The Attitude to Health Change scale(s)(AHC)

People who have chronic, life-limiting or terminal illnesses experience a considerable number of physical challenges relating to their condition, treatment and side effects. These challenges are often accompanied by emotional, mental, behavioural and spiritual issues that the person also needs to manage.

The Attitude to Health Change scales (AHC) are designed to help health and social care professionals who have contact with patients and carers to carry out an effective assessment of the impact of the illness on patients and their carers, and their ability to cope with it. It can also be used to monitor and review the changes in health perspective along the illness journey and to consider the effectiveness of the support being offered.

In 2019 a study which evaluated the perceived merits of the AHC scales, from the perspectives of practitioners using the scales with patients and carers in a palliative care setting, was conducted by Lancaster University, International Observatory on End of Life Care. Overall, the scales were viewed positively as assessment, intervention and outcome tools and for their capacity to generate conversations about the psychological impact of life-limiting illness (Dunleavy, L., Walshe, C, and Machin, L. 2020). A new iteration of the AHCs resulted from this study ( Machin, L, Walshe, C. and Dunleavy, L. 2021) and can be accessed from the Resources page. Further research is in progress to validate the scales.


Dunleavy, L., Walshe, C, and Machin, L. (2020) Exploring the psychological impact of life-limiting illness using the Attitude to Health Change scales: A qualitative focus group study in a hospice palliative care setting. European Journal of Cancer Care. DOI: 10.1111/ecc.13302.

Machin, L., Walshe, C, and Dunleavey, L. (2021) Exploring Specialist Palliative Care Practitioner Perspectives on the Face Validity of the Attitude to Health Change Scales in Assessing the Impact of Life-limiting Illness on Patients and Carers. Journal of Palliative Care.

Children’s Attitude to Grief scale (CAG)

Children and young people can be especially vulnerable when bereaved. Helping them articulate their feelings and thoughts through the CAG scale can be a useful step in finding the areas in which help is most needed and in monitoring their progress.

Attitude to Life Losses scale (ALL) 

The ALL scale has the potential for use in a range of practice settings where loss is a central issue.  

Guidance for the use of the AHC scales, CAG scale and the ALL scale reflect the same concepts based on the RRL and follow the same principles as those described for the practice use of the AAG. The scales can be accessed from the Resource page.

Interest in these scales or questions about them, please contact Linda Machin