Assessing Parents’ Stage of Change: Factor Analysis of the Parent Readiness For Change Scale (PRFCS)

Jenelle R. ShanleyLarissa N. Niec

Central Michigan University

Introduction

• Research has demonstrated that parent involvement in treatment is important to effectively reduce child behavior problems.

• However, parent training differs from other forms of child therapy by working with the parent (Butcher & Niec, 2005).

Parent Involvement in Therapy• Many studies have demonstrated the

importance of parents’ motivation and readiness to changes in treatment outcome.

• Spoth, Redmond, Haggerty, and Ward (1995) found parents’ readiness for change to be an important predictor for treatment success.

• Miller and Prinz (2003) found that parents with expectations of treatment targeting their child were more likely to terminate early.– In addition, premature termination was predicted

from assignment to a treatment condition that did not match parent’s pretreatment motivations.

Importance of Addressing Parents’ Expectations

• If parents are not convinced that modifying parent-child interactions can impact children’s behavior, these parents may terminate prematurely (Reimers, Wacker, Derby, & Cooper, 1995).

• High attrition rates are prominent - suggesting that not all parents seeking treatment for their child are ready to actively participate.

• Consequently, assessing parents’ willingness to change at the onset of treatment is important to better understand how to engage parents in the treatment process.

Study Purpose

• Although many studies have demonstrated the importance of parents’ motivation and readiness to change for treatment outcome, few studies have evaluated measures that assess such factors (Butcher & Niec, 2005).

• The purpose of this study was to evaluate the factor structure of the Parent Readiness for Change Scale (PRFCS; Brestan, Ondersma, Simpson, & Gurwitch, 1999).

Transtheoretical Model (TTM)

• The PRFCS is based on the Transtheoretical Model (TTM; DiClemente & Prochaska, 1998)

• TTM provides a framework for the overall process of behavior change, including parenting behavior

• TTM suggests that behavior change occurs through five stages: – Stage 1: Precontemplation– Stage 2: Contemplation– Stage 3: Preparation (aka Decision Making)– Stage 4: Action– Stage 5: Maintenance

Parent Readiness for Change Scale

• The 28-item PRFCS was designed to identify parents’ stage of change in regards to their parenting.

• Parents rate each statement using a five-point Likert scale (1 = strongly disagree to 5 = strongly agree).

• Adapted from the University of Rhode Island Change Assessment (URICA; McConnaughy, Prochaska, & Velicer, 1983)

• 3 subscales assessing different stages of change: Precontemplation, Contemplation, and Action. – Eleven items were not assigned to a subscale.

Example Items

• Precontemplation: “As far as I’m concerned, I don’t need to change how I take care of my child.”

• Contemplation: “I think I might be ready to improve how I take care of my child.”

• Action: “Even though I am not always successful in changing how I interact with my child, I am at least working on it.”

Mullins and colleagues (2005)

• Only study that has looked at PRFCS• Used the PRFCS as one measure to assess

treatment outcome for mothers of drug-exposed infants in reducing child maltreatment.– Termination status and PRFCS scores were not

significantly correlated– The PRFCS did not significantly add to the

prediction of re-report length after termination status was accounted for.

Hypothesis

It was hypothesized that a four-factor model would be the most robust factor structure of the PRFCS’s 28-items.

Participants

• 110 mothers completed the PRFCS as part of an intake battery for a Parent-Child Interaction Therapy Clinic– Age: 19 – 52 (M = 30.46, SD = 7.37)

– Martial status: 47% married, 23% single, 12% unmarried with partner, 18% widowed/divorced/other

– Education: 8 – 19 years (M = 12.94, SD = 1.97)

• Children (34% girls) referred for treatment for conduct problems– Age: 2 – 8 (M = 4.38, SD = 1.63)

– Race: 87% Caucasian, 3% Native American, 2% African American, 1% Hispanic, 7% biracial/other

Factor Analysis

• Several exploratory factor analysis methods were used to assess the internal structure of the 28-items PRFCS.

• Principal Component Analysis (PCA) was used to determine number of factors– Scree plot = 1 factor– Eigen value great than 1 = 7 factors

• 4 factors had only 1 or 2 items that loaded highest

– Compared PCA and (Principle Axis Factoring) PFA extracting 3 and 4 factors by examining the Pattern Matrices and total variance explained.

Results

• The PCA and PAF analyses yielded similar results; therefore the PCA with varimax rotation is presented here for ease of interpretation.– Support for a four-component scale structure.

• Total variance explained = 56.59%• 60.7% of the items loaded on their original

factor

Factor 1: Contemplation

• Loadings: .48 to .73• Includes items from the original Contemplation

scale (2, 6, 9, 12, 14), original Action scale (3, 7, 11, 23) and unscaled items (4, 26)

• Generally, these items assess parents’ serious consideration of the advantages and disadvantages of changing their behavior.

Factor 2: Precontemplation

• Loadings: -.70 to -.51 (.52)• Includes items from the original

Precontemplation scale (1, 5, 8, 10, 18) and one unscaled item (15) which was the only positive loading.

• Generally, these items assess parents’ who are not presently contemplating change.

Factor 3: Decision Making

• Loadings: .57 to .77 (-.57 & -.56)• Of the 6 items that load highest on this factor,

one item is from the original Contemplation scale (16) and the others are unscaled items (19, 24, 25, 27, 28)

• Overall, these items assess a parent in the process of planning to commit to change.

Factor 4: Action

• Loadings: .40 to .72• Includes items from the original Action

scale (13, 20) and unscaled items (17, 21, 22)

• Generally, these items assess parents who are actively involved in changing their behavior.

Discussion

• An exploratory factor analysis provided support for a four-component scale structure assessing the first four stages of change: Precontemplation, Contemplation, Decision Making, and Action.

• A majority of the items loaded on the factor for which they were created while unassigned items tended to load together on one factor.

• However, several items loaded on other scales, suggesting that these items should be reevaluated for content.

Limitations• This was the first study to analyze the factor

structure of the PRFCS.• However, additional research needs to be

completed in order to assess the stability of these four factors.

• Many items loaded on scales that were contrary to the stage of change these items were intended to measure, suggesting that many of the items may need to be reevaluated.

• Further validation is necessary.

Future Directions

• Further studies should examine the clinical utility of this measure.

• Developing a reliable and valid measure to assess parents’ stage of change prior to treatment will assist clinicians in engaging parents’ participation.

• By including this information, it may be possible to reduce premature termination in parent training.

ReferencesAvailable upon request

Thanks to everyone in the PCIT lab at Central Michigan University for their

input regarding this presentation.