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

Abstract

Objectives 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.

The balancing point: understanding uptake of advance directive forms in a rural Australian community

“…Our allocation of participants to a stage in the transtheoretical model was based on open-ended responses to interview questions, rather than using recently validated instruments,51 52 or probing for specific dates to ‘quantify’ intentions to engage in ACP. This methodology also left us unable to quantify an individual's level of personal empowerment.…”

“…Our proposed model has generated quantifiable hypotheses, and future research may employ recently validated instruments51 52 to examine how perceived susceptibility, empowerment and the balance between these constructs influence stage of readiness to engage in AD form completion. We predict that perceived susceptibility may be associated with transition from the precontemplation to contemplation stage of readiness, while empowerment may be associated with transition through the later stages of the model.…”

Feasibility and Acceptability of a Brief Motivational Stage-Tailored Intervention to Advance Care Planning

“…Attitudes toward ACP was measured by a decisional balance scale. 33 This scale consists of 12 items assessing positive attitudes (pros) and negative attitudes (cons) about ACP. Response categories were 1 ¼ strongly disagree to 5 ¼ strongly agree.…”

“…32 Successful ACP occurs when individuals proceed from precontemplation or contemplation toward the action stage along with positive changes in their thoughts, feelings, and actions toward engaging in ACP. 32,33 Passing through the stages toward the action stage, individuals gradually place more weight on the benefits rather than the barriers of ACP and gain self-efficacy. 11,15 Methodology…”

What makes us optimistic?: Psychosocial factors as predictors of dispositional optimism in young people

“…Specifically, religious beliefs and practices, beliefs in goodness and kindness (Kazemi, 2010), the self -reported spirituality (Lucchetti, Lucchetti & Koenig, 2011) and influenced on end-of-life decision making (Webb & Stouffer, 2014) all of them has been associated to the positive response to treatments to improve mental health, decrease drugs abuse (Ragsdale, Hegner, Mueller & Davies, 2014), health behavior change (Fried et al, 2012) and increase quality of life (Hasanovic & Pajevic, 2012;Moreira-Almeida & Koening, 2006;Robinson, Cranford, Webb & Brower, 2007).…”