Stages of Concern Questionnaire (SoC)
Stages of Concern Questionnaire · Also known as: SoC, Stages of Concern, SoC Questionnaire, CBAM-SoC
The Stages of Concern Questionnaire (SoC) is a 35-item self-report instrument that measures the types and intensity of concerns individuals experience when adopting new practices, technologies, or innovations. Developed by Hall and colleagues in the 1970s as part of the Concerns-Based Adoption Model (CBAM), the SoC measures seven stages of concern: Awareness (low concern about the innovation), Informational (interest in learning more), Personal (worry about one's competence and impact on one's role), Management (concern about logistics, time, and workflow integration), Consequence (focus on innovation's impact on students or clients), Collaboration (concern about coordinating with colleagues), and Refocusing (desire to modify or improve the innovation). The SoC has been widely used in education and increasingly in healthcare settings to understand implementation barriers from an individual change perspective and to tailor support strategies to address specific concerns.
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When to use it
The SoC is designed to assess individual concerns during implementation of innovations, changes, or new practices in any setting. It is particularly valuable in education, where it originated, but is increasingly used in healthcare implementation. Administer SoC at baseline (before implementation or very early in implementation) to identify concern profiles and stratify staff into support groups. Readminister at 3, 6, and 12 months post-implementation to track concern evolution. Early Stages (Awareness, Informational, Personal, Management) are expected at baseline and should decline by month 6 as staff move to Later Stages (Consequence, Collaboration, Refocusing). Stalled or increasing early-stage concerns at month 6 indicate implementation problems (inadequate support, workflow barriers) requiring intervention.
Strengths & limitations
- Individual-level diagnosis—identifies specific concerns of individual staff members, allowing segmentation and tailored support rather than one-size-fits-all approaches
- Stage progression model—tracks concern evolution over time; early-stage concerns (Awareness, Informational, Personal, Management) are expected early and should resolve, while later-stage concerns (Consequence, Collaboration, Refocusing) should increase, indicating maturation
- Predicts support needs—high Personal concerns predict need for confidence coaching and competence-building; high Management concerns predict need for workflow redesign; high Consequence concerns predict readiness for advanced responsibilities; allows organizations to match support to need
- Long track record—used since 1977; extensive literature documenting validity and effectiveness in education; growing validation in healthcare
- Practical implementation—35 items take only 5–8 minutes; results are intuitive and actionable for managers and implementation teams
- Assumes developmental progression—SoC theory assumes all individuals progress through stages in order (Awareness → Informational → Personal → Management → Consequence → Collaboration → Refocusing). Some individuals may cycle back or remain stuck in particular concerns despite time passage. Progression is not inevitable without targeted intervention
- Cultural and contextual variation—concern intensities and trajectories may vary by organizational culture, role, baseline competence, and innovation complexity. Early adopters in highly supportive settings may show different SoC profiles than resistors in resource-constrained settings; comparison across contexts requires caution
- Self-report bias—respondents may underreport concerns (e.g., Personal concerns about competence) if they perceive evaluation or social desirability pressure. Anonymous administration and confidentiality assurance improve data quality
- Limited guidance on intervention intensity—SoC identifies high concerns but does not specify intervention doses or expected concern reduction timelines. Organizations must infer from literature or experience how much coaching reduces Personal concerns or how much workflow redesign reduces Management concerns
Frequently asked
What does it mean if someone scores high on multiple stages simultaneously (e.g., high Personal AND high Consequence)?
This is common and indicates a complex concern profile. High Personal + high Consequence means someone cares deeply about impact on patients/clients (Consequence focus) but doubts their own competence (Personal concern). These individuals often become excellent implementers once Personal concerns are addressed (through training, coaching) because their motivation (Consequence focus) is intrinsic. Support by building competence through peer mentoring or advanced workshops rather than generic training.
Can SoC be used to identify staff who should NOT participate in implementation?
SoC is a diagnostic tool, not a screening tool for exclusion. High early-stage concerns (Personal, Management) predict need for support, not unsuitability for implementation. In fact, staff with high Personal concerns often become more skilled implementers once they gain competence, because they care about doing it right. Exclude staff based on objective factors (minimal patient contact, imminent retirement) rather than SoC profile; instead, provide targeted support to address SoC-identified concerns.
Is it normal for concerns to increase at some stages during implementation?
Yes—as implementation progresses and staff gain competence, Personal and Management concerns should decline, while Consequence, Collaboration, and Refocusing concerns should increase. However, if early-stage concerns (Personal, Management) increase at month 6 or later, this is a red flag indicating implementation disruption (new workflow changes, competing priorities, loss of support) requiring intervention. Monitor SoC trajectories; downward trajectory for early stages and upward trajectory for later stages predicts success.
Should different roles (clinicians vs. managers) be assessed separately?
Yes—different roles often show distinct SoC profiles. Clinicians may have high Personal or Management concerns (direct workflow impact), while managers may have high Consequence or Collaboration concerns (focus on team and outcomes). Separate reporting reveals role-specific barriers. For example, if managers score high Refocusing (want to modify the innovation) but clinicians score high Personal (struggling with use), stratified results guide distinct interventions: support clinicians' competence while channeling managers' improvement ideas.
How do I convert SoC scores to percentiles?
Each stage has a different number of items (3–5). Compute raw sum for each stage. Maximum possible sum per stage = 7 × number of items for that stage. Percentile = (Raw Sum / Maximum Possible Sum) × 100. Example: Awareness stage has 4 items, max possible = 28. If a respondent sums to 15, percentile = (15/28) × 100 = 54th percentile. Use percentile scale to compare across stages fairly (different item counts are normalized).
Sources
- George, A. A., Hall, G. E., & Stiegelbauer, S. M. (2006). Measuring implementation in schools: the stages of concern about the innovation. Journal of Educational and Psychological Consultation, 16(3), 189–211. link ↗
- Hall, G. E., George, A. A., & Rutherford, W. L. (1977). Measuring Stages of Concern about the Innovation: A manual for use of the Stages of Concern Questionnaire. Austin, TX: Southwest Educational Development Laboratory. link ↗
How to cite this page
ScholarGate. (2026, June 3). Stages of Concern Questionnaire. ScholarGate. https://scholargate.app/en/implementation-science/stages-of-concern-questionnaire
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