Document Type


Date of Award


Degree Name

Doctor of Philosophy (PhD)


Health Science

First Advisor

Haifa Samra


Type II diabetes is one of the most devastating chronic diseases in the United States and is associated with decreased lifespan and serious comorbidities. While evidence-based prevention strategies of nutrition and physical activity exist, behavior change is an essential component. Researchers use readiness to change to predict clinical outcomes of chronic disease prevention programs, however, this has not been well studied in rural populations. The purpose of this research was to study the relationship between readiness to change and attrition rates and clinical outcomes among rural dwellers enrolled in a nutrition and physical activity intervention. Article one of this three-article dissertation is a concept analysis, which resulted in an operational definition that readiness to change is the commitment and intention to engage in motivating cognitions and tasks necessary for sustainable behavior change leading to an expected outcome. This definition was used for tool validation and psychometric analyses in article two. Finally, the newly validated tool was used in article three to answer the primary questions of this research regarding the relationship between readiness to change and attrition and clinical outcomes. Results indicated that while readiness to change was not related to attrition nor did the stage of Readiness to Change predict attrition, the covariates of income and geography modified this relationship significantly. There was no significant relationship between readiness to change and weight, hemoglobin A1C, or blood glucose. However, a moderately strong effect size of 0.65 could indicate clinical significance in these results. This documents the need for future research with a larger sample size.

Subject Categories

Behavioral Disciplines and Activities | Behavior and Behavior Mechanisms


diabetes prevention; prediabetes; Readiness to change; rural health

Number of Pages



University of South Dakota