Health-Care, SDT Packet

Scale Description | The Scales

Download the complete Health-Care, SDT packet in a Word file

The Scales

Treatment Self-Regulation Questionnaire (TSRQ)

(Concerning Motivation for Healthy Behaving)

Scoring Information. This scale has 15 items: 6 that assess autonomous motivation, 6 that assess controlled motivation, and 3 that assess amotivation. The autonomous motivation subscale consists of items # 1, 3, 6, 8, 11, & 13; the controlled motivation subscale consists of items # 2, 4, 7, 9, 12, & 14; and the amotivation subscale consists of items # 5, 10, & 15. In some previous studies the TSRQ used only 4 autonomous items, 4 controlled items, and no amotivation items. The 8 items used in that version of the scale were: 2, 3, 4, 6, 7, 8, 13, & 14. The additional items were added to balance across subtle differences within both autonomous and controlled reasons and to allow the concept of amotivation to be examined when it is relevant to the scientific question being considered. The added items have all been validated in other self-regulation questionnaires based on SDT.

TSRQ (Smoking)

The following question relates to the reasons why you would either stop smoking or continue not smoking. Different people have different reasons for doing that, and we want to know how true each of the following reasons is for you. All 15 response are to the same question.

Please indicate the extent to which each reason is true for you, using the following 7-point scale:

The reason I would not smoke is:

1. Because I feel that I want to take responsibility for my own health.
2. Because I would feel guilty or ashamed of myself if I smoked.
3. Because I personally believe it is the best thing for my health.
4. Because others would be upset with me if I smoked.
5. I really don't think about it.
6. Because I have carefully thought about it and believe it is very important for many aspects of my life.
7. Because I would feel bad about myself if I smoked.
8. Because it is an important choice I really want to make.
9. Because I feel pressure from others to not smoke.
10. Because it is easier to do what I am told than think about it.
11. Because it is consistent with my life goals.
12. Because I want others to approve of me.
13. Because it is very important for being as healthy as possible.
14. Because I want others to see I can do it.
15. I don't really know why.

TSRQ (Diet)

The following question relates to the reasons why you would either start eating a healthier diet or continue to do so. Different people have different reasons for doing that, and we want to know how true each of the following reasons is for you. All 15 response are to the same question.

Please indicate the extent to which each reason is true for you, using the following 7-point scale:

The reason I would eat a healthy diet is:

1. Because I feel that I want to take responsibility for my own health.
2. Because I would feel guilty or ashamed of myself if I did not eat a healthy diet.
3. Because I personally believe it is the best thing for my health.
4. Because others would be upset with me if I did not.
5. I really don't think about it.
6. Because I have carefully thought about it and believe it is very important for many aspects of my life.
7. Because I would feel bad about myself if I did not eat a healthy diet.
8. Because it is an important choice I really want to make.
9. Because I feel pressure from others to do so.
10. Because it is easier to do what I am told than think about it.
11. Because it is consistent with my life goals.
12. Because I want others to approve of me.
13. Because it is very important for being as healthy as possible.
14. Because I want others to see I can do it.
15. I don't really know why.

TSRQ (exercise)

The following question relates to the reasons why you would either start to exercise regularly or continue to do so. Different people have different reasons for doing that, and we want to know how true each of the following reasons is for you. All 15 response are to the one question.

Please indicate the extent to which each reason is true for you, using the following 7-point scale:

The reason I would exercise regularly is:

1. Because I feel that I want to take responsibility for my own health.
2. Because I would feel guilty or ashamed of myself if I did not exercise regularly.
3. Because I personally believe it is the best thing for my health.
4. Because others would be upset with me if I did not.
5. I really don't think about it.
6. Because I have carefully thought about it and believe it is very important for many aspects of my life.
7. Because I would feel bad about myself if I did not exercise regularly.
8. Because it is an important choice I really want to make.
9. Because I feel pressure from others to do so.
10. Because it is easier to do what I am told than think about it.
11. Because it is consistent with my life goals.
12. Because I want others to approve of me.
13. Because it is very important for being as healthy as possible.
14. Because I want others to see I can do it.
15. I don't really know why.

TSRQ (alcohol)

The following question relates to the reasons why you would control your use of alcohol. Different people have different reasons for doing that, and we want to know how true each of the following reasons is for you. All 15 response are to the one question.

Please indicate the extent to which each reason is true for you, using the following 7-point scale:

The reason I would use alcohol responsibly is:

1. Because I feel that I want to take responsibility for my own health.
2. Because I would feel guilty or ashamed of myself if I did not use alcohol responsibly.
3. Because I personally believe it is the best thing for my health.
4. Because others would be upset with me if I did not.
5. I really don't think about it.
6. Because I have carefully thought about it and believe it is very important for many aspects of my life.
7. Because I would feel bad about myself if I did use alcohol responsibly.
8. Because it is an important choice I really want to make.
9. Because I feel pressure from others to do so.
10. Because it is easier to do what I am told than think about it.
11. Because it is consistent with my life goals.
12. Because I want others to approve of me.
13. Because it is very important for being as healthy as possible.
14. Because I want others to see I can do it.
15. I don't really know why.

Perceived Competence Scales (PCS)

Scoring Information. This scale has 4 items, and an individual's score is simply the average of his or her responses on the 4 items. When the PCS is used along with the TSRQ, the PCS items have sometimes been interspersed with the TSRQ items.

Perceived Competence (Not Smoking)

Please indicate the extent to which each statement is true for you, assuming that you were intending either to permanently quit smoking now or to remain permanently abstinent from smoking. Use the following scale:

1. I feel confident in my ability to not smoke.
2. I now feel capable of not smoking.
3. I am able to not smoke anymore.
4. I am able to meet the challenge of not smoking.

Perceived Competence (Maintaining a Healthy Diet)

Please indicate the extent to which each statement is true for you, assuming that you were intending either to permanently improve your diet now or to maintain a healthy diet. Use the following scale:

1. I feel confident in my ability to maintain a healthy diet.
2. I now feel capable of maintaining a healthy diet.
3. I am able to maintain a healthy diet permanently.
4. I am able to meet the challenge of maintaining a healthy diet.

Perceived Competence (Exercising Regularly)

Please indicate the extent to which each statement is true for you, assuming that you were intending either to begin now a permanent regimen of exercising regularly or to permanently maintain your regular exercise regimen. Use the following scale:

1. I feel confident in my ability to exercise regularly.
2. I now feel capable of exercising regularly.
3. I am able to exercise regularly over the long term.
4. I am able to meet the challenge of exercising regularly.

Perceived Competence (Using Alcohol Responsibly)

Please indicate the extent to which each statement is true for you, assuming that you were intending either to begin now permanently abstaining from alcohol use, to begin permanently using alcohol responsibly, or to permanently maintain your current abstinence or responsible use of alcohol. Use the following scale:

1. I feel confident in my ability to use alcohol responsibly.
2. I now feel capable of using alcohol responsibly.
3. I am able to use alcohol responsibly over the long term.
4. I am able to meet the challenge of using alcohol responsibly.

Health Care Climate Questionnaire (HCCQ)

Scoring Information. The version of the HCCQ presented here is the 6-item short form, concerning the 4 health behaviors. The items have been explicitly written for the target behaviors, whereas the general HCCQ typically does not specify particular behaviors. An individual's score on this scale is simply the average of his or her responses on the 6 items. The long 15-item form of the HCCQ can be found in this web site on the Perceived Autonomy Support: The Climate Questionnaires page.

HCCQ (Not Smoking)

This questionnaire contains items that are related to your visits with a health-care practitioner (or group of practitioners) in which your smoking was discussed in any way. Health-care practitioners (doctors, nurses, counselors, etc.) have different styles in dealing with patients, and we would like to know very specifically about your experience of your provider(s) in any encounters when your smoking was discussed. Your responses will be kept confidential, so none of your practitioners will know about your responses. Please be honest and candid. In some cases, you may have met with only your physician; in other cases you may have discussed your smoking with several people. If you have met only with your physician, please respond with respect to him or her; if you have met with several practitioners concerning this issue, please answer in terms of your experience of all these practitioners together.

In answering the questions, please use the following scale:

1. I feel that my health-care practitioners have provided me with choices and options about smoking (including not quitting).
2. I feel my health-care providers understand how I see things with respect to my smoking.
3. My health-care providers convey confidence in my ability to make changes regarding my smoking
4. My health care practitioners listen to how I would like to do things regarding my smoking.
5. My health-care practitioners encourage me to ask questions about my smoking.
6. My health-care practitioners try to understand how I see my smoking before suggesting any changes.

HCCQ (Healthy Diet)

This questionnaire contains items that are related to your visits with a health-care practitioner (or group of practitioners) in which your diet was discussed in any way. Health-care practitioners (doctors, nurses, counselors, etc.) have different styles in dealing with patients, and we would like to know very specifically about your experience of your provider(s) in any encounters when your diet was discussed. Your responses will be kept confidential, so none of your practitioners will know about your responses. Please be honest and candid. In some cases, you may have met with only your physician; in other cases you may have discussed your diet with several people. If you have met only with your physician, please respond with respect to him or her; if you have met with several practitioners concerning this issue, please answer in terms of your experience of all these practitioners together.

In answering the questions, please use the following scale:

1. I feel that my health-care practitioners have provided me with choices and options about changing my diet (including not changing).
2. I feel my health-care providers understand how I see things with respect to my diet.
3. My health-care providers convey confidence in my ability to make changes regarding my diet.
4. My health care practitioners listen to how I would like to do things regarding my diet.
5. My health-care practitioners encourage me to ask questions about my diet.
6. My health-care practitioners try to understand how I see my diet before suggesting any changes.

HCCQ (Exercising Regularly)

This questionnaire contains items that are related to your visits with a health-care practitioner (or group of practitioners) in which your exercising was discussed in any way. Health-care practitioners (doctors, nurses, counselors, etc.) have different styles in dealing with patients, and we would like to know very specifically about your experience of your provider(s) in any encounters when your exercising was discussed. Your responses will be kept confidential, so none of your practitioners will know about your responses. Please be honest and candid. In some cases, you may have met with only your physician; in other cases you may have discussed your diet with several people. If you have met only with your physician, please respond with respect to him or her; if you have met with several practitioners concerning this issue, please answer in terms of your experience of all these practitioners together.

In answering the questions, please use the following scale:

1. I feel that my health-care practitioners have provided me with choices and options about exercising regularly (including not exercising regularly).
2. I feel my health-care providers understand how I see things with respect to my exercising regularly.
3. My health-care providers convey confidence in my ability to make changes regarding my exercising regularly
4. My health care practitioners listen to how I would like to do things regarding my exercise.
5. My health-care practitioners encourage me to ask questions about my exercising.
6. My health-care practitioners try to understand how I see my exercising before suggesting any changes.

HCCQ (Using Alcohol Responsibly)

This questionnaire contains items that are related to your visits with a health-care practitioner (or group of practitioners) in which your use of alcohol was discussed in any way. Health-care practitioners (doctors, nurses, counselors, etc.) have different styles in dealing with patients, and we would like to know very specifically about your experience of your provider(s) in any encounters when your alcohol use was discussed. Your responses will be kept confidential, so none of your practitioners will know about your responses. Please be honest and candid. In some cases, you may have met with only your physician; in other cases you may have discussed your alcohol use with several people. If you have met only with your physician, please respond with respect to him or her; if you have met with several practitioners concerning this issue, please answer in terms of your experience of all these practitioners together.

In answering the questions, please use the following scale:

1. I feel that my health-care practitioners have provided me with choices and options about using alcohol responsibly (including not changing my drinking).
2. I feel my health-care providers understand how I see things with respect to my using alcohol responsibly.
3. My health-care providers convey confidence in my ability to make changes regarding my use of alcohol
4. My health care practitioners listen to how I would like to do things regarding my responsible use of alcohol.
5. My health-care practitioners encourage me to ask questions about my alcohol use.
6. My health-care practitioners try to understand how I see my use of alcohol before suggesting any changes.

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