Psychosocial factors of stages of change among adults with intellectual disabilities.
Standard readiness questionnaires mis-label adults with mild ID, so switch to language-simple versions or do a brief comprehension check first.
01Research in Context
What this study did
Hsu et al. (2011) asked adults with mild intellectual disability to fill out standard "stages of change" questionnaires.
The team wanted to see if the popular transtheoretical model could sort clients into readiness groups.
They ran the numbers to check how often the tool placed people in the right stage.
What they found
The off-the-shelf scale was only 56 percent accurate, barely better than a coin flip.
Some adults were labeled "ready" when carers said they were not, and vice-versa.
The authors say the wording is too complex for this population.
How this fits with other research
Stott et al. (2017) looked at every CBT-readiness tool for people with ID and reached the same warning: most are poorly validated.
Kooijmans et al. (2024) took the next step and rewrote items in plain language, pictures, and larger fonts; carers then saw answers that matched their own views.
Together the three papers show a clear arc: standard measures under-perform, then evidence piles up, then better accessible versions arrive.
Why it matters
If you use generic readiness or motivation scales to gate therapy or training, stop. Results can misplace clients and waste sessions. Instead, pick tools rewritten for cognitive accessibility, or run a quick comprehension check before you start.
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02At a glance
03Original abstract
Relationships among full constructs of the transtheoretical model using a sample of 121 adults with mild intellectual disabilities in Taiwan were examined. Self-reports of stages of change and transtheoretical model psychosocial measures were gathered through interviews. Although MANCOVA revealed that behavioral processes of change, cognitive processes of change, self-efficacy, and perceived pros increased across stages, we did not find a clear linear pattern of association. Direct discriminant function analysis indicated that the most important predictors of stages of change were behavioral processes, cognitive processes, and self-efficacy. The overall stage of change classification accuracy using transtheoretical model psychosocial constructs was 56.2%. Psychosocial measures specifically developed for this population should be further explored.
Intellectual and developmental disabilities, 2011 · doi:10.1352/1934-9556-49.1.14