Educational interventions that increase patient motivation to pursue living donor kidney transplant (LDKT), positive attitudinal change, and self-efficacy have been shown to increase LDKT rates, however measures of these variables have never been validated. Using the Transtheoretical Model of Behavioral Change (TTM) as a theoretical foundation, we developed three new measures of patient LDKT decision-making: (1) Stage of Change (SOC), a measure of their readiness to pursue LDKT, (2) Decisional Balance (DB), a measure of how they weigh the advantages and disadvantages of LDKT, and (3) Self-efficacy (SE), a measure of their belief that they can take LDKT actions in difficult circumstances. We conducted telephone surveys with two independent samples of Black and White kidney patients (N1 = 279, 50% Black; N2 = 204, 34% Black) and used factor analytic, structural modeling, and invariance procedures to test the internal and external validity of the LDKT decision-making measures.

Analyses on the first sample resulted in DB and SE factor structures similar to previous applications of the TTM to other health behaviors, showing excellent model fit and good internal validity for DB (Χ2 (53) = 68.45, p > .05, CFI = .97, AASR = .04, Pros Α = .78, Cons Α = .77) and SE (Χ2 (9) = 26.501, p < .01, CFI = .96, AASR = .02, Α = .90). Analyses on the second sample again found excellent model fit and good internal validity for DB (Χ2 (54) = 94.06, p < .01, CFI = .95 and AASR = .04, Pros Α = .86, Cons Α = .80) and SE (Χ2 (9) = 43.45, p < .01, CFI = .95, AASR = .04, Α =.88), and produced an externally valid assessment of SOC. Both samples were combined to analyze the measures for factorial invariance (testing the assumption that measures of constructs have the same meaning in two or more groups) by race and education level. Results showed the strongest level of invariance across these groups, indicating high construct validity of the measures for all races and education levels. These validated patient decision-making measures can now be used to tailor LDKT interventions to the needs of kidney patients as well as assess the effectiveness of these interventions.

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