discuss the behavior change process of a high fall risk patient. Applying this model to the high fall risk population may assist with decreasing the frustration of clinicians and caregivers, as it acknowledges the "smaller gains" with fall prevention.     

Readiness to change and clinical success in a diabetes educational program

BACKGROUND: We wanted to determine whether a simple tool characterizing readiness to change among patients before participating in a diabetes educational intervention successfully screens for patients who will achieve satisfactory clinical improvement. METHODS: Fifty patients referred to a diabetes educational center with hemoglobin A1c levels of more than 9.0% were asked four questions before participation in a diabetes educational program. Patients were categorized into precontemplation-contemplation, preparation, and action stages of readiness to change. Intensive diabetes education was offered to all participants. Hemoglobin A1c levels were measured for 24 months after the educational program. RESULTS: Patients in preparation and actions stages achieved a significantly larger reduction in hemoglobin A1c levels in a shorter time than patients in the combined precontemplation-contemplation stage. Average change in hemoglobin A1c levels at 12 months was -1.06 +/- 1.80 (P = .17) for the precontemplation-contemplation stage, -1.82 +/- 1.84 (P = .006) for the preparation stage, and -2.56 +/- 2.12 (P = .0006) for the action stage. Patients had significantly more hemoglobin A1c measurements in the preparation stage (4.63 +/- 2.42, P = .036) and the action stage (4.94 +/- 2.38, P = .013) than patients in the precontemplation-contemplation stage (3.00 +/- 1.22) during the 24-month study. CONCLUSIONS: In this small population, stage of change as determined by a simple clinical tool was significantly associated with clinical improvement in hemoglobin A1c levels at 3 months after an educational intervention. Significant differences in clinical improvement between groups persisted for at least 12 months. This tool could be used to tailor the most effective clinical diabetes interventions for patients and to address the needs of patients in a more targeted manner.     

Climate change and climate variability: personal motivation for adaptation and mitigation

Background

Global climate change impacts on human and natural systems are predicted to be severe, far reaching, and to affect the most physically and economically vulnerable disproportionately. Society can respond to these threats through two strategies: mitigation and adaptation. Industry, commerce, and government play indispensable roles in these actions but so do individuals, if they are receptive to behavior change. We explored whether the health frame can be used as a context to motivate behavioral reductions of greenhouse gas emissions and adaptation measures.

Methods

In 2008, we conducted a cross-sectional survey in the United States using random digit dialing. Personal relevance of climate change from health threats was explored with the Health Belief Model (HBM) as a conceptual frame and analyzed through logistic regressions and path analysis.

Results

Of 771 individuals surveyed, 81% (n = 622) acknowledged that climate change was occurring, and were aware of the associated ecologic and human health risks. Respondents reported reduced energy consumption if they believed climate change could affect their way of life (perceived susceptibility), Odds Ratio (OR) = 2.4 (95% Confidence Interval (CI): 1.4 - 4.0), endanger their life (perceived severity), OR = 1.9 (95% CI: 1.1 - 3.1), or saw serious barriers to protecting themselves from climate change, OR = 2.1 (95% CI: 1.2 - 3.5). Perceived susceptibility had the strongest effect on reduced energy consumption, either directly or indirectly via perceived severity. Those that reported having the necessary information to prepare for climate change impacts were more likely to have an emergency kit OR = 2.1 (95% CI: 1.4 - 3.1) or plan, OR = 2.2 (95% CI: 1.5 -3.2) for their household, but also saw serious barriers to protecting themselves from climate change or climate variability, either by having an emergency kit OR = 1.6 (95% CI: 1.1 - 2.4) or an emergency plan OR = 1.5 (95%CI: 1.0 - 2.2).

Conclusions

Motivation for voluntary mitigation is mostly dependent on perceived susceptibility to threats and severity of climate change or climate variability impacts, whereas adaptation is largely dependent on the availability of information relevant to climate change. Thus, the climate change discourse could be framed from a health perspective to motivate behaviour change.

     

The process of change for victims of intimate partner violence: support for a psychosocial readiness model.

Intimate partner violence (IPV) victimization is a women's health problem that imposes a significant health and health care cost burden. Although IPV victims cannot change the perpetrator's behavior, they can take actions to reduce exposure to the partner's abuse. The process of change for IPV victims has been described using the transtheoretical model (TTM), among others. We report results of a qualitative study with current and past IPV victims to 1) explicate the process of safety-seeking behavior change for female victims of IPV and 2) explore the fit of the TTM for explaining this process. Based on the results, we propose the psychosocial readiness model to describe the process of change for female victims of IPV. This model considers readiness as a continuum that ranges from robustly defending the status quo on 1 end to being ready to take action toward change on the other. Movement toward and away from change along the continuum results from a dynamic interplay of both internal factors and external interpersonal and situational factors.     

Readiness to change: newspaper coverage of tobacco farming and diversification.

Diversification, like tobacco use prevention and cessation, is an important public health concern. The multilevel patterns of tobacco dependency suggest the need for public health approaches to the "tobacco problem." To understand how newspaper and wire service journalists cover issues involving diversification among tobacco farmers, the authors performed a content analysis of a subset of 100 articles on diversification and tobacco farming. Prochaska and DiClemente's stages of change model was applied to the "problem behavior" of tobacco farming. Among news accounts relating to tobacco farmers or tobacco farming, print media accounts gave relatively little attention to the issue of diversification. Farmers in the sample of news accounts were generally cognizant of pressures to diversify away from reliance on tobacco cultivation but were frustrated due to obstacles to diversification such as limited diversification options and relative absence of infrastructure supports. Community leaders and policy-relevant sources generally supported diversification.     

Readiness to change questionnaire: reliability study of its Spanish version

The present study explored the reliability and validity of a Spanish version of the Readiness to Change Questionnaire (RCQ) (12-item short form) as it might be used for opportunistic intervention. The test has three scales to allocate patients to a stage of change: pre-contemplation (P), contemplation (C) or action (A). The RCQ was translated and back-translated prior to pilot administration to 15 patients. From two settings (a general hospital ward and a primary health care centre), 201 patients were identified as excessive drinkers on the Alcohol Use Disorders Identification Test. Patients known to be alcohol-dependent and attending for alcohol-related reasons were excluded. Patients completed the RCQ. Test-retest reliability after 2 days was assessed in 35 patients. A components analysis was performed. Patients were classified on RCQ scores to a stage of change. Two experts separately interviewed the patients and made an allocation to stage of change, blind to the RCQ score. Test-retest reliability was good (P: r = 0.81; C: r = 0.87; A: r = 0.86). Within the three scales, RCQ items showed fair consistency in terms of Cronbach's alpha (P: 0.58, C: 0.75, A: 0.80). Component analysis showed that together the scales accounted for 57. 4% of the variance. The experts agreed between themselves on patients' stage of change (weighted kappa 0.92) but much less with the stage of change according to RCQ (expert A, kappa = 0.44; expert B, kappa = 0.52). Omitting patients with low consumption did not improve internal reliability, and omitting those with low educational level who might have filled in the questionnaire wrongly did not improve internal reliability or agreement between RCQ and the experts. We conclude that the Spanish RCQ did not function efficiently in a population of opportunistically identified excessive drinkers.     

Readiness for school entry: a community survey

This study assessed the development of 4-5-year-old children in an urban low-income community in Sri Lanka, with the aim of investigating their readiness for formal education. A modified Denver developmental screening test was used to determine the presence of age-appropriate motor, cognitive (including language) and social skills in 295 children. Of these children, 17.8% were unable to perform more than 50% of the tasks correctly. Children with motor problems were more likely to have difficulties with cognitive tasks than children without motor problems. Children who attended preschool did significantly better in most tasks compared with those who did not. The level of maternal education did not show a direct association with the competencies of the children. This assessment schedule can be used as a quick screening method in the community for early recognition of children with the potential for learning problems in school.     

Assessing readiness to change binge eating and compensatory behaviors

The purpose of this study was to evaluate whether assessing motivation to change binge eating and compensatory behaviors separately would better describe concurrent bulimic symptomatology compared with a general measure of readiness to change eating behaviors. Participants completed the Eating Disorder Diagnostic Scale [EDDS: Stice, Telch, & Rizvi, in Psychol. Assess. 12 (2000) 123] to assess binging and compensatory behaviors, as well as three measures of readiness to change based on the University of Rhode Island Change Assessment Scale (URICA; McConnaughy, DiClemente, Prochaska, & Velicer (1989)): a general measure, which asked about eating behaviors in general, and two behavior specific measures, one asking about binging behavior only and the other asking about compensatory behaviors only. Results revealed that assessing readiness to change binge eating and compensatory behaviors separately accounted for greater variance in bulimic behaviors than a general measure of readiness to change. Results also provided discriminate validity for measuring readiness to change binge eating and compensatory behaviors separately. Results highlight the utility of assessing readiness to change bulimic symptomatology and the importance of measuring motivation to change binging and compensatory behaviors separately.     

Contribution of supervisor interventions to client change: The therapist perspective

We interviewed 15 advanced doctoral students about their experiences with a supervisor who had helped them help a client change. Analyses of interviews, using consensual qualitative research, suggested that therapists/supervisees viewed their supervisors as having helped them by providing guidance, facilitating case conceptualization, focusing on the person of the therapist, supporting the therapist, providing performance feedback, helping to set realistic expectations, and disclosing. We consider the implications of these findings for clinical supervision, supervisor training, and research on how the supervision process contributes to therapy outcomes.     

Readiness for change and short-term outcomes of female adolescents in residential treatment for anorexia nervosa

OBJECTIVE: To determine if readiness for change (RFC) at admission predicted length of stay (LOS) and short-term outcomes among female adolescents in residential treatment for anorexia nervosa (AN). METHOD: Using a prospective cohort design to collect data from participants (N = 65) at admission and discharge, Kaplan-Meier survival analysis and Cox regression tested whether RFC on admission predicted time in LOS to a favorable short-term outcome--a composite endpoint based on minimum criteria for weight gain, drive for thinness, depression, anxiety, and health-related quality of life (HRQOL). RESULTS: Participants with low RFC had a mean survival time to a favorable short-term outcome of 59.4 days compared to 34.1 days for those with high RFC (log rank = 8.44, df = 1, p = .003). The probability of a favorable short-term outcome was 5.30 times greater for participants with high RFC. CONCLUSION: Readiness for change is a useful predictor of a favorable short-term outcome and should be considered in the assessment profile of patients with AN.