The process of perspective transformation: Instrument development and testing in smokers and ex-smokers

This exploratory descriptive study, utilizing a methodological design, further explored the process of perspective transformation (PT) in the substantive smoking area. The purpose of the study was twofold: (1) to test the psychometric properties of two adapted instruments: the Marsh Revelation Readiness Index (MRRI) and adapted Marsh Revelation Scale (MRS), and (2) to estimate elements of the PT process.

The theoretical framework focused on measurement and the PT theories. A synthesized process model of PT emerged from related theories and relevant qualitative research of empowerment (Freire, 1970), PT in education (Lytle, 1990; Mezirow, 1981), revelation (Marsh, 1989), and health (Newman, 1986). The synthesized PT model reflects the three stages of readiness, revelation, and sustained change over time, with the corresponding concepts of: life dissatisfaction, critical analysis, and social support; knowledge, mystical experience, power, and redefined perspective; and time respectively.

Adaptations further indexing the PT domain were included in Marsh's (1989) newly developed norm referenced instruments. Five panel experts provided content validity estimates. Further revision and downsizing of the adapted MRRI and MRS to 36 and 62 five-point Likert scaled items respectively followed a pilot study (N = 60) reflecting acceptable initial internal consistency reliabilities and construct validities.

The adapted instruments were tested over a period of one year, by 159 employed mid-south adult women, aged 25-55 years, who were exsmokers for 1 to 5 years, smokers, or in the process of either unsuccessfully or successfully changing for less than one year. A second 24 member sample failed to meet the specified age, sex, and exsmoking time criteria; a third group combined samples 1 and 2.

Six reliability and validity focused hypotheses were tested. The adapted instruments reflected initial acceptable internal consistency reliabilities of 0.8634 or higher. Contrasted groups failed to detect any construct validity, although item analyses offered some limited support. Varimax factor analyses, extracting exclusive factor trends, provided partial construct validity. Content analyses of successful non-smokers' written accounts of the smoking cessation process, through two process matrixes, offered further estimates of the PT process and added support for the factor trends. The study's findings provide guidance and direction for future considerations and research avenues regarding the PT process, health behavior lifestyle changes, and usefulness to nursing.