School of Health and Rehabilitation Sciences, University of Queensland, Australia.
Ear Hear. 2013 Jul-Aug;34(4):447-57. doi: 10.1097/AUD.0b013e3182772c49.
This study investigated the application of the transtheoretical (stages-of-change) model in audiologic rehabilitation. More specifically, it described the University of Rhode Island Change Assessment (URICA) scores of adults with acquired hearing impairment. It reported the psychometric properties (construct, concurrent, and predictive validity) of the stages-of-change model in this population.
At baseline, 153 adults with acquired hearing impairment seeking help for the first time completed the URICA as well as measures of degree of hearing impairment, self-reported hearing disability, and years since hearing impairment onset. Participants were subsequently offered intervention options: hearing aids, communication programs, and no intervention. Their intervention uptake and adherence were assessed 6 months later and their intervention outcomes were assessed 3 months after intervention completion. First, the stages-of-change construct validity was evaluated by investigating the URICA factor structure (principal component analysis), internal consistency, and correlations between stage scores. The URICA scores were reported in terms of the scores for each stage of change, composite scores, stages with highest scores, and stage clusters (cluster analysis). Second, the concurrent validity was assessed by examining associations between stages of change and degree of hearing impairment, self-reported hearing disability, and years since hearing impairment onset. Third, the predictive validity was evaluated by investigating associations between stages of change and intervention uptake, adherence, and outcomes.
First, in terms of construct validity, the principal component analysis identified four instead of three stages (precontemplation, contemplation, preparation, and action) for which the internal consistency was good. Most of the sample was in the action stage. Correlations between stage scores supported the model. Cluster analysis identified four stages-of-change clusters, which the authors named active change, initiation, disengagement, and ambivalence. In terms of concurrent validity, participants who reported a more advanced stage of change had a more severe hearing impairment, reported greater hearing disability, and had a hearing impairment for a longer period of time. In terms of predictive validity, participants who reported a more advanced stage of change were more likely to take up an intervention and to report successful intervention outcomes. However, stages of change did not predict intervention adherence.
The majority of the sample was in the action stage. The construct, concurrent, and predictive validity of the stages-of-change model were good. The stages-of-change model has some validity in the rehabilitation of adults with hearing impairment. The data support that change might be better represented on a continuum rather than by movement from one step to the next. Of all the measures, the precontemplation stage score had the best concurrent and predictive validity. Therefore, further research should focus on addressing the precontemplation stage with a measure suitable for clinical use.
本研究探讨了跨理论（阶段变化）模型在听力学康复中的应用。更具体地说，它描述了罗得岛大学变化评估（URICA）得分的成年人获得性听力障碍。它报告了该人群中阶段变化模型的心理测量特性（构建、同时和预测有效性）。
在基线时，153 名首次寻求听力障碍康复帮助的成年人完成了 URICA 以及听力损伤程度、自我报告听力障碍和听力障碍发病时间的测量。随后，为参与者提供了干预选择：助听器、沟通计划和不干预。6 个月后评估他们的干预参与度和依从性，3 个月后评估他们的干预结果。首先，通过调查 URICA 因子结构（主成分分析）、内部一致性以及阶段评分之间的相关性，评估阶段变化的构建有效性。URICA 评分以每个阶段变化的得分、综合得分、得分最高的阶段和阶段聚类（聚类分析）报告。其次，通过检查阶段变化与听力损伤程度、自我报告听力障碍和听力损伤发病时间之间的关联，评估同时有效性。第三，通过调查阶段变化与干预参与度、依从性和结果之间的关联，评估预测有效性。
首先，在构建有效性方面，主成分分析确定了四个阶段（无意愿、思考、准备和行动），而不是三个阶段，其内部一致性良好。大多数样本处于行动阶段。阶段评分之间的相关性支持该模型。聚类分析确定了四个阶段变化聚类，作者将其命名为积极变化、启动、脱离和矛盾。在同时有效性方面，报告更先进阶段变化的参与者听力损伤更严重，报告听力障碍更大，听力障碍时间更长。在预测有效性方面，报告更先进阶段变化的参与者更有可能参与干预，并报告成功的干预结果。然而，阶段变化并没有预测干预依从性。
大多数样本处于行动阶段。阶段变化模型的构建、同时和预测有效性良好。阶段变化模型在成人听力障碍康复中有一定的有效性。数据支持变化可能更好地表示为连续体，而不是从一步到下一步的移动。在所有措施中，无意愿阶段评分具有最佳的同时和预测有效性。因此，进一步的研究应该集中在使用适合临床使用的测量方法来解决无意愿阶段。
