The Psychometric Properties of the Readiness and Motivation Questionnaire: A Symptom Specific
Measure of Readiness for Change in the Eating Disorders
Krista E. Brown, Josie Geller, Suja Srikameswaran, Erin C. Dunn, & Megan I. Jones
St. Paul’s Hospital & the University of British Columbia
Introduction
Participants
• Individuals with eating disorders are notoriously ambivalent
about recovery and treatment refusal, dropout, and relapse are
common occurrences in this group (Pike, 1998). As such,
addressing motivation for change is critical in this population.
• The Readiness and Motivation Interview (RMI; Geller & Drab,
1999; Geller, Cockell, & Drab, 2001) is a symptom specific
interview measure of readiness and motivation for change in the
eating disorders that demonstrates strong psychometric properties
(Geller et al., 2001). The RMI uses a motivational stance (MI;
Miller & Rollnick, 2002).
• Readiness for change, as assessed by the RMI, predicts
enrolment in intensive treatment, symptom change, dropout, and
relapse (Geller et al., 2001; Geller, Drab-Hudson, Whisenhunt, &
Srikameswaran,2004).
• Existing questionnaire measures of readiness have not
consistently predicted clinical outcome (Levy, Lucks & Pike,
1998; Pike, 1998) possibly because they conceptualize the eating
disorder as a global problem. Measures that have demonstrated
clinical utility were developed for use only with anorexia nervosa
(Rieger et al., 2000).
• Although clinically useful, the RMI is time consuming to train
and administer. Thus, there is a need to develop a questionnaire
measure of readiness for change suitable for all eating disorders
that has strong predictive utility.
Objective
• To establish the psychometric properties of the Readiness and
Motivation Questionnaire (RMQ), a symptom specific self-report
measure of readiness for change suitable for all eating disorder
diagnoses.
Procedure
• The RMQ was developed based upon the format of the RMI.
Similar to the RMI, the RMQ assesses stage of change and
internality (the extent to which change is occurring for self vs.
for others) for each of 12 eating disorder symptoms.
• In addition, a “confidence” rating was included as this variable
has been theoretically linked to health behaviour change (Miller
& Rollnick, 2002).
Summary of Findings
Description of Sample Readiness using the RMQ
Diagnosis (DSM-IV; APA, 1994)
AN-B/P
16.4 %
AN-R
12.7 %
BN
24.6 %
EDNOS
46.2 %
100
90
Precon
80
70
Action
60
50
Demographics
Mean
SD
40
30
Age
Socioeconomic status
Body Mass Index
Duration of Illness
Age of onset
28.13
49.70
19.35
11.24
16.59
(8.93)
(14.93)
(4.66)
(10.59)
(5.06)
10
0
Rest*
Cog
Comp*
Binge
Note. A series of ANOVAs compared RMQ Precontemplation and Action scores for
each symptom domain revealing a similar pattern of findings as on the RMI
* P < .001.
Internal Consistency Reliability
Convergent Validity
Convergent Validity
RMQ Total Scores
• Stages of Change Questionnaire (SCQ; McConnaughy,
Prochaska, & Velicer, 1983). A 32-item general measure of
stage of change.
• Brief Symptom Inventory (BSI; Derogatis, 1993). A 53-item
questionnaire measure of psychiatric symptom severity.
• Eating Disorders Inventory – 2 (EDI-2; Garner, 1991). A
91-item questionnaire measure of eating disorder symptom
severity.
Precontemplation
Action
Internality
Confidence
.16
-.05
-.23*
.01
-.14
.08
.44***
.43***
-.32***
.22*
.29**
.15
-.21*
.03
.29**
.21
Precontemplation
Contemplation
Action
Internality
.45***
-.10
-.40***
-.22*
-.47***
-.10
.62***
.21*
-.40***
.14
.31***
.52***
-.36***
-.03
.42***
.17
BSI GSI
.48***
-.06
-.28**
-.34**
EDI Total Score
.49***
-.34**
-.10
-.51***
SCQ Subscales
Precontemplation
Contemplation
Action
Maintenance
RMI Subscales
Note. * P < .05, ** P < .01, ***P < .001
• Several rounds of pilot testing were conducted and minor
wording changes were made to increase clarity of RMQ items.
• Completion of recovery activities (CRA; Geller et al.,
2001). Participants select three recovery related tasks from the
ADRA of varying anticipated difficulty. In a follow-up phone
call, completion of these behavioural tasks is scored by the
study coordinator.
• These findings suggest that like other questionnaire measures of
readiness, the RMQ may not consistently predict outcome.
• Given that the assessment of readiness allows for the
identification of patients who are ready for intensive treatment
and contributes to appropriate resource allocation, development
of an efficient measure of readiness that predicts outcome
remains critical.
• Future research needs to investigate the relation between the
RMQ and other measures of criterion validity. Alternatively, as
questionnaire measures of readiness have been inconsistent
predictors of outcome, the development and validation of a brief
version of the RMI may be the most appropriate avenue for future
investigation.
• An interview of this nature would enable clinicians to accurately
and efficiently assess readiness for change and, in turn, make
appropriate treatment recommendations for their patients.
References
• Correlations between RMQ precontemplation, action, internality, and confidence scores
were conducted with age, BMI, age of onset, SES, and duration of illness. The majority of
RMQ subscale scores were unrelated to the discriminant validity measures (all p’s > .05).
However, RMQ precontemplation and confidence scores were related to duration of illness
(p < .05 and p < .01, respectively).
Criterion Validity
• Anticipated difficulty of recovery activities (ADRA; Geller
et al., 2001). A 26-item questionnaire measure assessing
anticipated difficulty of completing recovery related tasks in
the week following the research assessment.
Conclusions
Discriminant Validity
Discriminant Validity
• Demographic Information. Participants provided their age,
height, weight, duration of illness, and occupation (used to
calculate SES) on a self-report questionnaire.
• Similar to the RMI (Geller et al., 2001), participants reported
lower readiness on the restriction and compensatory domains of
the RMQ.
• The interview format of the RMI promotes open discussion
about ambivalence, which may enable clients to better articulate
their readiness. Thus, the RMI remains the gold standard
assessment of readiness for change in the eating disorders.
Cronbach’s Alpha
.53
.66
.83
.80
Precontemplation
Action
Internality
Confidence
Measures
• Readiness and Motivation Interview (RMI; Geller & Drab,
1999; Geller, Cockell, & Drab, 2001). A symptom specific
interview measure of readiness and motivation for change in
the eating disorders.
• Overall, the RMQ demonstrated reasonable psychometric
properties, including internal consistency, convergent and
discriminant validity.
• Regarding criterion validity, RMQ scores were correlated with
the ADRA. However, unlike the RMI, RMQ scores were not
related to completion of behavioural tasks.
20
Note: Socioeconomic status (SES) was calculated using the the 1981
socioeconomic index for occupations in Canada (Blishen et al., 1987).
• Thus, the RMQ yields global and symptom specific
precontemplation, action, internality, and confidence scores. All
RMQ scores range from 0 to 100.
• Participants (n = 152) completed the RMQ, RMI and a
questionnaire package containing reliability and validity
measures at the time of their initial referral to a tertiary care
Canadian eating disorders program.
Discussion
Results
Criterion Validity
Recovery Activities
RMQ Subscales
ADRA
CRA
Precontemplation
Action
Internality
Confidence
.45***
-.43***
-.33***
-.43***
.04
.16
.13
-.05
• Correlations were also conducted between the RMI and SCQ subscales and the ADRA and
CRA. SCQ subscales were not associated with either the ADRA or CRA (all p’s > .05).
However RMI precontemplation, action, and internality scores were associated with the
ADRA (p < .001, p < .001, and p < .05, respectively) and RMI action scores were associated
with the CRA (p < .05).
Blishen, B.R., Carroll, W.K. & Moore, C. (1987). The 1981 socioeconomic index for occupations in Canada.
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Please address correspondence to: Krista Brown
E-mail: kbrown@providencehealth.bc.ca