Clinicians working with patients in the action stage of dietary change can use a stage-based approach and should evaluate commitment to health as part of an overall assessment. Those with high-level commitment will successfully change from action to maintenance with minimal professional assistance. Those with middle-level commitment risk relapse to a pre-action stage will benefit most from professional intervention. Those in the lower level of commitment are most likely to revert to a pre-action stage of change and may be not be ready for dietary change.
This article introduces commitment to health as a middle-range. Commitment to health (CTH) is derived from Prochaska and DiClemente's (1983) Transtheoretical Model of Behavior Change. CTH theory is designed to predict the likelihood of behavior change between the action and maintenance stages of change. Commitment is defined as a freely chosen internal resolve to perform health behaviors, even when encumbered or inconvenienced by difficulties. Health is defined as the optimal level of well-being. Commitment is an independent continuous variable, but it can be categorized into three time-oriented categories: (1) low-level, (2) middle-level, and (3) high-level commitment. The higher the level of commitment, the more likely the individual will adopt long-term behavior change. This article presents the definitions, assumptions, and relational statements of CTH.
The Commitment to Health Scale (CHS) was developed to predict likelihood of clients being able to permanently adopt new health-promoting behaviors. Commitment is based on the association between starting new health behaviors and long-term performance of those behaviors. The CHS evolved from an examination of Prochaska and DiClemente's Stages of Change Algorithm, Decisional Balance Scale, and Strong and Weak Principle (Velicer, Rossi, Prochaska, & DiClemente, 1996). Scale items were assessed by classical and Rasch measurement methods. The research was performed in three separate studies at various locations in the United States and included approximately 1100 subjects. A new unidimensional variable was identified called Commitment to Health. Internal consistency reliability of the scale was .94 (Cronbach's alpha). External validity and reliability were assessed based on expected and observed ordering and between known groups. Scale scores predicted self-reported health behaviors and body mass index.
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