PAS - Health Care Climate

The Health Care Climate Questionnaire (HCCQ)

Scale Description

The HCCQ has a long form containing 15 items and a short form containing 6 of the items. There are also variants to the questionnaire. Specifically, depending on the issue being examined, the HCCQ can be used to assess patients' perceptions of the degree to which their specific doctor is autonomy supportive, or it can be used to assess patients' perceptions of the degree to which their team of health care providers is autonomy supportive. The latter would be more appropriate for example, if patients are seeing several providers within a clinic to deal with a particular problem. For example, patients with diabetes may see a physician, a nurse educator, and a dietician, all working together to treat the disease. If a researcher were interested in the relation between physician's interpersonal style and their patients' motivation, behavior, and health, the questionnaire is best used with respect to the individual doctor. If the research question concerns the interpersonal climate of a clinic or group of providers, the word "providers" or "practitioners" is substituted for "physician" or "doctor." Below, you will find the 15-item version of the questionnaire, worded in terms of "my physician." If you would like to use the 6-item version, simply reconstitute the questionnaire using only items # 1, 2, 4, 7, 10, and 14.

Scoring: Scores on both the 15-item version and the 6-item version are calculated by averaging the individual item scores. However, for the long version, before averaging the item scores, you must first "reverse" the score of item 13 (i.e., subtract the score on item 13 from 8 and use the result as the item score for this item--for example, the score of 3, when reversed would become 5). Higher average scores represent a higher level of perceived autonomy support.

 


 

Articles that have Used the Health Care Climate Questionnaire (or an earlier version).

Williams, G. C., Cox, E. M., Kouides, R., & Deci, E. L. (1999). Presenting the facts about smoking to adolescents: The effects of an autonomy supportive style. Archives of Pediatrics and Adolescent Medicine, 153, 959-964.
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Kasser, V. M., & Ryan, R. M. (1999). The relation of psychological needs for autonomy and relatedness to health, vitality, well-being and mortality in a nursing home. Journal of Applied Social Psychology, 29, 935-954.
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Williams, G. C., Rodin, G. C., Ryan, R. M., Grolnick, W. S., & Deci, E. L. (1998). Autonomous regulation and adherence to long-term medical regimens in adult outpatients. Health Psychology, 17, 269-276.

Williams, G. C., Freedman, Z. R., & Deci, E. L. (1998). Supporting autonomy to motivate glucose control in patients with diabetes. Diabetes Care, 21, 1644-1651.
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Williams, G. C., Grow, V. M., Freedman, Z. R., Ryan, R. M., & Deci, E. L. (1996). Motivational predictors of weight loss and weight-loss maintenance. Journal of Personality and Social Psychology, 70, 115-126.

Williams, G. C., Gagné, M, Ryan, R, M., & Deci, E. L. (2002). Supporting autonomy to motivate smoking cessation: A test of self-determination theory. Health Psychology 21, 40-50.

Williams, G. C. & Deci, E. L. (2001). Activating patients for smoking cessation through physician autonomy support. Medical Care 39, 813-823.


The HCCQ as a rating device.

The HCCQ was designed to be used by patients to report their perceptions of their doctors or their team of health care providers. However, it has also been used effectively for having trained observers rate the autonomy supportiveness of a provider, based on listening to tape recorded interactions between providers and patients. Observers have some initial training until they are able to achieve high inter-rater reliability with other observers. The rater listens to the tape and responds to each item as if he or she were the patients. The score for the provider's rated autonomy support is the average of the 15 ratings (after reverse scoring item 13 as explained above in the instructions for scoring). Typically, in studies that involve ratings, there are at least two raters so as the assure reliability. These can be used in two ways. Either the scores of two or more raters can be averaged, or, if the analyses are being done by Structural Equation Modelling, the average rater score for each of three raters can be used as indicators of the latent variable "rated provider autonomy support."

This method was used in the following study.

Williams, G. C., & Deci, E. L. (2001). Activating patients for smoking cessation through physician autonomy support. Medical Care, 39, 813-823