Readiness to Change Questionnaire

Readiness to Change Questionnaire

This is a patient self-administered 32-item questionnaire that should take five to ten minutes to complete. Your practitioner will use your responses to generate a “readiness to change” score. (Ceccarini 2015) Each statement below describes how a person might feel when approaching problems in their lives.
Name*

First NameLast Name
Please indicate the extent to which you tend to agree or disagree with each statement.

In each case, make your choice in terms of how you feel right now, not what you have felt in the past or would like to feel. For all statements that refer to your “problem,” answer in terms of problems related to reasons you are seeing your health practitioner. Circle the number that best describes how much you agree or disagree with each statement.
1. As far as I'm concerned, I don't have any problems that need changing.*

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1 is Strongly Disagree, 5 is Strongly Agree
2. I think I might be ready for some self-improvement.*

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1 is Strongly Disagree, 5 is Strongly Agree
3. I'm doing something about the problems that have been bothering me.*

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1 is Strongly Disagree, 5 is Strongly Agree
4. It might be worthwhile to work on my problem/s.*

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1 is Strongly Disagree, 5 is Strongly Agree
5. I'm not the problem. It doesn't make much sense for me to be here.*

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1 is Strongly Disagree, 5 is Strongly Agree
6. It worries me that I might slip back on a problem I've already changed, so I'm here to seek help.*

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1 is Strongly Disagree, 5 is Strongly Agree
7. I'm finally doing some work on my problems.*

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1 is Strongly Disagree, 5 is Strongly Agree
8. I've been thinking that I might want to change something about myself.*

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1 is Strongly Disagree, 5 is Strongly Agree
9. I've been successful in working on my problem but I'm not sure I can keep up the effort on my own.*

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1 is Strongly Disagree, 5 is Strongly Agree
10. At times, my problem is difficult, but I'm working on it.*

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1 is Strongly Disagree, 5 is Strongly Agree
11. Trying to change is pretty much a waste of time for me because the problem doesn't have to do with me.*

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1 is Strongly Disagree, 5 is Strongly Agree
12. I'm hoping my practitioner will help me to better understand myself.*

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1 is Strongly Disagree, 5 is Strongly Agree
13. I guess I have faults, but there's nothing that I really need to change.*

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1 is Strongly Disagree, 5 is Strongly Agree
14. I'm really working hard to change.*

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1 is Strongly Disagree, 5 is Strongly Agree
15. I have a problem and I really think I should work on it.*

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1 is Strongly Disagree, 5 is Strongly Agree
16. I'm not following through with what I had already changed as well as I had hoped, and I'm here to prevent a relapse of the problem.*

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1 is Strongly Disagree, 5 is Strongly Agree
17. Even though I'm not always successful in changing, I'm at least working on my problem.*

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1 is Strongly Disagree, 5 is Strongly Agree
18. I thought once I had resolved the problem I would be free of it, but sometimes I still find myself struggling with it.*

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1 is Strongly Disagree, 5 is Strongly Agree
19. I wish I had more ideas on how to solve my problem.*

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1 is Strongly Disagree, 5 is Strongly Agree
20. I've started working on my problems, but I would like help.*

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1 is Strongly Disagree, 5 is Strongly Agree
21. Maybe my practitioner will be able to help me.*

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1 is Strongly Disagree, 5 is Strongly Agree
22. I may need a boost right now to help me maintain the changes I've already made.*

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1 is Strongly Disagree, 5 is Strongly Agree
23. I may be part of the problem, but I don't really think I am.*

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1 is Strongly Disagree, 5 is Strongly Agree
24. I hope that my practitioner will have some good advice for me.*

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1 is Strongly Disagree, 5 is Strongly Agree
25. Anyone can talk about changing; I'm actually doing something about it.*

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1 is Strongly Disagree, 5 is Strongly Agree
26. All this talk about psychology is boring. Why can't people just forget their problems?*

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1 is Strongly Disagree, 5 is Strongly Agree
27. I'm here to prevent myself from having a relapse of my problem.*

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1 is Strongly Disagree, 5 is Strongly Agree
28. It's frustrating, but I feel I might be having a recurrence of a problem I thought I had resolved.*

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1 is Strongly Disagree, 5 is Strongly Agree
29. I have worries, but so does the next person. Why spend time thinking about them?*

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1 is Strongly Disagree, 5 is Strongly Agree
30. I'm actively working on my problem.*

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1 is Strongly Disagree, 5 is Strongly Agree
31. I would rather cope with my faults than try to change them.*

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1 is Strongly Disagree, 5 is Strongly Agree
32. After all I had done to try and change my problem, every now and then it comes back to haunt me.*

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1 is Strongly Disagree, 5 is Strongly Agree
Total Score %:
Readiness to change is a measurement based on the Transtheoretical Model of Change, which has been widely applied to understanding the various stages involved with changing health behaviors. (Hashemzadeh 2019). By measuring readiness to change, you and your practitioner will be able to better understand where you are at in your behavioral change journey and develop a treatment plan based on your specific needs and readiness. (Prochaska 1997)
Thank you for completing this questionnaire!
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Readiness to Change Questionnaire

Please indicate the extent to which you tend to agree or disagree with each statement.

Thank you for completing this questionnaire!