Promoting advance care planning as health behavior change: Development of scales to assess Decisional Balance, Medical and Religious Beliefs, and Processes of Change

• Published in: Patient education and counseling Vol. 86; no. 1; pp. 25 - 32
• Main Authors: Fried, Terri R, Redding, Colleen A, Robbins, Mark L, Paiva, Andrea, O’Leary, John R, Iannone, Lynne
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ireland Ltd 01.01.2012; Elsevier
• Subjects: Advance Care Planning; Aged; Analysis of Variance; Attitude to Death; Behavioural changes; Biological and medical sciences; Care management; Cognitive processes; Cross-Sectional Studies; Decision Making; Female; Health Behavior; Health Knowledge, Attitudes, Practice; Health Promotion; Humans; Internal Medicine; Male; Medical sciences; Miscellaneous; Models, Psychological; Nursing; Pilot Projects; Principal Component Analysis; Psychometrics - methods; Public health. Hygiene; Public health. Hygiene-occupational medicine; Reliability; Religion; Religious beliefs; Transtheoretical model; United States > US; Advance care planning; Health behavior; Belief; Health; Theory; Religion; Process; Change; Decision; Care; Scale (size); Measurement technique; Decision aid; Models; Behavior; Planning
• ISSN: 0738-3991; 1873-5134
• DOI: 10.1016/j.pec.2011.04.035

Abstract Objective To develop measures representing key constructs of the Transtheoretical Model (TTM) of behavior change as applied to advance care planning (ACP) and to examine whether associations between these measures replicate the relationships posited by the TTM. Methods Sequential scale development techniques were used to develop measures for Decisional Balance (Pros and Cons of behavior change), ACP Values/Beliefs (religious beliefs and medical misconceptions serving as barriers to participation), Processes of Change (behavioral and cognitive processes used to foster participation) based on responses of 304 persons age ≥ 65 years. Results Items for each scale/subscale demonstrated high factor loading (>.5) and good to excellent internal consistency (Cronbach α .76–.93). Results of MANOVA examining scores on the Pros, Cons, ACP Values/Beliefs, and POC subscales by stage of change for each of the six behaviors were significant, Wilks’ λ = .555–.809, η2 = .068–.178, p ≤ .001 for all models. Conclusion Core constructs of the TTM as applied to ACP can be measured with high reliability and validity. Practice implications Cross-sectional relationships between these constructs and stage of behavior change support the use of TTM-tailored interventions to change perceptions of the Pros and Cons of participation in ACP and promote the use of certain Processes of Change in order to promote older persons’ engagement in ACP.