Date of Award


Degree Type


Degree Name

Doctor of Philosophy in Psychology


Clinical Psychology



First Advisor

James O. Prochaska


Primary Care is considered to be in a crisis in the U.S. related to increasing rates of chronic disease, increasing numbers of patients, less physicians, and less money. This dilemma has led to the rise of what could be a disruptive innovation in the form of retail health clinics, health clinics located within retail settings like pharmacies and large retail stores. The core aim of this study was to use a sequential approach to measurement development to develop TTM measures for the Stage of Change, Decisional Balance, and Self-Efficacy for patients’ readiness to utilize retail health clinics using split half validation procedures. The sample consisted of 551 patients with a stage distribution of Precontemplation 24.4%, Contemplation 14.2%, Preparation 20.3%, Action 5.8% and Maintenance 35.3%. Table 3 reports demographics and Stage of Change. Exploratory principle components analyses produced a 2-factor (Pros α=.88; Cons α=.85) 8-item scale for the Decisional Balance measure and a 1-factor 5-item scale for the Self-Efficacy measure (α=.83). Confirmatory analyses replicated the hypothesized factor structures for both the decisional balance (CFI=.958, SRMR=.055, loadings .63-.88) and Self-Efficacy (CFI=.999, SRMR=.019, loadings .73-.84) scales. MANOVA results by stage of change were significant Wilk’s Λ= .79, F(4, 4,484)= 9.85, p<.001, multivariate η2=.076. The Self-Efficacy measure and the Pros scale of the Decisional Balance measure replicated the expected patterns across the stages. The Cons scale deviated from the expected pattern of decreasing from Precontemplation to Maintenance, actually resulting in an increase. Overall, this study supports the application of the TTM to retail health clinic utilization and the initial development of specific TTM measures for Self-Efficacy and Decisional Balance.

Available for download on Saturday, July 27, 2019