Measures of self-efficacy: Arthritis Self-Efficacy Scale (ASES), Arthritis Self-Efficacy Scale-8 Item (ASES-8), Children's Arthritis Self-Efficacy Scale (CASE), Chronic Disease Self-Efficacy Scale (CDSES), Parent's Arthritis Self-Efficacy Scale (PASE), and Rheumatoid Arthritis Self-Efficacy Scale (RASE)

Authors

  • Teresa J. Brady

    Corresponding author
    1. Centers for Disease Control and Prevention, Atlanta, Georgia
    • Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS K-51, Atlanta, GA 30341
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  • The findings and conclusions herein are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

INTRODUCTION

Enhancing self-efficacy has become an essential feature of many arthritis management interventions because of its robust relationships with health behaviors and health status. Empirical studies document that self-efficacy predicts health behaviors such as physical activity, eating behaviors, and pain coping strategies (1). In rheumatoid arthritis and osteoarthritis, self-efficacy has also been correlated with measures of health status such as daily pain and mood ratings (2), pain, stiffness, function, and physical and mental well-being (3); it has also been correlated with changes in pain, function, and depression (4). Adherence with medications and other health recommendations has also been associated with self-efficacy (5, 6). In addition to evidence that self-efficacy is associated with health behaviors, current and future health status, and adherence to health recommendations, the fact that self-efficacy can change through efficacy-enhancing interventions makes it a rich target of arthritis interventions (1).

Self-efficacy, defined in Bandura's seminal 1977 article as “the conviction that one can successfully execute the behavior required to produce the outcomes” (7), was hypothesized to influence whether a behavior was initiated and sustained despite obstacles or adverse experiences, and to influence the level of effort invested in the behavior. Bandura's definition of self-efficacy evolved slightly over time; in his 1997 publication, Bandura defined self-efficacy as “belief in one's capability to organize and execute the courses of action required to produce given attainments” (8). Bandura has consistently described self-efficacy as domain specific and distinct from other constructs in social learning theory such as outcome expectations, defined as a person's estimate that a given behavior will lead to certain outcomes (7). Self-efficacy beliefs are also conceptualized as distinct from actual ability to perform a task (e.g., can I ride a bicycle), actual task performance (e.g., do I ride a bicycle), or intention to perform task (e.g., do I intend to ride a bicycle) (8, 9). These different types of beliefs are clearly distinguished in Gecht et al's survey of exercise beliefs and habits among people with arthritis (10). In that survey, respondents were asked about their self-efficacy expectations regarding exercise (“If I want to exercise, I know I can do it”), and their outcome expectations regarding exercise (“regular exercise will probably make my arthritis worse in the future”); they were also asked to report their actual behavior (how often they did specific exercises in the past 2 weeks). Self-efficacy theory hypothesizes that both efficacy expectations and outcome expectations influence whether or not an individual will initiate and sustain a specific behavior (7). Gecht et al found that positive outcome expectations and self-efficacy for exercise were associated with participation in exercise (10). Conversely, self-efficacy theory predicts that if a patient believes that they can exercise (self-efficacy expectation) but also believes that exercise will be harmful for their arthritis (outcome expectation), the patient would be less likely to exercise than if they expected positive outcomes from exercise (7). Social learning theory suggests that it is important for clinicians and others hoping to help a person adopt health behaviors to understand both whether the person believes they can perform the behavior, and whether they believe that behavior will lead to positive outcomes.

Outcome expectations have received very little attention in arthritis-related research, but self-efficacy has been measured extensively (11). This review focuses on self-efficacy measures in the domain of arthritis management, and measures frequently used in arthritis management intervention studies (i.e., Arthritis Self-Efficacy Scales [12], Rheumatoid Arthritis Self-Efficacy Scale [13]). One nonarthritis specific measure, the Chronic Diseases Self-Efficacy Scale (14), is included because it is frequently used in evaluation of self-management education programs. The review also includes a child-focused measure, the Children's Arthritis Self-Efficacy Scale (15), and a companion scale focused on parents' self-efficacy to manage arthritis-specific parenting tasks, the Parent's Arthritis Self-Efficacy Scale (16).

There are a number of related domain-specific measures, such as exercise self-efficacy scales (17, 18), self-efficacy for managing anterior cruciate ligament injuries (19), and chronic pain self-efficacy scales (20–22), that are not reviewed here. However, all are included in a 2006 review by van Hartingsveld et al that covers a wide number of measures of patient expectations, including self-efficacy, across a wide range of musculoskeletal conditions (23).

Also not included in this review are scales which include the term self-efficacy in their titles, but do not measure domain- or behavior-specific efficacy beliefs such as the Generalized Self-Efficacy Scale (24, 25) and the Self-Efficacy Scale (26). These general scales measure global beliefs in self-efficacy without specifying activities or conditions (e.g., “I can handle whatever comes my way,” or “I can always manage to solve difficult problems”) and are designed to assess a unidimensional global perception or static trait (25) rather than changeable domain- or behavior-specific beliefs. As such, these general scales appear more closely related to measures of perceived coping competence or mastery (27) rather than the domain-specific construct of self-efficacy as delineated by Bandura (7).

One area in the conceptualization and operationalization of self-efficacy that remains unclear in the literature is the delineation between efficacy expectations and outcome expectations, and this ambiguity is reflected in self-efficacy measures. In his more recent writings, Bandura has focused on self-efficacy as a person's belief in their “capability to produce given attainments” (8, 18) rather than to execute the behavior required to produce outcomes (7); although in distinguishing self-efficacy from locus of control, Bandura described perceived self-efficacy as “beliefs about whether one can produce certain actions” while describing locus of control as “beliefs about whether actions affect outcomes” (8). Bandura cautioned against confusing performance, an accomplishment specified by descriptive markers (e.g., the academic grades of A, B, C, D, and F), with outcome, defined as something that flows from performance (specifically positive or negative physical, social, or self-evaluative effects) (8). This delineation between performance (attainment) and the physical, social, or self-evaluative effects (outcomes) that follow from that attainment is reasonably clear when considering academic grades (can I perform to the level of an A) but less clear when examining symptom relief, such as relief of pain (28). Some arthritis-related self-efficacy measures, such as the Arthritis Self-Efficacy Scales (12), consider symptom relief part of the efficacy belief (as a descriptive marker of the accomplishment), while others, such as the Rheumatoid Arthritis Self-Efficacy Scale (13), which focuses more on the execution of behaviors, consider symptom relief an outcome expectation (and not part of the efficacy belief). These distinctions are highlighted in the following review of measures.

ARTHRITIS SELF-EFFICACY SCALE (ASES)

Description

Purpose.

The ASES was developed to measure patients' arthritis-specific self-efficacy, or patients' beliefs that they could perform specific tasks or behaviors to cope with the consequences of arthritis (12). The initial scale was published in 1989, and it was the first arthritis-specific measure of self-efficacy to appear in the literature. It remains the most widely used arthritis-specific measure. ASES was originally developed to help explain changes resulting from health education interventions in arthritis, and was developed using samples of people with arthritis attending community-based education programs, but has since been used in clinically based samples as well. The full 20-item scale has been translated into Swedish (29), Dutch (30), and Turkish (31). A shorter 8-item version of the ASES is available; see information of 8-item ASES reviewed elsewhere in this article.

Content.

Items are designed to capture how certain the individual is that they can perform a specific activity or achieve a result. Items include specific behaviors (e.g., “Walk 100 feet on flat ground in 20 seconds” or “Scratch your upper back with both your right and left hands”) and performance-attainment items (e.g., “Decrease your pain quite a bit,” or “Control your fatigue”).

Number of items.

Original ASES has 20 items in 3 subscales: self-efficacy for managing pain (PSE), 5 items; self-efficacy for physical function (FSE), 9 items; and self-efficacy for controlling other symptoms (OSE), 6 items.

Response options/scale.

Items are rated on a 10 (very uncertain) to 100 (very certain) rating scale, in 10-point increments. More recent versions of ASES have converted this to a 1–10 scale, as demonstrated on the web site where the scale is available (URL: http://patienteducation.stanford.edu/). The scale asks the respondent “how certain are you that you can” keep arthritis pain from interfering with your sleep (example from pain subscale), walk 10 steps downstairs in 10 seconds (example from function subscale), and control your fatigue, or do something to help yourself if you are feeling blue (examples from other symptoms subscale).

Recall period for items.

Now or at the present time.

Endorsements.

There are no noted endorsements.

Examples of use.

ASES has been used in the evaluation of the Arthritis Self-Management Program (32, 33) and in investigations of the association of self-efficacy to various health outcomes (34–36).

Practical Application

How to obtain.

A copy of the ASES is included in the original publication (12). The full scale as well as the shortened scale are available from the web site of the Stanford Patient Education Research Center, URL: http://patienteducation.stanford.edu/.

Method of administration.

Written, self-administered self-report questionnaire.

Scoring.

Scoring instructions are provided on the web site (listed above), including instructions for handling missing values. Computer scoring is not required; scoring requires simple addition and division to calculate mean scores for each subscale.

Score interpretation.

Score range is 10–100 or 1–10 for each subscale, depending on response options used. Higher scores indicate greater confidence or self-efficacy. No cut points or population-based norms are provided, although mean scores from the validation sample are provided.

Respondent burden.

Time to complete is not reported, but estimated to be 5–10 minutes to complete all 20 items. Reading level appears appropriate, although some items may be complex (i.e., asking respondent to consider their certainty, about managing symptoms, to do desired activities).

Administrative burden.

No training is required to administer ASES, scoring time requires calculation of 3 mean scores.

Translations/adaptations.

The full 20-item ASES has been revalidated in Swedish (29, 37), Dutch (30), and Turkish (31). The PSE and OSE subscales were evaluated for appropriateness for use with community-based samples in the UK, and determined to be appropriate, valid, and reliable with no modification necessary (38). The Swedish ASES was also adapted for chronic pain patients by replacing “arthritis” with “disease,” and “arthritis pain” with “pain.”

Psychometric Information

Method of development.

A rheumatologist generated 23 original items; these items were refined, and an additional 20 items added following 3 focus groups of people with arthritis. Initial validation sample (n = 97) produced a 2-factor solution (other symptoms, function) using 25 items. The replication study (n = 144) produced a 3-factor solution (pain, other symptoms, function) using 20 items. Developers stated that the choice between the 2 and 3 factor solution was arbitrary, and they based the decision on the importance of pain and the performance of the other symptoms subscale in regard to depression. The Turkish translation of ASES resulted in a 4-factor solution, with function separated into upper and lower function. An item response theory analysis of the PSE and OSE subscales suggested the possibility that a single unidimensional factor underlies these 2 subscales, although 2 items needed to be removed to improve the fit of this 1-factor solution (38).

Acceptability.

Original validation study does not address acceptability or missing items. The revalidation in the UK reported that no problems with comprehension, completion, or missing data were observed. It is not known if any ceiling or floor effects exist (28).

Reliability.

Internal consistency reliability was estimated via Cronbach's alpha using data from 144 people who had registered for a community-based arthritis education program. Cronbach's alpha for PSE was 0.76, for FSE was 0.89, and for OSE was 0.87. Test–retest reliability (2–29 days between retesting) was calculated using respondents who had previously completed a community-based arthritis education program (n = 91). Test–retest reliability coefficients for PSE was 0.87, for FSE was 0.85, and for OSE was 0.90.

Validity.

Initial validation was done using the same samples as were used for the development of the subscales, participants who had registered or completed a community-based arthritis education program. Construct validity was demonstrated by finding significant correlations among ASES subscales and measures of health status (pain, disability, and depression). Concurrent correlations between the pain subscale and health status measures were −0.29 for pain, −0.21 for disability, and −0.33 for depression. Concurrent correlations between the function subscale and health status measures were −0.29 for pain, −0.76 for disability, and −0.16 for depression. Concurrent correlations between other symptoms subscale and health status measures were −0.27 for pain, −0.25 for disability, and −0.44 for depression. Correlations of baseline self-efficacy with health status at 4 months for the pain subscale were −0.39 for pain, −0.21 for disability, and −0.45 for depression. Correlations of baseline self-efficacy with health status at 4 months for the function subscale were −0.30 for pain, −0.71 for disability, and −0.30 for depression. Correlations of baseline self-efficacy with health status at 4 months for the other symptoms subscale were −0.47 for pain, −0.21 for disability, and −0.59 for depression. In addition, participants who had participated in the arthritis education program showed greater change in self-efficacy scores than those that had not. Translated versions of the full ASES found similar theoretically relevant corrections with health status measures.

Ability to detect change.

Sensitivity is unknown. Participants in the Arthritis Self-Management Program did demonstrate changes in ASES scores; although these changes were not statistically significant in the initial validation study, they were significant in subsequent evaluations of the Arthritis Self-Management Program.

Critical Appraisal of Overall Value to the Rheumatology Community

Strengths.

Self-efficacy has become an important construct in understanding arthritis management and arthritis interventions, and the ASES (either the full 20-item scale or the 8-item scale) is the most common instrument used to measure self-efficacy for managing arthritis. The full ASES includes 3 subscales (pain, function, and other symptoms) assumed to be distinct in arthritis management, and this factor structure has been replicated in translated versions, although an item response theory analysis has raised questions about a single factor structure underlying PSE and OSE. The measure has been extensively used in evaluating education interventions and some clinical interventions as well. Items do cover a range of levels of task difficulty. All 3 subscales demonstrate good internal consistency and test–retest reliability, and are correlated with theoretically relevant health outcomes.

Caveats and cautions.

In the initial validation article, the authors raise the question on whether they are capturing self-efficacy for behavior or outcome or some combination, but conclude that the distinction is not central for their purpose of identifying elements of health education programs that contribute to decreasing pain and increasing well-being and activity potential. Although the ASES does correlate with relevant health status measures, other aspects of self-efficacy theory, such as prediction of initiation or persistence of behavior, have not been examined. Some concerns have been raised that some items, particularly on the FSE, may tap actual performance rather than efficacy beliefs, and in the initial validation study, there was a 0.61 correlation between FSE and observed task performance (28). The majority of the validation studies have been conducted with community-based samples of people with arthritis; there has been no psychometric evaluation of comparability with a clinical population.

Clinical usability.

Neither the administrative nor respondent burden should preclude its use, but the absence of any population-based norms or cut-off scores make it difficult to interpret an individual's score.

Research usability.

The available psychometric data, including good reliability, validity, and demonstrated change with interventions, all suggest the ASES is appropriate for use in research. Neither the administrative nor respondent burden should preclude its use, although many investigators are using the 8-item version (reviewed elsewhere in this article).

ARTHRITIS SELF-EFFICACY SCALE-8 ITEM (ASES-8)

Description

Purpose.

Because the label Arthritis Self-efficacy Scale is used in the literature to refer to both the full ASES (20 items, 3 subscales) and the shortened 8-item ASES, and because the reference for the validation of the original 20-item scale is used to support the 8-item version, investigators may be unaware of the extent of the psychometric support for the 8-item measure. For the purpose of this review this shorter measure has been christened the ASES-8. It is reviewed here as a separate measure because its psychometric support is significantly different than that of the original ASES. The ASES-8 was developed in the process of developing a set of Spanish-language health assessment instruments to be used in health promotion research. The original Spanish scale was published in 1995 (39). In 2003, a German language ASES-8 was validated with a small sample of patients with rheumatoid arthritis (n = 43) and 2 larger samples of people with fibromyalgia (40). While the ASES-8 is available in English, no psychometric studies of the English version have been published beyond mean and SD, and internal consistency reliability reported on the developer web site.

Content.

The ASES-8 includes 2 items from the ASES pain subscale, 4 items from the ASES other symptoms subscale, and 2 new items related to preventing pain and fatigue from interfering with things you want to do.

Number of items.

The total scale includes 8 items with no subscales.

Response options/scale.

1 (very uncertain) to 10 (very certain). Item stem for each question begins “How certain that you can. …”

Recall period for items.

Now.

Endorsements.

There are no noted endorsements.

Examples of use.

ASES-8 has been used in evaluations of self-management education programs (41–43), physical activity interventions (44), and associations of self-efficacy with various health outcomes (45, 46).

Practical Application

How to obtain.

Spanish ASES-8 is available in original publication. Spanish and English versions are available from the web site of the Stanford Patient Education Research Center, URL: http://patienteducation.stanford.edu/.

Method of administration.

The majority of the psychometric evaluation of the Spanish ASES-8 was done by interviewer administration; an undisclosed number were done by written self-report in the replication study.

Scoring.

Scoring for the ASES-8 Spanish and English versions are available on the Stanford Patient Education Research Center web site, including instructions for handling missing items. No computer is necessary for scoring, which consists of calculating the mean of 8 item ratings.

Score interpretation.

Scores range from 1–10. No cut points or population norms are available, although the mean scores for the Spanish validation sample, and an unpublished sample drawn from participants in the Arthritis Self-Management Program (n = 175), are provided on the Stanford Patient Education Research Center web site.

Respondent burden.

Time to complete is not described, but assumed to be <5 minutes. Spanish items were pretested by interview and no difficulties noted; it is not clear if the written format is similarly problem free.

Administrative burden.

No training is necessary for administration, and scoring is simple calculation of a mean score.

Translations/adaptations.

ASES-8 was originally developed for Spanish-speaking respondents, although it is now being used with English respondents as well. The English version of the ASES-8 refers to both arthritis and fibromyalgia in each item. A German version was translated from the English version and tested in both rheumatoid arthritis and fibromyalgia samples; for the fibromyalgia sample, the term arthritis was replaced by fibromyalgia.

Psychometric Information

Method of development.

The original item bank consisted of the 5-item pain self-efficacy and 6-item other symptom self-efficacy subscales of the original ASES, plus 2 other items “found to be useful in subsequent studies conducted by the investigators” (39). All items were translated into standard Spanish to avoid language variations found in various Spanish-speaking countries, using both back translation and translation by committee. Of the original 13 items, 5 were removed from the final scale because of low test–retest reliability, based on content review that suggested items were redundant or ambiguously worded, leaving 8 items for the short ASES in Spanish. Principal component factor analysis of the German version of the ASES-8 confirmed the single factor structure.

Acceptability.

For the Spanish ASES-8, pretesting was done by administering the scale by interview and then questioning respondents about any difficulties they encountered; no difficulties were noted. It is not clear if missing data are common, or if there are ceiling or floor effects. The German version found no floor or ceiling effects.

Reliability.

For the Spanish ASES-8, initial evaluation was by interview with respondents from 5 sites across the US and 1 site in Venezuela (n = 272); replication was done by interview and self-administered through the mail, with 151 subjects recruited from senior citizen centers and Hispanic service centers in the San Francisco Bay area. The Spanish ASES-8 had a Cronbach's alpha of 0.92, and item-to-scale correlations ranging from 0.65–0.83. Internal consistency reliability ranged from 0.88 for the Cuban-origin group to 0.93 for people from Mexican and Central American descent. Reliability was also high when looking exclusively at the self-administered subgroup in the replication study (α = 0.96). Ten- to 14-day test–retest reliability was calculated using data from 25 participants in the replication study. Test–retest reliability was 0.69. The German translation of the English measure found reasonably similar reliability data (α = 0.90), although the 8-week test–retest reliability was 0.51, using fibromyalgia and rheumatoid arthritis samples. The Stanford Patient Education Research Center web site, where the English ASES-8 is located, reports internal consistency reliability of 0.94 based on unpublished data from 175 participants in Stanford's Arthritis Self Management Program.

Validity.

No validity data were presented for the Spanish ASES-8 or the English translation. The German translation of the English ASES-8 demonstrated theoretically relevant correlations between the ASES-8 and function (r = 0.20), depression (r = −0.53), and coping techniques (i.e., planning behavior; r = 0.35), and medium correlations with theoretically relevant constructs such as internal locus of control (r = 0.33), optimism (r = 0.39), and general self-efficacy (r = 0.40) among the 148 people with fibromyalgia in the initial evaluation.

Ability to detect change.

Sensitivity of the Spanish or English ASES-8 is not reported, although it has been used in arthritis intervention studies and change has been reported. The German ASES documented medium size change (effect size 0.31) in a sample of 43 people with fibromyalgia in a clinical setting.

Critical Appraisal of Overall Value to the Rheumatology Community

Strengths.

A shorter version of the ASES has intuitive appeal for both research and clinical use. The German version, as used in people with fibromyalgia, has documented reliability, validity, and sensitivity to change. The Spanish ASES-8 has documented reliability, but validity is undocumented. The factor analysis of the German ASES-8 supports a single factor underlying responses. The English and Spanish versions have been used in intervention trials.

Caveats and cautions.

A major weakness of the English version of the ASES-8 is the absence of any published psychometric data supporting its use. The articles documenting the development of the Spanish ASES-8 or the development of the full 20-item ASES are generally cited, yet neither of these articles describes any psychometric testing conducted on this 8-item measure. Further, 2 of the items are not part of the full ASES. Only the German version, tested primarily in people with fibromyalgia, has documented reliability, validity, sensitivity to change, and consistent underlying factor structure.

Clinical usability.

Neither the administrative nor respondent burden should preclude its use, but psychometric information and population-based norms or cut-off scores will be necessary before it is useful in a clinical setting.

Research usability.

The small administrative and respondent burden of the ASES-8 makes this an attractive option for research, but without psychometric evaluation of the English version of the ASES-8, it is difficult to determine its appropriateness for use in research with English-speaking subjects.

CHILDREN'S ARTHRITIS SELF-EFFICACY SCALE (CASE)

Description

Purpose.

The CASE was designed to measure children's perceived ability to control or manage salient aspects of life with juvenile idiopathic arthritis (JIA). It is designed to capture beliefs related to disease management as well as social and emotional issues. The instrument was validated in children ages 7–17 years in 2001 (15); a Finnish translation was validated in 2007 with children ages 8–17 years (47).

Content.

Items tap confidence in the ability to manage symptoms (“hurt,” “tiredness”), emotions (“sad,” “annoyed or fed-up”), and social participation (“at school,” “with my friends”). Principal component factor analysis confirmed this 3-factor structure.

Number of items.

11 items total, in subscales: activity (4 items), symptom (4 items), and emotions (3 items).

Response options/scale.

Five-point scale, from 1 (“not at all sure”) to 5 (“very sure”). Item stem for each question is either “I can find ways to” control the hurt of arthritis, stop arthritis from making me feel sad; or “I can control my arthritis” “at school,” “when I go out with my family.” Finnish translation used not at all certain to very certain. Scale is 1–5 for each subscale.

Recall period for items.

Not specified: mark which “describes you the best.”

Endorsements.

There are no identified endorsements.

Examples of use.

CASE has been used in an evaluation of an internet-based self-management education program for adolescents (48).

Practical Application

How to obtain.

Contact Julie Barlow, BA, PhD, Applied Research Centre in Health and Lifestyle Interventions, School of Health and Life Sciences, Coventry University, Priory Street, Coventry CV1 5FB, UK. Phone: 024 7688 7452. E-mail: j.barlow@coventry.ac.uk. Entire scale is published as appendix in original validation article (15).

Method of administration.

Self-administered written self-report.

Scoring.

Mean scores are calculated manually for each subscale using simple addition and division. Authors also calculated standard scores on a 0–10 scale to allow comparisons across subscales. No specific instructions are provided for handling missing values.

Score interpretation.

Range for each subscale is 1–5 with higher scores indicating greater efficacy. No cut points or norms are available, but means are provided for each subscale in the original publication and the Finnish revalidation.

Respondent burden.

Not specified, but estimated at <5 minutes. Items use language familiar to children and item length is short to ease readability. Topics are relevant to living with JIA and do not appear sensitive.

Administrative burden.

Takes approximately 5 minutes to administer; scoring can be done manually by calculating means for each subscale. No training is required.

Translations/adaptations.

Finnish translation was validated in 2007 (47).

Psychometric Information

Method of development.

Items were developed based on literature review and focus groups with 5 subgroups: children with mild or severe JIA, parents of children with mild or severe JIA, and health professionals. Eleven issues emerged as salient to children with JIA. Items were written in language the children used. Subscales were developed using principal component factor analysis and explain 76.5% of the variation. Item response theory was not used in scale development.

Acceptability.

The CASE was pilot tested for ease of use and comprehensibility before the validation study; no problems were noted. Readability appears appropriate for children; it is not clear if there are ceiling or floor effects, or whether missing data are common.

Reliability.

All 3 subscales showed reasonable internal consistency reliability in the initial validation (Cronbach's alpha ranging from 0.85–0.90) and in the Finnish revalidation (Cronbach's alpha ranging from 0.77–0.80).

Validity.

In terms of construct validity, CASE correlated significantly with theoretically relevant variables; positive correlations were found with hope and physical and psychological well-being, and negative correlations were found with measures of function, anxiety, pain, fatigue, and stiffness. In terms of criterion validity, CASE subscales had positive correlations with the Children's Hope scale, identified as a measure of control: activity subscale (r = 0.56), symptoms subscale (r = 0.56), and emotions subscale (r = 0.61). The Finnish revalidation study found all correlations in the expected direction as well (2). Finnish revalidation study also generally confirmed the factor structure of the CASE; in both validation studies, 1 item (swollen joints) loaded on both the symptoms and emotions subscales.

Ability to detect change.

Unknown.

Critical Appraisal of Overall Value to the Rheumatology Community

Strengths.

The CASE is the only arthritis-specific measure of self-efficacy for children with arthritis, and self-efficacy is assumed to be an important factor in managing juvenile arthritis. Although the initial validation study was small (89 children from a single hospital specialty clinic in the UK), the revalidation of a Finnish translation used a slightly larger sample size (120 children from a rheumatology specialty hospital). In both studies, there could be bias toward children that need specialty care, but the Finnish investigators reported that the catchment area for the hospital was the entire country, suggesting a more population-based sample. The CASE has reasonably good internal consistency reliability and construct validity.

Caveats and cautions.

Evidence on test–retest reliability and sensitivity to change would strengthen confidence in the use of this measure. The CASE developers raise concerns that the beliefs and expectations of adolescents with JIA may be different than younger children, but there is no adolescent arthritis self-efficacy measure in the literature.

Clinical usability.

Both the respondent and administrative burdens are reasonable for clinical use. CASE developers stated that it was developed to help understand variations in adjustment to JIA and that it may assist in identifying children at risk for poor adjustment (based on low self-efficacy), but the lack of population norms will limit clinicians' ability to draw conclusions about individuals based on their CASE scores.

Research usability.

Both the respondent and administrative burdens are reasonable for use in research. CASE developers stated that a second reason for development was to serve as an outcome measure in evaluation of psychoeducational interventions. Test–retest reliability and information on sensitivity to change could strengthen CASE for use in intervention research.

CHRONIC DISEASE SELF-EFFICACY SCALE (CDSES)

Description

Purpose.

The CDSES was developed to assist in program evaluation of Stanford's Chronic Disease Self-Management Program. The development and testing of the CDSES is detailed in a book by Lorig et al published in 1996 (14); full psychometric data have not been published in the peer-reviewed literature. The authors describe self-efficacy as a belief in one's ability to use those skills in realistic contexts, and a belief that the use of the skills will produce the desired outcomes. The authors delineated 3 types of self-efficacy beliefs (to perform specific behaviors, to manage disease generally, and to achieve outcomes); a total of 10 subscales, each ranging from 1–10 items, is included in the original CDSES. More recently, a shortened version, labeled the Self-Efficacy for Managing Chronic Disease 6-item Scale, has been used. This 6-item scale combines items from 2 of the original 10 subscales (49, 50).

Content.

The full CDSES measures multiple diverse aspects of managing chronic disease (see description of subscales below). Some items are specific to a behavior (do aerobic exercise 3–4 times per week, ask your doctor about things that concern you), and some items assess confidence in attaining a result (get friends to help you, reduce emotional distress, keep fatigue from interfering with things you want to do). Items on the 6-item scale pertain primarily to performance accomplishment rather than behavior (keep various symptoms from interfering with things you want to do).

Number of items.

The original CDSES, in its entirety, contains 33 items in 10 subscales. It is not clear if any studies have used all 10 subscales. The subscales are conceptually divided into 3 types of self-efficacy, as follows: self-efficacy to perform self-management behaviors (exercise regularly [3 items], get information about disease [1 item], obtain help from community, family, friends [4 items], communicate with physician [3 items]), self-efficacy to manage disease in general (manage disease in general [5 items]), and self-efficacy to achieve outcomes (do chores [3 items], social/recreational activities [2 items], manage symptoms [5 items], manage shortness of breath [1 item], control/manage depression [6 items]). The shortened version, Self-Efficacy for Managing Chronic Disease 6-item Scale, contains 3 items from the manage symptoms subscale and 3 from the manage disease in general subscale. No published psychometric data are available on this shortened version; mean, SD, and internal consistency reliability is reported for an undescribed sample of 605 people with chronic disease on the developer web site.

Response options/scale.

Item stem for each item is “How confident are you that you can …” Responses are a 1–10 numerical rating scale for each item (1 = not at all confident, 10 = totally confident).

Recall period for items.

“At the present time.”

Endorsements.

There are no known endorsements.

Examples of use.

The CDSES, in its various lengths, has been used in the evaluation of self-management education program, primarily the Chronic Disease Self Management Program in its various forms (49–58). The full 33-item measure has been used (51, 52), as well as select subscales of the full scale (53, 54) and shortened versions (49, 50, 55).

Practical Application

How to obtain.

The full scale and shortened scale are available from the web site of the Stanford Patient Education Research Center, URL: http://patienteducation.stanford.edu/.

Method of administration.

Written questionnaire; self-administered.

Scoring.

Scoring instructions are provided, including how to handle missing items. Computer scoring is not required; scoring involves addition and division to calculate mean score for each subscale used.

Score interpretation.

Each subscale score range is 1–10. There are no population-based norms or cut-off scores, although scale documentation does provide mean scores and SDs for each subscale for respondents participating in the validation sample (ranging from 280–478 per subscale).

Respondent burden.

Time to complete will depend on number of subscales used. The shortened 6-item version can be completed in approximately 3 minutes. Reading level is not difficult but some items are complex (i.e., “how confident are you that you can do things other than just take medications to reduce how much your illness affects your everyday life?”).

Administrative burden.

No training is required to administer the CDSES; scoring time will depend on the number of subscales used, but each subscale should take <5 minutes.

Translations/adaptations.

A 4-item Spanish CDSES is available (55); the developers state that it was developed and tested in Spanish (rather than translated from English), but very limited psychometric data are available on the developer web site.

Psychometric Information

Method of development.

Items were generated as a result of literature review that identified 12 self-management tasks common across chronic conditions, and 11 focus groups where participants were asked to describe their experiences and perceptions. Subcategories of self-efficacy (for self-management behaviors, manage disease in general, and to achieve outcomes) were delineated conceptually. It is not clear how the individual subscales were created, but the developer reports using multi-trait scaling approaches to assure correlation of an item to its designated subscale and limited correlation with other subscales.

Acceptability.

Reading level seems appropriate, although some items appear complex. The authors report no ceiling or floor effects. It is not clear how much missing data occurred.

Reliability.

Initial validation of the CDSES was drawn from a number of respondents in the Chronic Disease Self-Management Program intervention trials (total n = 1,130, although no subscale had more than 478 respondents). Internal consistency coefficients ranged from 0.77–0.92 among the various subscales of the CDSES for this accumulated convenience sample. Stability was measured in a small sample (51 respondents) in a 10-day test–retest procedure. Test–retest correlations were 0.82–0.89 for the different subscales. Internal consistency coefficient for the 6-item shortened scale was reported as 0.91 on the web site, but no publication is cited. Data are derived from an undescribed sample of 605 people with chronic disease. No test–retest coefficient is reported for the shortened scale. In the randomized controlled trial of the Spanish intervention program, the Spanish CDSES had an internal consistency alpha coeffiecient of 0.85 (n = 147) and test–retest coefficient of 0.80.

Validity.

Limited data on validity are available. The publication includes a correlation matrix showing that the subscales of the full measure are correlated between 0.14 (self-efficacy to manage shortness of breath with do chores) and 0.68 (self-efficacy to manage symptoms with manage depression). The self-efficacy to manage disease subscale has correlated more strongly with the other subscales, which the developer expects since it is more of a summary measure. No data are reported to demonstrate correlations of the CDSES with other measures of self-efficacy to evaluate criterion validity. Modest support for construct validity can be derived from the correlations between self-efficacy subscales and their corresponding health behavior scales (ranging from 0.01–0.41) and correlations between health outcomes and self-efficacy subscales (range from 0.14–0.75). No intervariable correlations are available to examine the validity of the shortened 6-item scale or the Spanish version of the scale.

Ability to detect change.

Sensitivity to change is not addressed in the CDSES documentation, although intervention studies do show changes in self-efficacy scores.

Critical Appraisal of Overall Value to the Rheumatology Community

Strengths.

The CDSES is widely used in evaluation of generic chronic disease self-management interventions, which often include people with arthritis. The 10 subscales of the full CDSES would provide the opportunity to assess a broad array of self-efficacy beliefs related to management of chronic disease.

Caveats and cautions.

No psychometric data on the CDSES have been published in peer-reviewed publications. While the authors make conceptual distinctions among self-efficacy to perform specific behaviors from self-efficacy to manage the disease in general, and self-efficacy to achieve outcomes, some of the items in the behavior-specific subscales appear to tap concepts that could be considered outcomes of behavior rather than behavior itself (i.e., “get family and friends to help you”). It is also unclear how similar or different self-efficacy to achieve outcomes is from outcome expectations. There are limited validity data on the shortened 6-item scale, which is probably used most commonly, or the Spanish 4-item scale. Finally, the introduction of the shortened 6-item scale has also introduced some variability and confusion into the literature. Some investigators use the 6-item shortened scale (a composite of 3 items from the managing disease in general and 3 items from the managing symptoms subscales of the full scale) (49, 50), while others use just the 5-item managing disease in general subscale (55); in both cases, it is usually called chronic disease self-efficacy. Other articles just refer to the CDSES developed at Stanford or for the Chronic Disease Self-Management Program without specifying the number of items, so it is not clear which iteration was used (56, 57).

Clinical usability.

Although there are means and SDs for scores from the accumulation of respondents used for the psychometric report, there are no published population-based norms or cut-off points, which makes it difficult to interpret individual scores. Respondent and administrative burden could be a problem for the full scale, but the shortened scales should not create a problem.

Research usability.

Select subscales of the CDSES, or its 6-item shortened version, have been used extensively in research on the Chronic Disease Self-Management Program. Most investigators have used selected subscales or the shortened 6-item scale.

PARENT'S ARTHRITIS SELF-EFFICACY SCALE (PASE)

Description

Purpose.

The PASE was designed to measure mothers' and fathers' perceived ability to manage or control salient aspects of their school-aged child's juvenile idiopathic arthritis (JIA) (16). The psychometrics of the scale were reported separately for mothers and fathers. It is challenging to place the PASE in the context of self-efficacy measures because it asks individuals (parents) to estimate how certain they are that they can control aspects of another person's (their child's) arthritis, in contrast to usual self-efficacy measures that question a person's confidence in their own ability to perform a specific action. The scale is not a proxy measure (e.g., asking parents to estimate their child's efficacy) but is measuring the parent's self-efficacy for an arthritis-specific parenting task. It is important to note that the scale is based on the hypothesis that a parent's health status is influenced by their perceived ability to handle a specific parenting task, that is, managing their child's arthritis. It was hypothesized, secondarily, that the parental sense of competence would influence the child's physical and psychological health status, but self-efficacy theory does not seem the basis for this theoretical formulation. The measure was originally published in 2000, with a Finnish translation and revalidation published in 2007 (47).

Content.

Items reflect 14 issues found to be salient in preliminary research. These include management of pain, stiffness, swelling, fatigue, sleep, loneliness, frustration, pleasure, and participation in school, family, and friend activities. Where content was similar, items were modifications of Arthritis Self-Efficacy Scale items. Item example: “How certain are you that you can keep arthritis pain from interfering with your child's sleep?”

Number of items.

14 items total; initial validation study principal component factor analysis revealed 2 subscales (symptoms and psychosocial), each consisting of 7 items. In the validation of the Finnish translation, this 2-factor solution was not supported and a 3-factor model emerged (somatic [5 items], psychological [5 items], and social [4 items]). However, this analysis was done combining mothers' and fathers' responses, where the original factor analysis separated mothers and fathers.

Response options/scale.

A 7-point response scale from 1 (very uncertain) to 7 (very certain), and a not applicable category, in response to items that begin “How certain are you that you can. …”

Recall period for items.

“At the present time.”

Endorsements.

There are no known endorsements identified.

Examples of use.

There are no references located beyond the psychometric studies.

Practical Application

How to obtain.

Contact Julie Barlow, BA, PhD, Applied Research Centre in Health and Lifestyle Interventions, School of Health and Life Sciences, Coventry University, Priory Street, Coventry CV1 5FB, UK. Phone: 024 7688 7452. E-mail: j.barlow@coventry.ac.uk. The entire scale is published as an appendix in the original validation article (16).

Method of administration.

Written, self-administered self-report that is easy to administer.

Scoring.

Sum of item scores on each subscale; this can be done manually. Validation study also standardized scores to a 0–10 scale allowing easier comparison across subscales. This would be labor intensive if attempted manually. There are no instructions for handling missing values or “not applicable” responses.

Score interpretation.

Total score range would be 7–49 for each subscale, assuming no “not applicable” responses were recorded. Higher scores reflect greater confidence in ability to manage or control aspects of child's juvenile arthritis. No cut points or population norms are provided, although the initial validation and Finnish translation revalidation do report mean scores and SDs for each subscale for both mothers and fathers.

Respondent burden.

Not reported; estimated to be <5 minutes. Items appear easy to read and not sensitive.

Administrative burden.

Administration time is likely to be rapid; manual scoring or mean subscale scores should be rapid, although calculation of standard scores could be more time consuming. No training is required.

Translations/adaptations.

A Finnish translation was validated in 2007 (47).

Psychometric Information

Method of development.

Items were generated by instrument developers based on past experience, literature review on self-efficacy and impact of arthritis on parenting, and focus groups with 5 subpopulations (children with mild or severe JIA, parents of children with mild or severe JIA, and health professionals). Principal component factor analysis was used to generate the subscales, which explain 75.5% of variance for mothers and 65.8% of variance for fathers.

Acceptability.

The PASE was pilot tested for ease of use and comprehensibility by parents of 13 children with JIA; no problems were noted. It is not known if there are ceiling or floor effects, or if missing data are common.

Reliability.

Questionnaires were sent to 149 families from 2 hospitals in the UK. A total of 178 parents participated in the validation study. In the initial validation study, internal consistency reliability was reasonable, with Cronbach's alpha for mothers ranging between 0.92 (symptoms subscale) and 0.96 (psychological subscale); Cronbach's alpha for fathers ranged between 0.89 (symptoms subscale) and 0.93 (psychological subscale). In the Finnish translation and revalidation study, internal consistency reliability was conducted for mothers and fathers combined for the 3 subscales that emerged; Cronbach's alpha ranged from 0.84 (somatic) to 0.88 (psychological) and 0.93 (social). No test–retest reliability data are available.

Validity.

Criterion validity was demonstrated by significant correlations with the Generalized Self-Efficacy Scale (a general measure of perceived coping competence) with both subscales of the PASE, for both mothers and fathers (0.27 for symptoms subscale for mothers, 0.36 for symptoms subscale for fathers, 0.43 for psychosocial subscale for mothers, and 0.33 for psychosocial subscale for fathers). Construct validity was demonstrated for mothers by significant negative association of mothers' anxious and depressed mood with symptoms subscale (r = −0.28) and psychosocial subscale (r = −0.43), and significant associations of mothers' psychosocial efficacy with their physical function (r = 0.27), energy (r = 0.27), pain (r = 0.31), and general health perceptions (r = 0.37). The only significant associations for fathers were positive associations between fathers' general health perceptions and psychosocial subscale (r = 0.31), and negative association between fathers' depressed mood and psychosocial subscale (r = −0.29). Authors also investigated the associations between parents' or child's ratings of child's physical and psychosocial well-being and parental self-efficacy ratings. Investigators specify that they expected parental self-efficacy to be reflected in child's well-being, but did not provide strong theoretical rationale for including this as evidence of construct validity.

Ability to detect change.

No evidence of ability to detect change is available.

Critical Appraisal of Overall Value to the Rheumatology Community

Strengths.

The PASE purports to measure a factor (parents' perceived competence in managing their child's JIA) that may be related to the physical and psychological health statuses of children with JIA and their parents. This could help increase understanding of family adaptation to JIA by measuring parental self-efficacy. This could also be useful in considering the family as a unit, rather than just considering the child in isolation. Internal consistency reliability for both subscales was strong, and the measure performs in theoretically consistent ways for mothers but not fathers. The sample for the initial validation study was 178 parents (115 mothers, 63 fathers) drawn from 2 hospitals in the UK; however, the authors state those hospitals draw from a wide geographic area, which could widen its generalizability.

Caveats and cautions.

There is no information about test–retest reliability or sensitivity to change which can limit its usefulness in evaluating interventions. Similar to the Arthritis Self-Efficacy Scale on which it was modeled, the PASE focuses on performance attainments (decrease child's pain), which some might consider an outcome expectation. Since its initial publication in 2000, it does not appear to have been used in any published studies beyond the Finnish translation and re-validation, which makes it unclear if investigators will find it useful. It is noteworthy that the original validation study identified a 2-factor structure, while the Finnish revalidation study identified a 3-factor structure.

Clinical usability.

Both the respondent and administrative burdens are reasonable for clinical use. PASE developers stated that it may be useful to identify mothers at risk of poor adjustment due to their child's JIA, and may help understand variations in family adjustment, but the lack of population norms will limit clinicians' ability to draw conclusions about mothers or families based on their PASE scores.

Research usability.

Both the respondent and administrative burdens are reasonable for use in research. The PASE could be useful for evaluating parent-oriented interventions to improve management of or coping with JIA, but information on sensitivity to change and test–retest reliability would be necessary.

RHEUMATOID ARTHRITIS SELF-EFFICACY SCALE (RASE)

Description

Purpose.

The RASE was developed to measure task-specific self-efficacy for the initiation of self-management–related behavior, and was carefully worded to tap beliefs about capability to perform the behavior, rather than actual ability, performance, or outcome expectation. It was developed specifically for patients with rheumatoid arthritis (RA) in the UK, although the items reflect self-management behaviors important in self-management of other forms of arthritis as well. The original validation study was published in 2001 (13), with a revalidation published in 2008 (9), and a Danish translation published in 2010 (58). A shortened version of the RASE based on an item response theory (IRT) analysis in the US has also been proposed (38).

Content.

Self-efficacy for self-management in RA is assumed to be a multidimensional concept; items address beliefs about ability to perform tasks across 8 dimensions of self-management identified as important in RA (relaxation, relationships, function, leisure activities, exercise, sleep, medication, and fatigue). However, these dimensions are all summed into a single factor, rather than subscales. The authors note that some people will have high self-efficacy for some tasks and low self-efficacy for others.

Number of items.

28. No subscales are used, although factor analysis showed 8 factors explaining 75% of the variance. A shortened RASE (9 items) has been proposed based on a content- and statistics-driven IRT analysis, which produced a scale of modest reliability (0.84) (38).

Response options/scale.

Item stem is “I believe I could” with response options 1 (strongly disagree) to 5 (strongly agree).

Recall period for items.

Not specified.

Endorsements.

There are no noted endorsements.

Examples of use.

RASE has been used in evaluations of an arthritis education program (59) and a physical activity program (60).

Practical Application

How to obtain.

Contact Sarah Hewlett, PhD, MA, RN, Professor of Rheumatology and Nursing, Academic Rheumatology, Bristol Royal Infirmary, Bristol BS2 8HW, UK. Phone: 44 (0) 117 928 2903. Fax: 44 (0) 117 928 3841. E-mail: Sarah.Hewlett@uwe.ac.uk. The full instrument is published as Appendix 1 in the original validation study and 2008 revalidation (9, 13).

Method of administration.

Self-administered written self-report questionnaire.

Scoring.

Scoring is simple addition of responses; no computer is necessary. There are no instructions for handling missing items.

Score interpretation.

Score range is 28–140 with higher scores indicating greater self-efficacy. No cut-off scores or population norms are available.

Respondent burden.

Not reported; estimated to be <10 minutes.

Administrative burden.

No training is required to administer the RASE; scoring time is the time to add 28 items.

Translations/adaptations.

A Danish translation was published in 2010 (58).

Psychometric Information

Method of development.

A multi-stage process was used for item generation. Initial items emerged from interviews with 19 health professionals and 17 people with RA. The original pool of 166 items was reduced to 100 items by examination of frequency of mention and designation of helpfulness by the 17 people with arthritis. The 100-item initial questionnaire was pilot tested with 92 people with RA in the UK. Three sets of analyses (item correlation with other SE items or clinical and psychological variables, principal component analysis, and correlations of each item with mean RASE score) were used to pare the original 100 items to the 28 items included in the final RASE. A separate IRT analysis was conducted by Mielenz et al using data gathered from educated white women in the US with a variety of types of arthritis. This analysis proposed a 9-item shortened RASE that they report is representative of the construct of interest, which they describe as a common construct with 9 subfactors. Item selection for this shortened version relied on both content and statistical analysis, with IRT analysis used to support this conceptualization (38).

Acceptability.

Items do not appear difficult to complete; in the initial validation, 85% of the respondents completed more than 90% of the items and no item was consistently omitted.

Reliability.

Initial reliability and validity testing utilized outpatients with RA (n = 107). Cronbach's alpha showed good internal consistency reliability in the 2008 revalidation (0.89) and moderate to strong correlation of each item to the total RASE score. Four-week test–retest reliability was also good (0.90 in the initial validation study). Confirmatory factor analysis in the 2008 revalidation (n = 128 people with RA who enrolled in an education program, from 11 treatment centers) showed similar factor loadings on the 8 factors identified in the initial validation study.

Validity.

In terms of construct validity, as predicted by self-efficacy theory, the RASE is correlated with initiation of corresponding self-management behaviors (mean change score 5.4 points on 0–28 scale) following self-management education intervention. In terms of convergent validity, a significant correlation was found between the Arthritis Self-Efficacy Scale (ASES) other symptoms subscale and the RASE (r = 0.313); changes in the RASE were correlated with changes in the ASES pain subscale (r = 0.35) and ASES other symptoms subscale (r = 0.32). In terms of divergent validity, neither the RASE nor ASES showed significant correlation with the General Self-Efficacy Scale, a trait measure of optimistic self-beliefs and perceived coping competence (in contrast to the more behavior-specific concepts of the RASE and ASES).

Ability to detect change.

RASE showed small but significant changes in SE following participation in a variety of self-management education programs in the UK (mean change 5.2 points on scale scoring 28–140). The standardized response means showed sensitivity to change whether calculated as absolute change or percentage change, and were similar in both the 2-week and 8-week post intervention analyses.

Critical Appraisal of Overall Value to the Rheumatology Community

Strengths.

The RASE is a measure of self-efficacy beliefs related to self-management behaviors in RA. Although it was developed specifically for RA patients in the UK, the items appear to be appropriate for other forms of arthritis, and other countries as well. Extensive psychometric evaluation has been conducted, and the RASE has good reliability, validity, and sensitivity to change. In contrast to the ASES, which includes items addressing specific functions (“walk 100 feet on flat ground in 20 seconds”) and performance results (“decrease your pain quite a bit”), the RASE asks about ability to perform specific self-management behaviors (“use relaxation techniques to help with pain”). A shortened version of the RASE has been proposed following an IRT analysis, but no published use of this shortened version was located.

Caveats and cautions.

The 28-item RASE has been validated exclusively in the UK; although it has been used in the US, there has been no psychometric analysis to confirm its appropriateness. Similarly, the majority of the psychometric analysis has used in people with RA; although the RASE has been used in community samples of people with arthritis, the instrument has not been revalidated with this more broad population.

Clinical usability.

Neither the administrative nor respondent burden should preclude its use, but the absence of any population-based norms or cut-off scores makes it difficult to interpret an individual's score.

Research usability.

The available psychometric data, including good reliability, validity, and reasonable sensitivity to change, all suggest the RASE is appropriate for use in research. Neither the administrative nor respondent burden should preclude its use.

Table  . Summary Table for Self-Efficacy Measures
ScalePurpose/contentMethod of administrationRespondent burdenAdministrative burdenScore interpretationReliability evidenceValidity evidenceAbility to detect changeStrengthsCautions
Arthritis Self-Efficacy ScaleArthritis-specific measure of self- efficacy beliefs; originally designed to help explain changes resulting from arthritis education programsSelf-administered, self-reportNot reported, estimated to be 5–10 minutesTime to administer and score 5–15 minutes; can be scored by handRange 10–100 or 1–10 for each subscale; higher scores indicate higher self-efficacyCronbach's alpha ranged 0.76–0.87 per subscale, test–retest ranged 0.85–0.90 per subscaleConstruct validity: correlated in predicted ways with health status measuresUnknown, but changes reported in intervention studiesDemonstrates reasonable reliability and validity data and has demonstrated sensitivity to change in intervention studies; appropriate for use in intervention evaluation studiesUnclear if scales correlate with corresponding health behaviors; concerns about possible overlap between self-efficacy for physical function and actual function; no ability to interpret individual scores
Arthritis Self-Efficacy Scale-8 ItemShortened version of the Arthritis Self- Efficacy ScaleSelf-administered, self-report; original Spanish version is interviewer administeredNot reported, estimated to be <5 minutesTime to administer and score 5–10 minutes; can be scored by handRange 1–10; higher scores indicate higher efficacySpanish version: Cronbach's alpha 0.92, test–retest 0.69; German translation: Cronbach's alpha 0.90, test–retest 0.51No information on Spanish or English versions; construct validity: German version correlated with theoretically relevant variablesNot reported for Spanish or English versions, but changes reported in interventions studies; German version reported medium size changesShortened version is intuitively appealing for speed and ease of use; German translation showed good reliability and validity, and sensitivity to changeThe limited psychometric data on the English translation are unpublished; no ability to interpret individual scores
Children's Arthritis Self-Efficacy ScaleArthritis-specific measure designed to measure children's perceived ability to control or manage salient aspects of life with juvenile idiopathic arthritisSelf-administered, self-reportNot reported, estimated to be <5 minutesTime to administer and score 5–10 minutes; can be scored by hand; creation of standard scores likely takes more timeRange 1–5 for each subscale, higher scores indicate higher efficacyCronbach's alpha ranged 0.85–-0.90; Finnish translation Cronbach's alpha ranged 0.77–0.80Construct validity: correlated with theoretically relevant health status variablesUnknownOnly arthritis-specific measure of self-efficacy for children; reasonably good reliability and validity demonstrated; could be used for evaluation of interventionsNo test–retest reliability data; no ability to interpret individual scores
Chronic Disease Self-Efficacy ScalesNon–arthritis-specific measure of perceived ability to manage a chronic disease, to perform specific behaviors, and to achieve outcomes related to chronic disease managementSelf-administered, self-reportDepends on number of subscales used, shortened 6-item version estimated to be 3 minutesTime to administer and score depends on number of subscales used, 6-item version administered and scored in 5–7 minutes; can be scored by handRange 1–10 for each subscale; higher scores indicate higher self-efficacyCronbach's alphas ranged 0.77–0.92 for subscales, test–retest ranged 0.82–0.89; Cronbach's alpha for 6-item version 0.91, no test–retest reportedConstruct validity: correlations among subscales and health status and health behaviors; no data on 6-item versionUnknown; changes reported in intervention studiesThe menu of 10 subscales offers the opportunity to select most relevant subscales in researchPsychometric data for full scale or 6-item shortened scale have not been published in peer- reviewed publications; managing disease in general subscale can be confused with the 6-item measure; creation of the subscales is not defined; no ability to interpret individual scores
Parent's Arthritis Self-Efficacy ScaleDesigned to assess arthritis-specific parenting challenges and perceived ability to manage or control their school-aged child's juvenile idiopathic arthritisSelf-administered, self-reportNot reported, estimated to be <5 minutesTime to administer and score estimated to be 5-10 minutes; can be scored by handRange 7–49 for each subscale, higher scores indicate higher self-efficacyCronbach's alpha 0.92 and 0.96 for mothers; 0.89 and 0.93 for fathers; Finnish translation combined mothers and fathers for Cronbach's alpha 0.84–0.93Construct validity: for mothers, correlations with select health status variables; for fathers, 1 significant correlationUnknownOnly measure of parental efficacy in handling child's arthritis; good internal consistency reliabilityNo information of test–retest reliability or sensitivity to change; no ability to interpret individual scores
Rheumatoid Arthritis Self-Efficacy ScaleRheumatoid arthritis–specific measure designed to measure initiation of arthritis self-management behaviorsSelf-administered, self-reportNot reported, estimated to be <10 minutesTime to administer and score estimated to be 10–15 minutes; can be scored by handRange 28–140; higher scores indicates greater efficacyCronbach's alpha 0.89; test–retest 0.90Construct validity: correlations with initiation of health behaviors; convergent validity: modest correlations with subscales of Arthritis Self-Efficacy ScaleDetected change in intervention studiesItems focus on behavior-special conference; strong reliability, validity, and sensitivity to changeValidation studies conducted in rheumatoid arthritis; no ability to interpret individual scores

AUTHOR CONTRIBUTIONS

Dr. Brady drafted the article, revised it critically for important intellectual content, and approved the final version to be published.

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