Rationale: One component of successful cardiac rehabilitation is the integration of regular exercise into the individual's life; a transition that often requires a significant process of behavioral change. The Transtheoretical Model (TTM) of Behaviour Change is one method that can be used to assess behavioral change as a program outcome. The continuum across the Stages of Change (SOC) includes precontemplation, contemplation, preparation, action, and maintenance.
Purpose: Readiness for change was evaluated in individuals admitted to ambulatory services at the Cardiac Rehabilitation Centre (CRC) in Kingston, Ontario. A battery of 6 questionnaires addressing the TTM were used to determine which combination of questionnaires provided an accurate measurement of individuals' readiness for change and the clinical utility of these tools.
Methods: Fifty-six participants entering the CRC from July to December 2005 were asked to participate in the study at the conclusion of the initial visit. Thirty-three clients volunteered to participate; all of them had a primary diagnosis of cardiac disease. The Stages of Change-short form (SOC-SF) and continuous measure (SOC-CM), Processes of Change (POC), Exercise Self-Efficacy (SE), Cardiac Exercise SE (SE), and Decisional Balance (DB) measures were used to assess participant's readiness for regular exercise. This series of questionnaires was completed at the conclusion of the initial visit.
Results: The SOC-CM identified the Contemplation Stage (44%) and the SOC-SF identified the Action Stage (48%) as the predominant SOC. Only a "fair" correlation (r = 0.57) was found between these 2 measures. The number of POC used across all stages was relatively high; 7 of a maximum of 10, with Self Re-evaluation being a highly utilized process across all stages. Self-efficacy was ranked as high across all SOC using both SE measures. On the DB measure, the benefits of exercising (pros) were rated to be high in relation to the costs (cons) across all SOC. The time to complete the battery of 6 questionnaires was 17:26 +/- 4:16 minutes:seconds.
Conclusions: A surprising finding was that individuals identified more "pros" than "cons" with respect to exercise even in the earliest SOC which is different from that reported in the literature in which "pros" increase and "cons" decrease across the SOC continuum. The SOC-SF appeared to overestimate the "readiness" stage at which individuals entered the CRC program, a finding in agreement with the literature. The 2 SE scales both indicated trends for enhanced SE as individuals progressed through the SOC; however, the Cardiac Exercise SE measure appeared to be more discriminatory. From these findings, it is recommended that the SOC-CM, POC, cardiac exercise SE and DB be used to assess an individual's readiness for change upon entry to cardiac rehabilitation. The time to complete these 4 questionnaires was less than 10 minutes and therefore this would not be an onerous additional assessment tool in the cardiac rehabilitation setting.