Processes of Change Questionnaire – Smoking

Abstract

The Processes of Change Questionnaire- Smoking (POCS) is a specialized psychometric instrument designed to measure the frequency with which individuals utilize specific cognitive, affective, and behavioral strategies during their attempt to quit smoking. Developed within the framework of the Transtheoretical Model (TTM), the POCS assesses ten distinct processes of change that drive movement across the stages of change (e.g., precontemplation to action). The scale exists in two primary validated forms: a 40-item version and a shorter, more commonly used 20-item version. Its primary application lies in clinical and research settings to tailor smoking cessation interventions to the individual’s current readiness to change.

Keywords

Transtheoretical Model, TTM, Processes of Change, Smoking Cessation, Nicotine Dependence, Behavior Change, Health Psychology, Self-Efficacy, Dramatic Relief, Stimulus Control.

Authors

J.O. Prochaska, W.F. Velicer, C.C. DiClemente, J.L. Fava.

Purpose

The core purpose of the Processes of Change Questionnaire- Smoking is to quantify the degree to which smokers engage in the ten Processes of Change defined by the TTM. These processes are the mechanisms—cognitive maneuvers and overt actions—that mediate behavior change. By measuring these processes, researchers and clinicians can determine if an individual is utilizing the appropriate strategies for their current stage of readiness (e.g., using experiential processes in earlier stages and behavioral processes in later stages).

The instrument provides an empirical basis for personalized intervention, ensuring that therapeutic efforts are matched (or “staged”) to the client’s position along the change continuum. For instance, a person in the contemplation stage should score highly on experiential processes, while someone in the action stage should score highly on behavioral processes. The POCS helps identify these patterns, optimizing the effectiveness of behavior change programs.

Construct

The POCS specifically measures the Processes of Change construct, which is one of the key dimensions of the TTM. These processes are divided into two macro-categories: Experiential (or cognitive/affective) processes and Behavioral processes. The Experiential processes tend to be utilized more frequently during the early stages of change (Precontemplation and Contemplation), focusing on internal experiences and awareness. The Behavioral processes are generally employed more often during the later stages (Action and Maintenance), concentrating on overt actions and environmental modification.

The ten measured processes are crucial for understanding the dynamic nature of addiction recovery. They include strategies like seeking out information (Consciousness Raising), emotional response to warnings (Dramatic Relief), modifying the environment to support change (Stimulus Control), and seeking social support (Helping Relationships). The scale assesses how frequently a respondent engages in these activities using a 5-point Likert scale ranging from 1 (Never) to 5 (Repeatedly).

Validity

The POCS has demonstrated robust construct and predictive validity, particularly in its original application to smoking cessation. Studies, such as those by Prochaska et al. (1988) and Perz et al. (1996), established that the utilization patterns of the ten processes vary systematically across the stages of change (Precontemplation, Contemplation, Preparation, Action, and Maintenance). This stage-process interaction confirms the primary theoretical assertion of the TTM, providing strong evidence for the instrument’s validity. Furthermore, the processes have been shown to predict movement from one stage to the next, indicating predictive validity in determining successful quitting outcomes.

Reliability

Reliability for the POCS is typically assessed via internal consistency (Cronbach’s alpha) for each of the ten subscales. Across numerous studies involving diverse populations attempting to quit smoking, the subscales generally exhibit acceptable to good internal consistency (alpha coefficients usually ranging from 0.70 to 0.90), confirming that the items within each process dimension measure a coherent underlying strategy. Test-retest reliability has also been reported as stable over short periods, reflecting the consistent use of change strategies within a given stage.

Factor Analysis

The original development of the POCS (40-item version) utilized factor analysis (typically oblique rotation) to confirm the hypothesized ten-factor structure, corresponding to the ten specific processes of change. These ten factors consistently cluster into two higher-order factors: Experiential and Behavioral processes.

The 40-item version maps four items to each of the ten processes:

• Experiential Processes:
  • Consciousness Raising: Items 6, 8, 10, 17
  • Dramatic Relief: Items 11, 30, 31, 32
  • Environmental Re-evaluation: Items 9, 21, 34, 39
  • Self-Re-evaluation: Items 25, 35, 36, 38
  • Social Liberation: Items 2, 7, 20, 24
• Behavioral Processes:
  • Reinforcement Management: Items 12, 19, 22, 33
  • Counter Conditioning: Items 5, 26, 27, 28
  • Helping Relationships: Items 1, 3, 14, 40
  • Self-Liberation: Items 4, 13, 16, 18
  • Stimulus Control: Items 15, 23, 29, 37

The 20-item version retains two items per process, maximizing efficiency while maintaining psychometric properties. The source content provides the following mapping for the 20-item version:

• Experiential Processes (20-item):
  • Consciousness Raising: Items 4, 11
  • Dramatic Relief: Items 7, 18
  • Environmental Re-evaluation: Items 6, 12
  • Self Re-evaluation: Items 8, 15
  • Social Liberation: Items 3, 14
• Behavioral Processes (20-item):
  • Reinforcement Management: Items 5, 20
  • Counter Conditioning: Items 1, 17
  • Helping Relationships: Items 10, 16
  • Self Liberation: Items 2, 13
  • Stimulus Control: Items 10, 16 (Note: This specific mapping in the source content overlaps with Helping Relationships and should be verified against primary TTM literature.)

Instrument

Test Type: Self-report questionnaire.

Format: 40 items (long form) or 20 items (short form). Responses are recorded on a 5-point Likert scale defined as: 1=Never, 2=Seldom, 3=Occasionally, 4=Often, 5=Repeatedly.

Language Available: English (original). Translations are available in numerous languages due to the global application of the TTM.

Population Group: Individuals who smoke or who have recently quit smoking.

Age Group: Typically utilized with adolescents and adults.

Population Details: The scale is designed for use across all stages of change, from those not considering quitting (Precontemplation) to those actively maintaining abstinence (Maintenance).

Test Methodology: Quantitative assessment of cognitive and behavioral change strategies based on the Transtheoretical Model.

Keywords

Psychometric Scale, Health Behavior, Addiction, Intervention Matching, Stage of Change, Nicotine Addiction, Cognitive Processes, Behavioral Processes, Prochaska.

Authors

Author ORCID Identifier: N/A (Information not provided in source.)

Affiliation Email addresses: N/A (Information not provided in source.)

Correspondence Address: Correspondence is often directed to James O. Prochaska or Carlo C. DiClemente (Original affiliations include the University of Rhode Island and UMBC).

Permissions & Fee and Test Year

The original instrument was developed and published in 1988 (Prochaska, Velicer, DiClemente, & Fava). Information regarding current permissions and licensing fees should be sought from the primary authors or the relevant research group, such as the Habits Lab at UMBC. The instrument is generally available for non-commercial academic research use. The instrument can be found online at: http://habitslab.umbc.edu/processes-of-change-questionnaire/.

Reference’s

The foundational research supporting the Processes of Change Questionnaire- Smoking includes:

• Prochaska, J.O., Velicer, W.F., DiClemente, C.C., and Fava, J.L. (1988). Measuring the process of change: Applications to the cessation of smoking. Journal of Consulting and Clinical Psychology, 56, 520-528.
• DiClemente, CC, Prochaska, JO, Fairhurst, SK, Velicer, WF, Velasquez, MM, & Rossi, JS. (1991). The process of smoking cessation: An analysis of precontemplation, contemplation, and preparation stages of change. Journal of Consulting and Clinical Psychology, 59, 295-304.
• Perz, CA, DiClemente, CC, & Carbonari, JP. (1996). Doing the right thing at the right time? The interaction of stages and processes of change in successful smoking cessation. Health Psychology, 15, 462-468.

Items of the Processes of Change Questionnaire- Smoking

40 item version

1. Special people in my life accept me the same whether I smoke or not.
2. I see “No Smoking” signs in public buildings.
3. I can be open with at least one special person about my experiences with smoking.
4. I tell myself I can choose to smoke or not.
5. Instead of smoking I engage in some physical activity.
6. I recall articles with the problems of quitting smoking.
7. I notice that public places have sections set aside for smokers.
8. I recall information people have personally given me on the benefits of quitting smoking.
9. I am considering the belief that people quitting smoking will help to improve the world
10. I think about information from articles and advertisements on how to stop smoking.
11. Remembering studies about illnesses caused by smoking upsets me.
12. Other people in my daily life try to make me feel good when I don’t smoke.
13. I tell myself I am able to quit smoking if I want to.
14. I have someone who listens when I need to talk about my smoking.
15. I remove things from my home that remind me of smoking.
16. I tell myself that if I try hard enough I can keep from smoking.
17. I recall information people have personally given me on how to stop smoking.
18. I make commitments not to smoke.
19. I reward myself when I don’t smoke.
20. I notice that nonsmokers are asserting their rights.
21. I stop to think that smoking is polluting the environment.
22. I can expect to be rewarded by others if I don’t smoke.
23. I keep things around my place of work that remind me not to smoke.
24. I find society changing in ways that make it easier for the nonsmoker.
25. I get upset when I think about my smoking.
26. I find that doing other things with my hands is a good substitute for smoking.
27. When I am tempted to smoke‚ I think about something else.
28. I do something else instead of smoking when I need to relax or deal with tension.
29. I remove things from my place of work that remind me of smoking.
30. Warnings about the health hazards of smoking move me emotionally.
31. Dramatic portrayals of the evils of smoking affect me emotionally.
32. I react emotionally to warnings about smoking cigarettes.
33. I am rewarded by others if I don’t smoke.
34. I consider the view that smoking can be harmful to the environment.
35. I reassess the fact that being content with myself includes changing the smoking habit.
36. I consciously struggle with the issue that smoking contradicts my view of myself as a caring and responsible person.
37. I put things around my home that remind me not to smoke.
38. My dependency on cigarettes makes me feel disappointed in myself.
39. I am considering the idea that the world around me would be a better place without my smoking.
40. I have someone whom I can count on when I’m ha‎ving problems with smoking.

20 item version

1. When I am tempted to smoke‚ I think about something else.
2. I tell myself I can quit if I want to.
3. I notice that nonsmokers are asserting their rights.
4. I recall information people have given me on the benefits of quitting smoking.
5. I can expect to be rewarded by others if I don’t smoke.
6. I stop to think that smoking is polluting the environment.
7. Warnings about the health hazards of smoking move me emotionally.
8. I get upset when I think about my smoking.
9. I remove things from my home or place of work that remind me of smoking.
10. I have someone who listens when I need to talk about my smoking.
11. I think about information from articles and ads about how to stop smoking.
12. I consider the view that smoking can be harmful to the environment.
13. I tell myself that if I try hard enough‚ I can keep from smoking.
14. I find society changing in ways that makes it easier for nonsmokers.
15. My need for cigarettes makes me disappointed in myself.
16. I have someone I can count on when I’m ha‎ving problems with smoking.
17. I do something else instead of smoking when I need to relax.
18. I react emotionally to warnings about smoking cigarettes.
19. I keep things around my home or place of work that remind me not to smoke.
20. I am rewarded by others if I don’t smoke