A natural language screening measure for motivation to change
Introduction
There is broad consensus that motivation for change is a significant issue when addressing addictions, and more generally in promoting health behavior change (Rollnick, Miller, & Butler, 2008). Whereas once clients were blamed or dismissed for not being “ready” for change, it is now widely recognized that enhancing motivation is an important part of the clinician's task in treatment (Moyers and Martin, 2006, DiClemente and Velasquez, 2002, Prochaska, 1994).
Consequently, there has been growing interest in how to measure client motivation. A wide range of questionnaires assess a variety of motivational constructs including stages of change (McConnaughy, Prochaska, & Velicer, 1983), decisional balance (Janis & Mann, 1977), self-efficacy (Bandura, 1997), readiness (Forsberg, Halldin, & Wennberg, 2003), goals (Cox & Klinger, 2004), and craving (Sayette et al., 2000). Such measures have often focused on a single latent construct, and studies have seldom measured more than one such dimension.
The latent factor structure of motivation is complex, and clearly involves multiple dimensions. Perceived probability and magnitude of potential loss or gain have been hypothesized to form a motivational construct of importance, separate from confidence or one's judged ability to accomplish a change (Rogers, 1975, Rollnick, 1998). These in turn influence intention or commitment as a final common pathway to change (Ajzen, 1985, Ajzen, 1991, Gollwitzer, 1999). This is consistent with self-regulation theory, wherein perceived discrepancy between current status and desired state triggers a search for alternative courses of action, and the identification of a possible and efficacious option increases the probability of its enactment (Kanfer, 1970, Miller and Brown, 1991).
An earlier attempt to develop a scale to measure motivation for change in substance abuse led to the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES; Miller & Tonigan, 1996). It was so named because our original intent had been to generate alcohol-specific items mirroring the transtheoretical stages of change (DiClemente and Velasquez, 2002, McConnaughy et al., 1983). We were unsuccessful in producing scales reflecting the stages of change, however, and instead found two robust factors (problem recognition, and taking steps toward change) and a less stable third factor (ambivalence). These are represented in a reduced 19-item scale (Miller & Tonigan, 1996) that changes in response to treatment (Mitchell, Angelone & Cox, 2007) and has been found in some studies to predict substance abuse treatment outcome (e.g., Maisto et al., 1999, Miller et al., 1996).
Another route to accessing the structure of motivation is through analysis of natural language about change (Amrhein, 1992). The English language phrase of “ready, willing, and able,” for example, parallels the above-described components of intention, importance, and confidence (Rollnick, 1998). In psycholinguistic analyses of motivational interviews focused on drug abuse, Amrhein et al. (2003) distinguished clients' natural language reflecting the themes of desire, ability, reasons, need, and commitment. Of these, only the strength of commitment language directly predicted actual change in drug use. The other four, however, preceded and predicted commitment strength, which in turn presaged behavior change (Amrhein, Miller, Yahne, Palmer, & Fulcher, 2003). This is consistent with importance and confidence feeding into a final common pathway of commitment or intention to change. Subsequent coding of client language during motivational interviews suggested the need for an additional dimension related to intention, namely the verbalization of action already being taken to change (“Taking Steps”).
The purpose of this study was to determine how well these underlying dimensions of motivation for change could be captured in a relatively brief questionnaire based on the structure of natural language that predicts behavioral outcome. Our intent was to develop a short and simple screening measure for motivation to change, that could be administered in either verbal or written form.
Section snippets
Method
The five categories of motivational speech identified by Amrhein et al. (2003) — Desire, Ability, Reasons, Need, and Commitment (DARN-C) — plus Taking Steps were used as a guide in initial scale development. Individual items were crafted using common linguistic markers of each dimension, with two items representing each construct within a 12-item Change Questionnaire (CQ). The original CQ items and the dimensions to which they were intended to correspond are listed in Table 1. Clients answered
Results
The dimensionality of the 12 items of the Change Questionnaire was analyzed using maximum likelihood factor analysis. Three criteria were used to determine the number of factors to rotate: the a priori conception that there were six separate factors representing change talk, the scree test, and the interpretability of factors. The scree plot indicated that there were only three (rather than six) factors with eigenvalues greater than 1. The rotated solution shown in Table 1 reflects these three
Discussion
The initial 12 items were intended to measure various possible components of motivation for change, tapping semantic dimensions that should cross cultures well (Goddard & Wierzbicka, 1994). The basic item stems could be used to inquire about any specific behavior change. The first two factors that emerged — importance and commitment — mirror the two factors (problem recognition and taking steps) of the SOCRATES (Miller & Tonigan, 1996) that have been replicated across cultures (e.g., Figlie,
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