Stages of change in obesity and weight management: factorial structure of the Italian version of the University of Rhode Island Change Assessment Scale

  • Giada PietrabissaEmail author
  • Angela Sorgente
  • Alessandro Rossi
  • Susan Simpson
  • Giuseppe Riva
  • Gian Mauro Manzoni
  • James O. Prochaska
  • Janice M. Prochaska
  • Roberto Cattivelli
  • Gianluca Castelnuovo
Original Article



To examine the factorial structure of the University of Rhode Island Change Assessment Scale (IT-URICA) for weight management in a sample of Italian overweight and obese patients enrolled in a nutritional rehabilitation program.


334 inpatients completed the translated and adjusted version of the IT-URICA at admission to the hospital. Psychometric testing included confirmatory factor analysis and internal consistency (Cronbach’s α).


The IT-URICA for weight management was successfully translated into Italian, and the factorial analysis confirmed the four-factor solution of the commonly accepted version of the measure.


High levels of RTC are considered critical to the long-term success of weight management, and the IT-URICA may be an appropriate measure of motivational readiness for use among Italian overweight and obese patients. Its use is, therefore, recommended for clinical and research purposes.


Obesity Overweight Readiness to change Stages of change Validation University of Rhode Island Change Assessment Scale 



The author(s) received no financial support for the research, authorship and/or publication of this article.

Compliance with ethical standards

Conflict of interest

The authors declare that there are no conflicts of interest.

Research involving human participants and/or animals

All procedures performed in studies were run in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from all participants.


  1. 1.
    Pietrabissa G et al (2012) Addressing motivation in globesity treatment: a new challenge for clinical psychology. Front Psychol 3:317. doi: 10.3389/fpsyg.2012.00317 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Apovian CM (2016) The obesity epidemic-understanding the disease and the treatment. N Engl J Med 374(2):177–179. doi: 10.1056/NEJMe1514957 CrossRefPubMedGoogle Scholar
  3. 3.
    Bhurosy T, Jeewon R (2014) Overweight and obesity epidemic in developing countries: a problem with diet, physical activity, or socioeconomic status? Sci World J 2014:964236. doi: 10.1155/2014/964236 CrossRefGoogle Scholar
  4. 4.
    Castelnuovo G et al (2015) Chronic care management of globesity: promoting healthier lifestyles in traditional and mHealth based settings. Front Psychol 6:1557. doi: 10.3389/fpsyg.2015.01557 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Knight H et al (2015) Diet self-management and readiness to change in underserved adults with type 2 diabetes. Prim Care Diabetes 9(3):219–225. doi: 10.1016/j.pcd.2014.09.007 CrossRefPubMedGoogle Scholar
  6. 6.
    Dorflinger L, Kerns RD, Auerbach SM (2013) Providers’ roles in enhancing patients’ adherence to pain self management. Transl Behav Med 3(1):39–46. doi: 10.1007/s13142-012-0158-z CrossRefPubMedGoogle Scholar
  7. 7.
    Dunn EC, Neighbors C, Larimer M (2003) Assessing readiness to change binge eating and compensatory behaviors. Eat Behav 4(3):305–314. doi: 10.1016/S1471-0153(03)00023-0 CrossRefPubMedGoogle Scholar
  8. 8.
    Prochaska JO, DiClemente CC (1982) Transtheoretical therapy: toward a more integrative model of change. Psychother Theory Res Pract 19(3):276–288. doi: 10.1037/h0088437 CrossRefGoogle Scholar
  9. 9.
    Ceccarini M et al (2015) Assessing motivation and readiness to change for weight management and control: an in-depth evaluation of three sets of instruments. Front Psychol 6:511. doi: 10.3389/fpsyg.2015.00511 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    McConnaughy EA, Prochaska JO, Velicer WF (1983) Stage of change in psychotherapy: measurement and sample profiles. Psychother Theory Res Pract 20(3):368–375. doi: 10.1037/h0090198 CrossRefGoogle Scholar
  11. 11.
    Prochaska JO et al (1992) Attendance and outcome in a work-site weight control program: processes and stages of change as process and predictor variables. Addict Behav 17:35–45. doi: 10.1016/0306-4603(92)90051-V CrossRefGoogle Scholar
  12. 12.
    Field CA et al (2009) Construct, concurrent and predictive validity of the URICA: data from two multi-site clinical trials. Drug Alcohol Depend 101(1–2):115–123. doi: 10.1016/j.drugalcdep.2008.12.003 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Horwath CC (1999) Applying the transtheoretical model to eating behaviour change: challenges and opportunities. Nutr Res Rev 12(2):281–317. doi: 10.1079/095442299108728965 CrossRefPubMedGoogle Scholar
  14. 14.
    World Health Organization. Physical status: the use and interpertation of anthropometry, in technical report series; 854, WHO Expert Committee, Editor 2005: GenevreGoogle Scholar
  15. 15.
    Terwee CB et al (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60:34–42. doi: 10.1016/j.jclinepi.2006.03.012 CrossRefPubMedGoogle Scholar
  16. 16.
    Muthén BO, du Toit SHC, Spisic D (1997) Robust inference using weighted least squares and quadratic estimating equations in latent variable modeling with categorical and continuous outcomes. Accessed March 2016
  17. 17.
    Muthén, LK, Muthén BO (2012) Mplus user’s guide. Seventh Edition, Muthén & Muthén, Los Angeles, CAGoogle Scholar
  18. 18.
    Barrett P (2007) Structural equation modelling: adjudging model fit. Personal Individ Differ 42(5):815–824. doi: 10.1016/j.paid.2006.09.018 CrossRefGoogle Scholar
  19. 19.
    Bentler PM, Bonett DG (1980) Significance tests and goodness of fit inthe analysis of covariance structures. Psych Bull 88:588–606. doi: 10.1037/0033-2909.88.3.588 CrossRefGoogle Scholar
  20. 20.
    Hoyle RH (2012) Handbook of strucural equation modeling. The Guildford Press, New YorkGoogle Scholar
  21. 21.
    Wheaton B et al (1977) Assessing reliability and stability in panel models. In: Heise DR (ed) Sociological methodology. Jossey-Bass Inc, San Francisco, pp 84–136Google Scholar
  22. 22.
    Hu LT, Bentler PM (1999) Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Modeling 6:1–55. doi: 10.1080/10705519909540118 CrossRefGoogle Scholar
  23. 23.
    Browne MW, Cudeck R (1990) Single sample cross-validation indices for covariance structures. Multivar Behav Res 24:445–455. doi: 10.1207/s15327906mbr2404_4 CrossRefGoogle Scholar
  24. 24.
    Yu CY (2002) Evaluating cutoff criteria of model fit indices for latent variable models with binary and continuous outcomes. University of California, Los AngelesGoogle Scholar
  25. 25.
    Cronbach LJ (1951) Coefficient alpha and the internal structure of tests. Psychometrika 16(3):297–334. doi: 10.1007/bf02310555 CrossRefGoogle Scholar
  26. 26.
    Dozois DJ et al (2004) Stages of change in anxiety: psychometric properties of the University of Rhode Island Change Assessment (URICA) scale. Behav Res Ther 42(6):711–729. doi: 10.1016/S0005-7967(03)00193-1 CrossRefPubMedGoogle Scholar
  27. 27.
    Hunt YM et al (2006) University of Rhode Island Change Assessment-Trauma: preliminary psychometric properties in an alcohol-dependent PTSD sample. J Trauma Stress 19(6):915–921. doi: 10.1002/jts.20161 CrossRefPubMedGoogle Scholar
  28. 28.
    Arnold HJ, Feldman DC (1981) Social desirability response bias in self-report choice situations. Acad Manag J 24:377–385. doi: 10.2307/255848 CrossRefGoogle Scholar
  29. 29.
    Holland LA, Bodell LP, Keel PK (2013) Psychological factors predict eating disorder onset and maintenance at 10-year follow-up. Eur Eat Disord Rev 21(5):405–410. doi: 10.1002/erv.2241 CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Safer DL et al (2002) Predictors of relapse following successful dialectical behavior therapy for binge eating disorder. Int J Eat Disord 32(2):155–163. doi: 10.1002/eat.10080 CrossRefPubMedGoogle Scholar
  31. 31.
    Strecher VJ et al (1986) The role of self-efficacy in achieving health behavior change. Health Educ Q 13(1):73–92. doi: 10.1177/109019818601300108 CrossRefPubMedGoogle Scholar
  32. 32.
    Resnicow K et al (2008) Tailoring a fruit and vegetable intervention on novel motivational constructs: results of a randomized study. Ann Behav Med 35(2):159–169. doi: 10.1007/s12160-008-9028-9 CrossRefPubMedGoogle Scholar
  33. 33.
    Castelnuovo G et al (2011) The STRATOB study: design of a randomized controlled clinical trial of cognitive behavioral therapy and brief strategic therapy with telecare in patients with obesity and binge-eating disorder referred to residential nutritional rehabilitation. Trials 12:114. doi: 10.1186/1745-6215-12-114 CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Hankey CR, Leslie WS, Lean ME (2002) Why lose weight? Reasons for seeking weight loss by overweight but otherwise healthy men. Int J Obes Relat Metab Disord 26(6):880–882. doi: 10.1038/sj.ijo.0801999 CrossRefPubMedGoogle Scholar
  35. 35.
    Mastellos N et al (2014) Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults. Cochrane Database Syst Rev 2:CD008066. doi: 10.1002/14651858.CD008066.pub3 CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Giada Pietrabissa
    • 1
    • 2
    Email author
  • Angela Sorgente
    • 2
  • Alessandro Rossi
    • 1
  • Susan Simpson
    • 3
  • Giuseppe Riva
    • 2
    • 4
  • Gian Mauro Manzoni
    • 1
    • 5
  • James O. Prochaska
    • 6
  • Janice M. Prochaska
    • 7
  • Roberto Cattivelli
    • 1
    • 2
  • Gianluca Castelnuovo
    • 1
    • 2
  1. 1.Psychology Research LaboratoryOspedale San Giuseppe, IRCCS, Istituto Auxologico ItalianoVerbaniaItaly
  2. 2.Department of PsychologyCatholic University of MilanMilanItaly
  3. 3.School of Psychology, Social Work and Social Policy, University of South AustraliaAdelaideAustralia
  4. 4.Applied Technology for Neuro-Psychology LaboratoryIstituto Auxologico Italiano IRCCSMilanItaly
  5. 5.Faculty of PsychologyeCampus UniversityNovedrateItaly
  6. 6.Department of PsychologyUniversity of Rhode IslandKingstonUSA
  7. 7.Pro-Change Behavior Systems, IncWest KingstonUSA

Personalised recommendations