Commitment to Health Scale.

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 1,100 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. Keywords: Rasch rating scale method: Transtheoretical Model of Behavior Change; Commitment to Health Scale; healthy behaviors Elimination of unhealthy behaviors (cigarette smoking, high-fat diets, and sedentary lifestyle) known to be highly associated with cardiovascular heart disease are at the core of public and occupational health interventions (Blair, Piserchia, Wilbur, & Crowder, 1986; Blix, 1999; Cohen & Colligen, 2001; Field et al., 1995; Hymel & Peterson, 2001 ; Riedel, Lynch, Base, Hymel, & Peterson, 2001 ; Stamler et al., 2000). Making clinical work even more challenging is the fact that unhealthy behavior patterns do not usually appear as individual risk factors, but in combination (Campbell et al., 2000; Emmons, Marcus, Linnan, Rossi, & Abrams, 1994; Franklin & Kahn, 1996; Ma, Belts, & Hampl, 2000; Patterson, Haines, & Popkin, 1994; Unger, 1996; Yusuf, Giles, Croft, Anda, & Casper, 1998). On the positive side, it appears that changes in one behavior will be accompanied by changes in other health behaviors (Davis et al., 1994; Emmons et al., 1994; King, Marcus, Pinto, Emmons, & Abrams, 1996). For clinicians who work with patients to reduce high-risk health behaviors, the Transtheoretical Model of Behavior Change (TTM) is an important framework that can be used to promote health behavior change (Samuelson, 1997). In TTM, change occurs as a series of discrete stages leading to adoption, modification, or cessation of the targeted health behavior. Each "stage of change" is defined by the patient's intent (King et al., 1996) or their thinking about changing a behavior within a specified time frame. Accordingly, moving toward behavior change and achieving behavior change is facilitated by changes in perceptions about the benefits (Pros) and risks (Cons) associated with change. Once change has occurred (Action Stage), if the patient is able to sustain change for more than 6 months, and integrate that change into their everyday activities, then the patient has achieved behavior change (Maintenance Stage). What is not presented in the TTM theoretical framework is/are variable(s) that can predict who will be able to achieve sustained and permanent change (Maintenance Stage), from those who begin to make a behavior change (Action Stage) but relapse into old patterns of behavior (Kelly, 2001). This article presents findings from pilot studies testing three of TTM's core variables: (1) Stages of Change, (2) Decisional Balance Scale, and (3) Strong and Weak Principle to determine if Action to Maintenance Stage can be predicted. This pilot research led to identification of a new variable called Commitment to Health that was used to predict Action to Maintenance Stage for three health behaviors (smoking cessation, healthy eating, and exercise adoption), and a new instrument called Commitment to Health Scale (CHS). This article presents those findings as well as the empirical properties of the CHS. …