Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, Albuquerque, New Mexico, USA.
Department of Clinical Psychology, The Wright Institute, Berkeley, California, USA.
Alcohol Clin Exp Res. 2022 Jul;46(7):1258-1267. doi: 10.1111/acer.14849. Epub 2022 May 25.
Progression through the stages of change is a proposed mechanism underlying the effects of treatment for alcohol use disorder (AUD). However, examining stages of change as a mechanism of treatment effects requires that the measure be invariant across patient subgroups, treatment conditions, and time. In this study, we examined measurement invariance of the University of Rhode Island Change Assessment Scale (URICA) in Project MATCH using an exploratory structural equation modeling (ESEM) approach.
We conducted a secondary analysis of data from Project MATCH (N = 1726; M = 40.2, SD = 10.9; 75.7% male; 80% non-Hispanic white), a multisite randomized clinical trial that tested three AUD treatments: Motivational Enhancement Therapy, Cognitive-Behavioral Therapy, or Twelve-Step Facilitation. Participants completed the 24-item URICA for assessing the stages of change in relation to drinking at baseline and post-treatment (3 months after baseline).
A 4-factor ESEM provided a good fit to the data and a better fit to the data than a conventional 4-factor confirmatory factor analysis model. Further, the URICA demonstrated scalar invariance across each patient subgroup at baseline (sex, ethnicity, marital status, education, and parental history of AUD) and treatment condition at follow-up. However, the URICA was not longitudinally invariant as the metric model resulted in a significant decrement in model fit.
Measurement invariance of the URICA over time was not supported. Longitudinally invariant measures of the stages of change are needed to test the proposal that progression through the stages explains treatment effects.
改变阶段的进展是治疗酒精使用障碍（AUD）效果的一个潜在机制。然而，检查改变阶段作为治疗效果的机制需要该测量在患者亚组、治疗条件和时间上保持不变。在这项研究中，我们使用探索性结构方程建模（ESEM）方法，在项目 MATCH 中检查了罗得岛大学变化评估量表（URICA）的测量不变性。
我们对项目 MATCH（N=1726；M=40.2，SD=10.9；75.7%为男性；80%为非西班牙裔白人）的数据进行了二次分析，这是一项多地点随机临床试验，测试了三种 AUD 治疗方法：动机增强治疗、认知行为治疗或十二步促进。参与者在基线和治疗后（基线后 3 个月）完成了 24 项 URICA，以评估与饮酒有关的改变阶段。
一个 4 因素 ESEM 为数据提供了良好的拟合，并且比传统的 4 因素验证性因素分析模型更好地拟合数据。此外，URICA 在基线时（性别、种族、婚姻状况、教育程度和父母 AUD 病史）和随访时的每个患者亚组和治疗条件下都表现出标度不变性。然而，URICA 没有时间上的不变性，因为度量模型导致模型拟合显著下降。
URICA 的时间不变性没有得到支持。需要具有阶段变化的纵向不变测量，以检验通过阶段变化解释治疗效果的假设。
