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. Author manuscript; available in PMC: 2011 Sep 1.
Published in final edited form as: Eval Health Prof. 2010 May 10;33(3):256–275. doi: 10.1177/0163278710363960

Table 1.

Procedures of the Post/Follow-up Commitment to Change (CTC) Approach

Stage Component Component Description Procedure Timing
Initial CTC
Request		 Question
soliciting a
CTC statement		 Participants are asked to list their
intended changes in practice (if any)
resulting from attending an
educational event. Participants are
often asked to identify up to 3-5
“specific,” “concrete” and/or
“measurable” changes. The words
“commitment to change” may or may
not be used in the request (e.g., they
may be included in a form title).		 A form or a card is
provided during or
immediately after
the event. A
sample form may
be part of the
registration
materials. A CTC
request may be embedded in the
course evaluation.
Time may be left
at the end of the
event to complete
the form. A self-
addressed
envelope may be
used. Participants
may be provided
an incentive (e.g.,
registration fee
discount).		 A
form/card
is collected
at the end
of an
educational
event.
Strength of
commitment
question		 Participants may be asked to
designate a level of commitment to a
change, using the Likert scale (e.g.,
from 1=lowest to 5=highest level of
commitment).
Signature Form may include a signature line.
Follow-up Reminder of
intended
changes		 The completed form/card is used as a
reminder of personal intended
changes.		 Usually, a copy of
the original CTC
form/card and a
questionnaire
about
implementation
and barriers are
mailed to
participants. A
follow-up may
also be done
through telephone
interviewing. A
2nd follow-up may
be used to reach
either non-
respondents only
or all participants.		 1-6 months
post event
(a 2nd
follow-up
may be
done 1-2
months
after the 1st
follow-up).
Question(s)
about
implementation		 Participants are asked if they
implemented their intended changes.
The answer choices may be yes/no or
specific degrees of implementation
(e.g., fully implemented/partially
implemented/not implemented;
implemented one out of three/two out
of three/all three).
Question(s)
about barriers		 In most cases, follow-up includes
questions about barriers to
change/reasons for non-
implementation. A list with the
barriers to choose from may be
included.
Additional
questions		 Participants may also be asked about:
sources of information that
precipitated changes; the degree of
difficulty of making the change (e.g.,
using a 5-point Likert scale); the
number of patients affected by the
change; and intention to continue
with the initiated changes.

Reviewed studies:

Curry and Purkis (1986); Dolcourt (2000); Eckstrom et al. (2008); Green et al. (2003); Habermann et al. (2002); Jones (1990); Lockyer et al. (2001); Lockyer et al. (2005); Mazmanian et al. (1998); Mazmanian et al. (2001); Pereles et al. (1997); Purkis (1982)