Department of Clinical Neuroscience, Section of Clinical Alcohol and Drug Addiction Research and
1 Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden
Received 24 May 2002; in revised form 23 December 2002; accepted 9 January 2003
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ABSTRACT |
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INTRODUCTION |
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The Readiness to Change Questionnaire (RTCQ) (Rollnick et al., 1992) was designed for clients with alcohol problems who might not be aware of having an alcohol problem. Items were initially chosen to represent a specific stage of change according to the Prochaska and DiClemente model (Prochaska and DiClemente, 1986
). The Maintenance stage is not included, because some individuals endorsed both Precontemplation and Maintenance items. Hence, the RTCQ aims at assessing three of the stages of change Precontemplation, Contemplation and Action. The test has been shown to have a three-factor structure (Rollnick et al., 1992
), corresponding to the three stages of change. However, the three factors are correlated, which indicates that the test measures a common dimension besides reflecting the three stages of change. The three-factor structure has been replicated with the Spanish version (Rodriguez-Martos et al., 2000
) and with the German version of the RTCQ (Hapke et al., 1998
) in samples of hazardous and harmful drinkers coming into contact with health care. However, in a German sample of hazardous drinkers, or alcohol-dependent subjects in the general population, the three-factor structure could not be replicated (Hannöver et al., 2002
). Five of 12 items loaded high on both the factors that emerged. In a Dutch study (Defuentes-Merillas et al., 2002
) on excessive drinkers who were admitted to an addiction treatment centre, a two-factor structure was found, with action items forming one factor and a bi-polar factor with Precontemplation and Contemplation items.
In the original study (Rollnick et al., 1992) the internal consistency reliability of the three scales was found to be satisfactory, as was the case in the Spanish (Rodriguez-Martos et al., 2000
) and the German (Hapke et al., 1998
) studies. The testretest reliability, calculated as a Pearson correlation coefficient, was reported in the original study (Rollnick et al., 1992
) and the Spanish study (Rodriguez-Martos et al., 2000
), and ranged from 0.78 to 0.87 for the three scales. However, an American study (Gavin et al., 1998
) reported a low internal reliability (Cronbachs alpha) for the Precontemplation and the Contemplation subscales. The latter authors suggested that this was due to the sample used, which was composed of alcohol-dependent patients applying for treatment. In contrast, in the Dutch study (Defuentes-Merillas et al., 2002
) on patients applying for alcohol treatment, the internal consistency in the three scales was acceptable.
The underlying model of stages of change has been questioned by the constructor of the RTCQ (Budd and Rollnick, 1996; Rollnick, 1998
), and a subsequent reanalysis of the original data (Budd and Rollnick, 1996
) produced a global second-order factor termed readiness to change, indicating that one single factor fits the data better than the three-factor solution. The continuous scale shows good internal consistency reliability. Furthermore, in a comprehensive review (Carey et al., 1999
) of the psychometric properties of tests assessing stages of change, including the RTCQ, Carey was in favour of a one-factor continuous readiness to change construct. Thus, there are mainly two ways to conceptualize the RTCQ, which is the comprising of one factor or three factors.
The aim of the present study was to examine psychometric properties and factor structure of the Swedish version of the RTCQ and to test the original three-factor concept to a one-factor model of the same test.
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SUBJECTS AND METHODS |
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Subjects
The original cohort consisted of patients (n = 563) recruited consecutively at a surgical ward at Danderyd Hospital in Stockholm, Sweden. Patients were recruited to the study if they were between 16 and 73 years of age and excluded if they were terminally ill, had insufficient language skills or used some form of illicit drug. The patients were informed that their results would not be registered in the hospital records and that they could withdraw from the study at any time.
Patients who gave their informed consent were interviewed using the screening questionnaires Mm-MAST (Kristenson and Trell, 1982), CAGE (Ewing, 1984
), and the Trauma Scale (Skinner et al., 1984
). Cut-off limits for hazardous alcohol habits were two affirmative answers in any of the questionnaires. Positive cases were further assessed with regard to alcohol consumption, and those showing risky consumption according to either of two criteria were subject to further analysis (Forsberg et al., 2000
). The first criterion of hazardous consumption was regular drinking [
162 g of absolute alcohol per week on average for men and
82 g for women (Ashley et al., 1994
)]. The second criterion was peak consumption during the last 12-month period [for males
1.05 g of absolute alcohol per kg body weight and for females
0.90 g (Babor and Grant, 1991
)]. In total, 165 patients out of 563 (29%) were classified as risky consumers and were included in the study (see sample characteristics in Table 1
). The preliminary medical diagnoses of the risky consumers at the surgical ward were classified in 11 categories and the most frequent diagnoses were appendicitis (27%), abdominal observation (22%) and trauma (21%).
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Analysis of data
The original three-factor model was tested against three criteria: (1) the model should show satisfactory fit-indices in a confirmatory factor analysis; (2) the correlations between adjacent stages/factors should be higher than for distanced stages/factors; (3) the internal reliability and testretest reliability of the test should be satisfactory.
The factor structure of the test was examined using a confirmatory factor analysis [LISREL 8.12a (Jöreskog and Sörbom, 1996)]. Fit-indices of one- and three-factor solutions of the test were compared. Internal consistency reliability of the test was provided when treating the test as one scale or three scales. In order to investigate the testretest reliability of the test, 18 patients responded to the questionnaire twice. These patients were chosen, because they were in-patients and were available for the second follow-up 1 or 2 days after the first occasion.
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RESULTS |
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Reliability of the test
The internal consistencies for each of the three scales of the test were reported as well as for one continuous 12-item scale (Table 4). Deleting items from the continuous (one-dimensional) scale did not increase reliability. Testretest reliability was calculated as a Pearson correlation between the two times. Furthermore, allocations to stage of change (or readiness score) were compared between the two times. As a three-factor test, 16 out of 18 patients were allocated to the same stage of change both times, and as a one-factor test, when treating the continuous variable as a trichotomous discrete variable, 15 patients were in the same third of the variable both times.
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DISCUSSION |
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The factor structure of RTCQ has now been studied in at least five countries, in five different languages and cultures (Rollnick et al., 1992; Budd and Rollnick, 1996
; Hapke et al., 1998
; Rodriguez-Martos et al., 2000
; Defuentes-Merillas et al., 2002
; Hannöver et al., 2002
) and the results, which are somewhat diverse, favour not only the notion that the RTCQ factor structure is consistent with the stages of change model with a three-factor structure, but also that the test measures a common construct representing severity of alcohol problems.
The testretest reliability was satisfactory for each of the three scales corresponding to the stages of the change model, and just as good for the continuous readiness scale. The internal consistency reliability was higher in the continuous scale, due to more items in this scale. The results correspond to earlier studies of RTCQ, which, with one exception, have shown the test to be reliable.
Yet, future research on the psychometrics of the RTCQ is needed. Budd and Rollnick (1996) proposed that the three-factor model and the one-factor model are examined further by contrasting the scale scores derived from each model. With the stage model, RTCQ is scored as a measure of stage of change, and as a continuous variable, the RTCQ score is the sum of the items in the questionnaire. A forthcoming study will investigate the proposal of Budd and Rollnick (1996)
to further examine the two alternative models with regard to validity, contrasting their relative merits.
The patients in the present study were representative of the target population that the test was developed for; however, patients who were alcohol-dependent were not excluded. Hence, the sample was heterogeneous with respect to the severity of alcohol problems and readiness to change the alcohol behaviour. As a consequence, the sample includes sufficient variation in responses to the RTCQ.
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ACKNOWLEDGEMENTS |
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FOOTNOTES |
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REFERENCES |
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