The Health Care Climate Questionnaire HCCQ

Abstract

The Health Care Climate Questionnaire (HCCQ) is a widely used psychological instrument designed to assess patients’ perceived autonomy support provided by their healthcare providers. Developed within the framework of Self-Determination Theory (SDT), the HCCQ evaluates the degree to which patients feel their physician or healthcare team offers choices, listens to their perspectives, and supports their intrinsic motivation for health behavior change. The scale exists in two primary forms: a 15-item long form and a 6-item short form, allowing for flexibility depending on research or clinical needs. It can be adapted to measure the interpersonal style of a specific doctor or an entire multidisciplinary healthcare team.

Keywords

Health Care Climate Questionnaire, HCCQ, Perceived Autonomy Support, Self-Determination Theory, SDT, Healthcare motivation, Patient adherence, Clinical climate

Authors

Geoffrey C. Williams, Edward L. Deci, Richard M. Ryan, V. M. Kasser, E. M. Cox, R. Kouides, G. C. Rodin, W. S. Grolnick, V. M. Grow, Z. R. Freedman, M. Gagné

Purpose

The primary purpose of the HCCQ is to quantify patients’ perceptions of the interpersonal climate created by their medical providers. This assessment is crucial for researchers and clinicians interested in understanding how the provider’s style influences patient motivation, behavior, and subsequent health outcomes. The questionnaire is versatile, designed to capture two distinct levels of interaction:

• Individual Provider Assessment: When researchers focus on the relationship between a single physician’s interpersonal style and patient outcomes (e.g., motivation or adherence), the scale is worded to reference “my physician” or “my doctor.”
• Team Climate Assessment: When the research question pertains to the overall interpersonal climate of a clinic or a multi-disciplinary group of providers (such as those treating complex conditions like diabetes, involving a physician, nurse educator, and dietitian), terms like “providers” or “practitioners” are substituted for “physician.”

By measuring the perceived level of autonomy support, the HCCQ helps determine whether the healthcare context facilitates or undermines patients’ self-initiated regulation of their health behaviors.

Construct

The HCCQ measures the psychological construct of Perceived Autonomy Support within the healthcare setting. This construct is fundamental to Self-Determination Theory, a macro-theory of human motivation. Autonomy support refers to the degree to which a provider takes the patient’s perspective, acknowledges their feelings, provides relevant information, offers choices, and minimizes the use of controlling language or pressures.

A high score on the HCCQ indicates that the patient perceives their provider as being highly autonomy supportive, fostering feelings of competence and relatedness, which are essential for promoting sustained intrinsic motivation and autonomous regulation of difficult health behaviors, such as smoking cessation or diet control. Conversely, low scores suggest a controlling climate that may lead to passive compliance or resistance.

Validity

The validity of the HCCQ is supported primarily through its consistent predictive power across numerous studies linking patient perceptions of autonomy support to positive health outcomes, including improved adherence to long-term medical regimens and sustained behavior change (e.g., weight loss and glucose control). Construct validity is established by demonstrating that the scale measures a single factor (autonomy support) and correlates appropriately with other measures of motivation and well-being, as documented in the related academic literature published by the authors.

Reliability

The reliability of the HCCQ has been established through internal consistency checks (e.g., high Cronbach’s alpha values reported in published studies) for both the 15-item and 6-item versions. Furthermore, when the HCCQ is employed as a rating device by trained observers—a distinct application—methods are utilized to ensure adequate scoring fidelity. Observers undergo training until they achieve high inter-rater reliability. The final score for rated autonomy support typically relies on the average of multiple raters’ scores, further assuring measurement stability.

Factor Analysis

Although specific factor analysis details are not present in the introductory materials, the HCCQ is designed to be a unidimensional scale, measuring the overall perception of autonomy support provided by the clinician or team. Studies utilizing this instrument often confirm its single-factor structure. When the instrument is used in complex modeling, such as by trained observers, advanced statistical techniques like Structural Equation Modelling (SEM) are sometimes employed. In SEM analyses, the average rater score from three different raters can be used as indicators of the latent variable, “rated provider autonomy support,” validating its underlying structure in observer contexts.

Instrument

Test Type: Self-report questionnaire (Patient perspective) or Observer rating device (Trained rater perspective).

Format: Likert-type scale, typically using a 7-point rating system ranging from “Strongly disagree” (1) to “Strongly agree” (7).

Language Available: Primarily English; translated versions are often available via the developers’ official academic resources, consistent with the use of similar SDT scales globally.

Population Group: Patients receiving medical care for various conditions (e.g., smoking cessation, diabetes, weight management) or receiving general medical attention.

Age Group: Typically utilized with adolescents and adults who can understand and respond to the items regarding their interpersonal experiences with healthcare providers.

Population Details: Has been validated across diverse medical settings, including primary care, specialized clinics, and nursing home environments, focusing on motivation related to long-term medical regimens and behavioral change.

Test Methodology: Patients respond to items reflecting their perceived experience with their provider. The scale is available in a 15-item long form and a 6-item short form (Items #1, 2, 4, 7, 10, and 14). When used as an objective measure, trained observers listen to recorded patient-provider interactions and rate the provider’s autonomy supportiveness, responding to the items as if they were the patient.

Keywords

Patient-provider relationship, Healthcare communication, Motivation, Adherence, Diabetes care, Weight loss, Smoking cessation, Clinical psychology, HCCQ

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: Not provided in source content.

Correspondence Address: Correspondence is typically directed through the Self-Determination Theory (SDT) organization or primary authors (Deci & Ryan) at the University of Rochester.

Permissions & Fee and Test Year

The HCCQ, like other scales developed under the SDT framework, is generally available for non-commercial academic research use without charge, though permission should be sought from the primary developers (G. C. Williams, E. L. Deci, R. M. Ryan). Early versions of the scale were in use in the mid-to-late 1990s, as evidenced by the foundational publications dating from 1996 through 2000.

Reference’s

The following articles document the use and development of the Health Care Climate Questionnaire or an earlier version:

• Williams, G. C., Cox, E. M., Kouides, R., & Deci, E. L. (1999). Presenting the facts about smoking to adolescents: The effects of an autonomy supportive style. Archives of Pediatrics and Adolescent Medicine, 153, 959-964.
• Kasser, V. M., & Ryan, R. M. (1999). The relation of psychological needs for autonomy and relatedness to health, vitality, well-being and mortality in a nursing home. Journal of Applied Social Psychology, 29, 935-954.
• Williams, G. C., Rodin, G. C., Ryan, R. M., Grolnick, W. S., & Deci, E. L. (1998). Autonomous regulation and adherence to long-term medical regimens in adult outpatients. Health Psychology, 17, 269-276.
• Williams, G. C., Freedman, Z. R., & Deci, E. L. (1998). Supporting autonomy to motivate glucose control in patients with diabetes. Diabetes Care, 21, 1644-1651.
• Williams, G. C., Grow, V. M., Freedman, Z. R., Ryan, R. M., & Deci, E. L. (1996). Motivational predictors of weight loss and weight-loss maintenance. Journal of Personality and Social Psychology, 70, 115-126.
• Williams, G. C., Gagné, M, Ryan, R, M., & Deci, E. L. (2000). Facilitating autonomous motivation for smoking cessation. Manuscript under editorial review.
• Williams, G. C., & Deci, E. L. (in press). Activating patients for smoking cessation through physician autonomy support. Medical Care.

Items of the The Health Care Climate Questionnaire HCCQ

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

This questionnaire contains items that are related to your visits with your doctor. Physicians have different styles in dealing with patients, and we would like to know more about how you have felt about your encounters with your physician. Your responses are confidential. Please be honest and candid.

1. I feel that my physician has provided me choices and options.

2. I feel understood by my physician.

3. I am able to be open with my physician at our meetings.

4. My physician conveys confidence in my ability to make changes.

5. I feel that my physician accepts me.

6. My physician has made sure I really understand about my condition and what I need to do.

7. My physician encourages me to ask questions.

8. I feel a lot of trust in my physician.

9. My physician answers my questions fully and carefully.

10. My physician listens to how I would like to do things.

11. My physician handles people’s emotions very well.

12. I feel that my physician cares about me as a person.

13. I don’t feel very good about the way my physician talks to me.

14. My physician tries to understand how I see things before suggesting a new way to do things.

15. I feel able to share my feelings with my physician.