Measures of self-efficacy, helplessness, mastery, and control: The Arthritis Helplessness Index (AHI)/Rheumatology Attitudes Index (RAI), Arthritis Self-Efficacy Scale (ASES), Children's Arthritis Self-Efficacy Scale (CASE), Generalized Self-Efficacy Scale (GSES), Mastery Scale, Multi-Dimensional Health Locus of Control Scale (MHLC), Parent's Arthritis Self-Efficacy Scale (PASE), Rheumatoid Arthritis Self-Efficacy Scale (RASE), and Self-Efficacy Scale (SES)

Authors

  • Teresa J. Brady

    Corresponding author
    1. Arthritis Program, Centers for Disease Control and Prevention, Atlanta, Georgia
    • Arthritis Program, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS K-45, Atlanta, GA 30341
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ARTHRITIS HELPLESSNESS INDEX (AHI)/RHEUMATOLOGY ATTITUDES INDEX (RAI)

General Description

Purpose.

The Arthritis Helplessness Index (AHI) and its variants were designed to assess patients' perceptions of helplessness in coping with arthritis as delineated by learned helplessness theory. Helplessness is considered a psychological state in which individuals expect their efforts will be ineffective and become more passive and more likely to be depressed. Learned helplessness theory postulates that this helplessness results from experiencing unpredictable and uncontrollable aversive events. Helplessness has also been postulated to mediate relationships between disease or treatment and health outcomes.

The Rheumatology Attitudes Index (RAI) is conceptually identical to the AHI. Item wording and response format were modified slightly to reduce respondent confusion when the instrument was used with individuals with other rheumatic conditions such as fibromyalgia or bursitis.

Four variants of arthritis helplessness measures are available: the original 15-item Arthritis Helplessness Index (1), a 5-item AHI Helplessness Subscale (2), the 15-item Rheumatology Attitudes Index (RAI) (3), and a 5-item RAI helplessness subscale (4).

Content.

The AHI/RAI consists of 2 types of items: items measuring patients' perceptions of their abilities (“I can reduce my pain by staying calm and relaxed”), and their inabilities (“No matter what I do or how hard I try, I just can't get relief from my pain”), to control their arthritis.

Further investigation revealed 2 distinct factors on both the AHI and RAI, internality (“Managing my arthritis is largely my responsibility,” 7 items) and helplessness (“Arthritis is controlling my life,” 5 items).

Developer/contact information.

(AHI) Perry M. Nicassio, PhD, Daley Hall, Room 104, CSPP SD AIU,10455 Pomerado Road, San Diego, CA 92131. E-mail: pnicassio@alliant.edu. (RAI) Leigh F. Callahan, PhD, Thurston Arthritis Research Center, University of North Carolina, 3310 Thurston Building CB#7280, Chapel Hill, NC 27599-7280. E-mail: leigh_callahan@med.unc.edu.

Versions.

Four versions are available, the original 15 item AHI and its 5-item helplessness subscale, and the 15 item RAI and its 5-item helplessness subscale. RAI items are identical to AHI items except the word arthritis was replaced by the word condition. This change affected 12 of the original 15 items. The 5-item subscales are considered conceptually cleaner because each consists of a single factor. They are also easier and faster to complete. A Spanish language version of the 5-item RAI-helplessness subscale has been evaluated for cross-cultural equivalence (5). RAI has been translated/adapted to Swedish.

Number of items in scale.

AHI/RAI has 15 items. AHI/RAI Helplessness subscales have 5 items.

Subscales.

The AHI has a 5-item helplessness subscale and 7-item internality subscale. The RAI has a 5-item helplessness subscale. A factor analysis revealed an internality subscale on the RAI as well, but no other information is provided.

Populations.

Developmental/target.

All psychometric work on the AHI and RAI was done on individuals with physician-confirmed rheumatoid arthritis.

Other uses.

RAI has been widely used, including with patients with osteoarthritis, fibromyalgia, systemic lupus erythematosis, and scleroderma.

WHO ICF Components.

Environmental factor.

Administration

Method.

Self-administered written self-report questionnaire. Easy to administer.

Training.

No training required.

Time to administer/complete.

The 5-item helplessness scales estimated to take less than a minute. The 15-item scales may take up to 3 minutes.

Equipment needed.

None.

Cost/availability.

Items and scoring available from the literature (see references.) Copy available at the Arthritis Care & Research Web site at http://www.interscience.wiley.com/jpages/0004-3591:1/suppmat/index.html.

Scoring

Responses.

Scale.

Original AHI has a 4-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = agree, 4 = strongly agree); AHI Helplessness subscale has a 6-point Likert scale (1 = strongly disagree, 2 = moderately disagree, 3 = disagree, 4 = agree, 5 = moderately agree, 6 = strongly agree); RAI has a 4-point Likert scale with 5 response options (1 = strongly disagree, 2 = disagree, 2.5 = do not agree or disagree, 3 = agree, 4 = strongly agree); RAI Helplessness Subscale has a 5-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = do not agree or disagree, 4 = agree, 5 = strongly agree).

Score range.

For all versions, higher scores indicate greater helplessness. Original AHI 15–60, AHI Helplessness subscale 5–30, RAI 15–60, RAI Helplessness Subscale 5–30.

Interpretation of scores.

For the AHI Helplessness subscale, empirically derived cut-points, which demonstrated statistically significant differences among groups on psychological, behavioral, and symptom severity measures have been published. The “low helplessness” group achieved better scores while “high helplessness” group scored worse on psychological, behavioral, and symptom severity scales. Cut-points are Low helplessness (< 11), Normal (11–19, combines low normal, normal and high normal), High helplessness (≥ 20). In other versions there is no guidance in interpretation of scores; since the RAI items are identical except for the substitution of “condition” for “arthritis” in 4 items, it is likely to have similar cut-points but this has not been tested.

Method of scoring.

All versions can be scored by hand. In the AHI/RAI reverse the 9 items indicating perceived control (items 2, 3, 5, 6, 8, 9, 11, 13, 15) and sum all items for total score. In the AHI/RAI helplessness subscale reverse scoring on item 4; sum all items for total score.

Time to score.

Not documented, likely to be very brief, but requires score conversion.

Training to score.

Need instructions or template to reverse the appropriate items before scoring (9 items on the 15-item scales, 1 item on the 5-item scales).

Training to interpret.

None required; these instruments have been used primarily in research. Clinicians who use them have relied on clinical judgment.

Norms available.

No formal norms have been published. Cut-points scores used to determine low, midrange, and high helplessness scores using the AHI helplessness subscale were empirically derived to categorize 20% of the sample as low helplessness, and 20% as high helplessness.

Psychometric Information

Reliability.

AHI.

Internal consistency reliability, Cronbach's alpha 0.69 (borderline acceptable for a presumed unidimensional scale). The 12-month test-retest reliability was 0.53.

AHI helplessness subscale.

Internal consistency reliability with Cronbach's alpha was 0.63 (item-to-total correlations ranging from 0.29 to 0.47). Internal consistency alpha via the Spearman-Brown prophecy formula (used to equate subscales to the number of items on the full scale) was 0.84. The 6-month test-retest reliability was 0.64.

AHI internality subscale.

Internal consistency reliability via Cronbach's alpha was 0.75 (item-to-total correlations ranging from 0.38 to 0.58). Internal consistency alpha via the Spearman-Brown prophecy formula (used to equate subscales to the number of items on the full scale) was 0.88 and the 6-month test-retest reliability was 0.59.

RAI.

Internal consistency reliability via Cronbach's alpha was 0.68. Two items had weak correlations with the parallel item on the AHI (I have considerable ability to control my pain”, and “If I do all the right things, I can successfully manage my condition.”)

RAI helplessness subscale.

Internal consistency reliability via Cronbach's alpha was 0.70 Sample A and 0.67 Sample B.

Validity.

AHI construct validity.

AHI correlates in expected ways with theoretically relevant variables such as health locus of control, self esteem, anxiety, and depression measures. All correlations were significant and remained significant when age- and education level-adjusted. AHI also significantly correlated with measures of functional status (Modified Health Assessment Questionnaire), dissatisfaction with functional status, pain, and general rating of perceived limitations.

AHI helplessness subscale construct validity.

Subscale correlated in expected ways with theoretically relevant measures including chance- and powerful other-health locus of control, depression, non-compliance, information seeking, pain rating, and Arthritis Impact Measurement Scales physical, pain, depression and global health status subscales. The 5-item subscale accounted for more variance in these measures than did the 15-item measure. Changes in the helplessness subscale were more strongly associated with changes in pain and depression than were changes in the scores on the 15-item scale.

AHI internality subscale construct validity.

Scores were associated with internal health locus of control scores. High scores were associated with less pain, depression, and behavioral ineffectiveness. Changes in the full scale were more strongly associated with changes in psychological and disease impact measures than were changes in the internality subscale.

RAI construct/criterion validity.

Correlation of 0.78 between RAI and AHI completed 1–24 hours apart. Validation article (3) presents a variety of correlations of RAI with 4 measures of disease activity, 3 measures of physical performance, and 3 self- report measures of functional status. No relationships between RAI and these measures are hypothesized a priori, so it is difficult to evaluate these as evidence of validity. RAI scores were significantly correlated with physical performance scores, and self-report measures of function; the latter had larger correlations.

RAI helplessness subscale construct/criterion validity.

Correlations of 0.79 between full RAI and RAI helplessness scale. Brief measure had significantly higher correlations to measures of self-reported functional status than did the full RAI.

Sensitivity/responsiveness to change.

AHI.

An observational study found a 1-point decrease in helplessness on 12- month retesting. Changes in the AHI were significantly correlated with changes in functional status at 12 months.

AHI helplessness subscale.

The 6-month retesting indicated changes over time, and these were more strongly related to changes in pain and depression than were changes in the full AHI.

RAI and RAI Helplessness Subscale.

Unknown.

Comments and Critique

The original 15-item AHI was developed to capture the construct of learned helplessness, the psychological state in which individuals believe their efforts will be ineffective. These perceptions are hypothesized to produce affective, motivational, and behavioral deficits. The original 15-item AHI has been correlated with theoretically relevant variables and has demonstrated construct validity. True criterion validity is not possible because there is no pre-existing gold standard helplessness measure in the literature. The 15-item AHI had modest internal-consistency reliability, however, suggesting it was not a uni-dimensional measure. Factor analysis found 2 factors or subscales, internality and helplessness. The internality subscale has received little attention, but the helplessness subscale has been demonstrated to be more conceptually clear and to account for more variance in variables of interest than does the full AHI. In addition, Stein et al (6) empirically developed a classification schema for the helplessness subscale that has predicted scores on psychological, behavioral, and symptom severity measures even after 2 years.

The RAI is a modification of the AHI, created by replacing the word arthritis with the word condition in 9 items, and creating a fifth response category (“do not agree or disagree”). The RAI appears to behave fairly similarly to the AHI but true psychometric data are thin. There is a 0.78 correlation between the AHI and its variant, the RAI. Factor analysis was also used to identify subscales for the RAI. The same 2 factors emerged, internality and helplessness with items identical to AHI subscales. As with the AHI, the RAI helplessness scale had a reasonably strong correlation with the full 15-item RAI and had stronger correlations to measures of functional status than did the full RAI.

As a measure of the construct of helplessness, the brief 5-item scales appear to be superior to the 15-item scales, because of their speed and ease of use and because of stronger correlations with other health status variables. The 5-item AHI has greater psychometric support than the 5-item RAI, and has demonstrated predictive utility. For these reasons it may be preferable to use the AHI helplessness subscale in situations where having the word arthritis in the item language is not problematic.

DeVellis and Callahan (4) note that reliabilities of these measures are at the low end of the acceptable range, however, with 30% of the score variance due to error. They suggest these measures are adequate for research and general screening purposes but should not be used alone for clinical decision-making.

References

1. (Original AHI) Nicassio PM, Wallston KA, Callahan LF, Herbert M, Pincus P. The measurement of helplessness in rheumatoid arthritis: the development of the Arthritis Helplessness Index. J Rheumatol 1985;12:462–7.

2. (Original AHI Helplessness) Stein MJ, Wallston KA, Nicassio PM. Factor structure of the Arthritis Helplessness Index. J Rheumatol 1988;15:427–32.

3. (Original RAI) Callahan LF, Brooks RH, Pincus T. Further analysis of learned helplessness in rheumatoid arthritis using a “Rheumatology Attitudes Index.” J Rheumatol 1988;15:418–26.

4. (Original RAI Helplessness) Devellis RF, Callahan LF. A brief measure of helplessness in rheumatoid disease: the helplessness subscale of the Rheumatology Attitudes Index. J Rheumatol 1993;20:866–69.

5. Escalante A, Cardiel MH, del Rincon I, Sudrez-Mendosa AA. Cross cultural equivance of a brief helplessness scale for Spanish speaking rheumatology patients in the United States. Arthritis Care Res 1999;12:341–50.

6. Stein MJ, Wallston KA, Nicassio PM, Castner CM. Correlates of a clinical classification schema for the arthritis helplessness subscale. Arthritis Rheum 1988;31:876–81.

ARTHRITIS SELF-EFFICACY SCALE (ASES)

General Description

Purpose.

The Arthritis Self-Efficacy Scale (ASES) was developed to measure patients' arthritis-specific self-efficacy, or patient's beliefs that they could perform specific tasks or behaviors to cope with the consequences of arthritis (1). It is based on the theory of self-efficacy as postulated by Bandura (2). Self-efficacy refers to personal judgments of performance capabilities in a given domain of activity, not to a generalized trait.

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 such as “Walk 100 feet on flat ground in 20 seconds,” or “Scratch your upper back with both your right and left hands; and performance-results items such as “Decrease your pain quite a bit,” or “Control your fatigue.”

Developer/contact information.

Kate Lorig, RN DrPH, Stanford Patient Education Research Center, 1000 Welsh Road Suite 204, Palo Alto, CA 94304.

Versions.

Swedish (3), Norwegian, and Spanish (4) versions of the ASES have been developed and evaluated.

Number of items in scale.

There are 20 items.

Subscales.

The ASES consists of 3 subscales Self-efficacy Pain (PSE), 5 items; Self-efficacy Function (FSE), 9 items; and Self-efficacy Other Symptoms (OSE), 6 items.

Populations.

Developmental/target.

Psychometric study of the ASES was done with volunteers recruited for the Arthritis Self-Help Course (development sample n = 97, replication sample n = 144), more than 80% female, close to age 65, and average education level more than 14 years.

Other uses.

ASES has been widely used with adults of all ages, and with a variety of arthritis conditions, including lupus, fibromyalgia, scleroderma, and chronic fatigue syndrome.

WHO ICF Components.

Environmental factor.

Administration

Method.

Self-administered written self-report. Easy to administer.

Training.

None.

Time to administer/complete.

Not reported, assumed to be brief.

Equipment needed.

None

Cost/availability.

Items and scoring available from the literature (see references.) Copy available at the Arthritis Care & Research Web site at http://www.interscience.wiley.com/jpages/0004-3591:1/suppmat/index.html.

Scoring

Responses.

Scale.

Items are rated on a 10 (very uncertain) to 100 (very certain) rating scale, in 10-point increments.

Score range.

Range is 10–100 on each subscale.

Interpretation of scores.

Higher scores indicate greater confidence or self-efficacy. No cut points are indicated.

Method of scoring.

Each subscale is scored separately, taking the mean of subscale items.

Time to score.

Not reported; calculation of mean scores on subscales of 5, 6, and 9 items.

Training to score.

None required except simple mathematical calculations.

Training to interpret.

None required.

Norms available.

None.

Psychometric Information

Reliability.

Internal reliability alpha estimates are PSE 0.76, FSE 0.89, and OSE 0.87. Item loadings (based on factor analysis or replication sample) are PSE 0.48–0.75, FSE 0.55–0.84, and OSE 0.63– 0.81. Test-retest reliability (2–29 days between retesting) are PSE 0.87, FSE 0.85, and OSE 0.90.

Validity.

No gold standard is available to determine criterion validity. Since its development, the ASES has become the gold standard.

Construct.

Validity was demonstrated by finding significant correlations among ASES subscales and measures of health status (pain, disability, and depression).

Known groups validity.

Participants in the Arthritis Self-Management Course showed growth in ASES scores while the control group did not.

Sensitivity/responsiveness to change.

Sensitivity is unknown. No criterion measure is available so it is unclear if changes in scores represent true changes in self-efficacy. Participants in the Arthritis Self-Management Course did demonstrate changes in ASES scores, although these changes were not statistically significant.

Comments and Critique

The ASES is the dominant measure of self-efficacy in the arthritis literature and has made significant contributions in measuring situation-specific perceptions of control, rather than more generalized or trait measures such as mastery or locus of control.

The ASES subscales show good internal consistency and test-retest reliability, and reasonable associations with measures of health status. Other aspects of self-efficacy theory, such as prediction of initiation or persistence of behavior as predicted by self-efficacy theory, have not been examined, The authors recognize a need to compare ASES results with theoretically distinct but related concepts such as learned helplessness and health-related locus of control to examine divergent and convergent validity, but this has not yet been done.

The ASES, as published, consists of 20 items that fall into 3 subscales. The initial development analysis produced a 2-factor scale (function and other symptoms) with 25 items. On replication, the factor analysis utilized 20 items with a 3-factor solution. Developers state that the choice between the 2-factor or 3-factor instrument was arbitrary, based on the perceived value of a pain measure, and the correlations of the other symptom measure with depression. While the factor subscales have been widely used, further replication of the factor structure has not been published.

Some investigators have modified the ASES to fit the needs of their studies (e.g., fitness in fibromyalgia). Many of these modifications have had no psychometric work done so it is impossible to determine their reliability or validity.

The combination of items tapping specific behaviors (walk 100 feet) and performance results (“decrease your pain quite a bit,” or “control your fatigue”) have raised debate in the literature on what the ASES is actually measuring, task-specific self-efficacy or confidence in ability to achieve results. See references 5 and 6 for more information.

References

1. (Original) Lorig K, Chastain RL, Ung E, Shoor S Holman H. Development and evaluation of a scale to measure perceived self efficacy in people with arthritis. Arthritis Rheum 1989;32:37–44.

2. Bandura A. Self-efficacy: toward a unifying theory of behavior change. Psychol Rev 1977;84:191–215.

3. Lomi C, Nordholm LA. Validation of a Swedish version of the Arthritis Self-Efficacy Scale. Scand J Rheumatol 1992;21:231–7.

4. Gonzales VM, Steward A, Ritter PL, Lorig K. Translation and validation of arthritis outcome measures into Spanish. Arthritis Rheum 1995;38:1429–46.

5. Brady TJ. Do common arthritis self efficacy measures really measure self efficacy? Arthritis Care Res 1997;10:1–8.

6. Lorig K, Holman H. Arthritis self-efficacy scales measure self-efficacy. Arthritis Care Res 1988;11:155–7.

CHILDREN'S ARTHRITIS SELF- EFFICACY SCALE (CASE)

General Description

Purpose.

The Children's Arthritis Self-Efficacy Scale (CASE) was designed to measure children's perceived ability to control or manage aspects of life with juvenile arthritis. It is designed to capture beliefs related to disease management as well as social and emotional issues (1).

Content.

Items were developed after focus groups of children with mild or severe juvenile idiopathic arthritis, parents of children with mild or severe juvenile idiopathic arthritis, and health professionals, and were written in language the children used. Items tap symptoms (“hurt,” “tiredness”), emotions (“sad,” “annoyed or fed-up”), and social participation (“at school,” “with my friends”).

Developer/contact information.

Julie Barlow, BA, PhD, Interdisciplinary Research Centre in Health, School of Health and Social Sciences, Coventry University, Priory Street, Coventry CV1 5FB, UK. E-mail: j.barlow@coventry.ac.uk.

Versions.

One.

Number of items in scale.

There are 11 items.

Subscales.

Factor analysis revealed 3 factors that account for 76.5% of the score variance. These are Activity (4 items), Symptoms (4 items), and Emotions (3 items).

Populations.

Developmental/target.

Eighty-nine children ages 7–17 years (average age 12.3) were recruited from a children's hospital database in Birmingham, UK.

Other uses.

None.

WHO ICF Components.

Environmental factor.

Administration

Method.

Self-administered written self-report. Easy to administer.

Training.

None required.

Time to administer/complete.

Estimated at 5 minutes.

Equipment needed.

None.

Cost/availability.

Items and scoring are available in the literature. Copy available at the Arthritis Care & Research Web site at http:/www.interscience.wiley.com/jpages/0004-3591:1/suppmat/index.html.

Scoring

Responses.

Scale.

The 5-point scale ranges from 1 (not at all sure) to 5 (very sure).

Score range.

The range is 1–5 for each subscale.

Interpretation of scores.

Higher scores indicate greater efficacy. No cut points are available.

Method of scoring.

Mean scores for each subscale, can be calculated manually. Authors also calculated standard scores on a 0–10 scale to allow comparisons across scales.

Time to score.

Not reported; assumed to be brief (simple addition and division).

Training to score.

None.

Training to interpret.

None.

Norms available.

No norms are available; original publication provided mean and standard scores for the 3 subscales: Activity, mean 3.21 (SD 1.36), standard score 5.56 (SD 2.94); Symptom, mean 2.91 (SD 1.36) standard score 4.75 (SD 2.86); Emotions, mean 3.39 (SD 1.39), standard score 6.02 (SD 3.00).

Psychometric Information

Reliability

Internal consistency of each subscale via Cronbach's alphas was Activity 0.90, Symptoms 0.87, Emotion 0.85.

Validity.

Construct validity.

CASE correlated significantly with theoretically relevant variables: positive correlations were found with hope and physical and psychological well-being, and negative correlations with measures of function, anxiety, pain, fatigue, and stiffness.

Sensitivity/responsiveness to change.

Unknown.

Comments and Critique

The CASE is a new measure designed to assess self-efficacy to manage consequences of arthritis among children ages 7–17 years. Psychometric data is limited (gathered from 89 children recruited from a single hospital, on a handful of health status measures) and the measure has not yet been widely used.

It is not clear whether the self-efficacy construct in children is similar to the self-efficacy construct in adults. The age appropriateness of items was not assessed, but measure development was guided by focus groups with children with juvenile arthritis and with parents of children with arthritis, and the measure was pilot-tested with children.

Reference

1. (Original) Barlow JH, Shaw KL, Wright CC. Development and preliminary validation of a Children's Arthritis Self-Efficacy Scale. (Arthritis Rheum). Arthritis Care Res 2001;45:159–66.

GENERALIZED SELF-EFFICACY SCALE (GSES)

General Description

Purpose.

The Generalized Self Efficacy Scale (GSES) (1) is a measure of perceived coping competence, or “global confidence in one's ability to cope across a range of demanding situations” (2). In contrast to Bandura's original conceptualization of self-efficacy as a situation- or behavior-specific belief, the GSES is conceived as a trait measure of “optimistic self beliefs” assumed to be relatively stable over time and domains of functioning. The GSES was originally developed in German by Jerusalem and Schwartzer (1).

Content.

Items are designed to assess the individual's belief in his/her ability to respond to novel or difficult situations. Items include “I am confident that I could deal efficiently with unexpected events,” and “When I am confronted with a problem, I usually find several solutions.”

Developer/contact information.

English adaptation by Julie Barlow, BA, PhD, Interdisciplinary Research Centre in Health, School of Health and Social Sciences, Coventry University, Priory Steet, Coventry CV1 5FB, UK. E-mail: j.barlow@coventry.ac.uk.

Versions.

Original measure is in German; Barlow validated an English adaptation (2). Spanish, French, Hebrew, Hungarian, Turkish, Czech, Slovak, Chinese, Indonesian, Japanese, and Korean adaptations or translations are available (3,4).

Number of items in scale.

There are 10 items.

Subscales.

None; assumed to be a unitary construct.

Populations.

Developmental/target.

English adaptation was participants in arthritis self-management programs in community settings across the United Kingdom. Primarily white women in their 50s with longstanding rheumatoid arthritis or osteoarthritis; approximately half did not have educational degrees.

Other uses.

None.

WHO ICF Components.

Environmental factor.

Administration

Method.

Self-administered written self-report. Easy to administer.

Training.

None required.

Time to administer/complete.

Estimated to be 3 minutes.

Equipment needed.

None.

Cost/availability.

Items and scoring available in primary reference (1). Copy available at the Arthritis Care & Research Web site at http:/www.interscience.wiley.com/jpages/0004-3591:1/suppmat/index.html.

Scoring

Responses.

Scale.

All items scored on a 4-point scale (1 = not at all true, 2 = barely true, 3 = moderately true, 4 = exactly true).

Score range.

The range is 10–40.

Interpretation of scores.

Higher scores indicate greater perceived competence to cope with difficult situations, or generalized self-efficacy. No cut points are provided.

Method of scoring.

Simple sum of item scores; can be done easily by hand.

Time to score.

No reported, expected to be brief.

Training to score.

None.

Training to interpret.

None.

Norms available.

No norms are available, but mean scores from the three validation studies for the English adaptation are published: 29.05 (SD 5.1), 28.71 (SD 5.9), and 30.23 (SD 4.8). These are similar to the mean score for the accumulated German sample of 29.98 (SD 4.6) for the German version of the GSES.

Psychometric Information

Reliability.

The internal consistency via Cronbach's alpha estimates was 0.88, 0.91, and 0.89 for validation studies 2, 3, and 4 respectively. The test-retest reliability over a 4-month period was 0.63. and the item-total correlations ranged from 0.31 to 0.81.

Validity.

Construct validity.

Factor analysis revealed a single-factor solution, which explained just over 50% of the variance, supporting the unidimensional nature of the measure. As hypothesized, the GSES was positively associated with positive affect and social support, and negatively associated with depression and health distress.

Divergent validity.

There were no significant associations between GSES and physical health status as measured by the Health Assessment Questionnaire, Visual Analog Scale-pain, and Visual analog Scale-fatigue.

Predictive validity.

GSES at time 1 was significantly associated with depression at time 2, explaining an additional 8% of the variance after controlling for demographic and physical health status. GSES was also significantly associated with positive affect, explaining an additional 15% of the variance.

Sensitivity/responsiveness to change.

None reported. Generalized self-efficacy is conceptualized as a dispositional characteristic or trait, and would be expected to be more stable and less susceptible to change.

Comments and Critique

The English adaptation of the Generalized Self-Efficacy Scale appears to be a valid and reliable measure of perceived competence to cope with difficult situations. As such, the title of the scale may be mis-leading because self-efficacy is most frequently used to refer to more changeable situation- or behavior-specific constructs. It may more closely resemble personal mastery, although no investigation of the relationship between GSES and mastery or personal competence has been done. The authors note the need to investigate the relationship between learned helplessness and the GSES.

The authors also caution that use of the GSES is inappropriate when the outcome of interest is performance of a specific behavior such as an exercise program. They recommend use of the GSES when measuring global confidence in one's ability to cope as a trait, or general adaptation to circumstances.

In contrast to a simple translation, Barlow and colleagues (2) adapted the GSES for an English audience. They modified 2 items to improve comprehensibility for an English audience; they replicated the original validation studies. The GSES is available in multiple other languages; before use it will be important to clarify if these are simple translations relying on the psychometrics of the original German scale, or adaptations for the specific language.

References

1. (Original) Jerusalem M, Schwarzer R. Self efficacy as a resource factor in stress appraisal process. In: Schwarzer R, editor. Self-Efficacy: thought control and action. Washington (DC):. Hemisphere 1992;.

2. (Original) Barlow BH, Williams B, Wright C. The Generalized self-efficacy scale in people with arthritis. Arthritis Care Res 1996;9:189–96.

3. Schwarzer R, Bassler J, Kwaitek P, Schroeder K, Zhang JX: The assessment of optimistic self-beliefs: comparison of the German, Spanish, and Chinese versions of the generalized self-efficacy scale. Appl Psychol Int Rev 1997;46:69–88.

4. Schwarzer R, Born A, Iwawaki S, Lee YE, Saito E, Yue. The assessment of optimistic self-beliefs: comparison of the Chinese, Indonesian, Japanese, and Korean versions of the generalized self-efficacy scale. Applied Psychol Int Rev 1997;40:1–13.

MASTERY SCALE

General Description

Purpose.

The Mastery Scale, initially developed by Pearlin and Schooler, is designed to measure “the extent to which one regards one's life chances as being under one's own control in contrast to being fatalistically ruled” (1, p. 5) or “the extent to which people see themselves as being in control of the forces that importantly affect their lives” (2, p. 340).

Mastery is conceived as a personality characteristic that serves as a psychological resource individuals use to help them withstand stressors in their environment.

Content.

Content consists of 7 items tapping sense of control, such as “I have little control over the things that happen to me” and “I can do just about anything I set my mind to do.” Two items are positively worded.

Developer/contact information.

Leonard Pearlin, PhD, University of California, San Francisco Human Development and Aging Program, San Francisco, CA 94143.

Versions.

One version. Scale has been translated to Chinese, Czech, Dutch, German, Hebrew, Vietnamese, Swedish, and Spanish. Spanish translation found low item-total correlations for the 2 positively-worded items.

Number of items in scale.

Seven.

Subscales.

None.

Populations.

Developmental/target.

Adults of working age (18–65 years) developed to gather information in interviews of a sample designed to be representative of census-defined urbanized area of Chicago.

Other uses.

Has been used by researchers in many countries and with many populations, from adolescents to older adults, and with mental and physical health difficulties.

Administration

Method.

Initial data collection performed using scheduled interviews.

Training.

None required.

Time to administer/complete.

Unknown, expected to be brief.

Equipment needed.

None.

Cost/availability.

Items available in literature, although no scoring directions are provided. Copy available at http://www.bsos.umd.edu/socy/faculty/word/Pearlin/Mastery.doc.

Scoring

Responses.

Scale.

Scoring instructions are not provided in the original publication. Various investigators have used 4-, 5-, and 7-point Likert scales. Some investigators list 1 as strongly agree while others use 1 as strongly disagree.

Score range.

Depends on number of points on Likert Scale. A 4-point scale ranges 4–28, a 5-point scale ranges 5–35, a 7-point scale ranges 7–49.

Interpretation of scores.

Unknown; no cut points are provided.

Method of scoring.

Some investigators use sum of item scores, others use mean score across the seven items.

Time to score.

Unknown, assumed to be brief.

Training to score.

Minimal, selected items need to be reversed in scoring. (5 items worded negatively, 2 items worded positively).

Training to interpret.

Unknown, not likely.

Norms available.

No.

Psychometric Information

Reliability.

Original publication (1) reports factor loadings for the 7 items loading on the mastery scale; these could be considered a form of internal consistency reliability. The 5 negatively worded items have factor loadings ranging from 0.76 and 0.56. The 2 positively worded items both have factor loadings of - 0.47. Correlation between time 1 and 2, four years later, was 0.44 (2). The time gap of 4 years negates the value of this correlation as a measure of test-retest reliability, however.

Validity.

No overt tests have been done to evaluate the validity of the Mastery scale. The scale has been used concurrently with a variety of other measures of psychological well-being or sense of control. The Mastery Scale has been widely used and translated into multiple languages despite an absence of validity data. This suggests strong face validity.

Sensitivity/responsiveness to change.

Unknown; as a trait measure it would be expected to be stable.

Comments and Critique

Although widely used, the Mastery Scale referred to as developed by either Pearlin and Schooler (1) or Pearlin et al (2) has not had significant psychometric work done, so it is not clear how valid or reliable it is as a measure of mastery. In addition, no standardized scoring recommendations were provided, so investigators are left to develop their own scoring protocols. This absence of standardized scoring makes it difficult to compare across studies.

The Mastery Scale has been incorporated into combined measures of psychological resources such as the Personal Resources Index and the Cognitive Adaptation Index, but individual components of these combination measures have not been evaluated. The Mastery Scale has not been widely used in rheumatology research.

References

1. Pearlin LI, Schooler I. The structure of coping. J Health Soc Behav 1981;19:2–21.

2. Pearlin LI, Liberman MA, Menaghan EG, Mullin JT. The stress process. J Health Soc Behav 1981;22:337–56.

MULTI-DIMENSIONAL HEALTH LOCUS OF CONTROL SCALE (MHLC)

General Description

Purpose.

The purpose of the Multi-Dimensional Health Locus of Control Scale (MHLC) is to provide information on 3 theoretically distinct and empirically differentiated dimensions of health locus of control (1). A secondary purpose was to create 2 equivalent forms (Form A and Form B) of the MHLC for use in repeated-measures studies. Later a third form (Form C) was created to be used with specific health conditions (2). The MHLC was developed to address the increased understanding of the locus of control and health locus of control constructs. The original health locus of control scale was conceptualized as a unidimensional construct (internal or external locus of control over health); later factor analysis of this measure, and new research in more generalized locus of control work, identified the need to measure health locus of control in 3 dimensions.

Form C of the MHLC was created for both theoretical and practical reasons. Theoretically, it was hypothesized that health locus of control beliefs about a specific health condition may correlate with health outcomes differently than more general health locus of control beliefs. Practically, several researchers observed some items on Forms A and B were problematic for individuals with chronic medical conditions to respond to. Form C was designd as a general-purpose condition-specific locus of control scale that could be easily adapted for use by individuals with specific medical conditions.

Content.

On Forms A and B, items reflect the 3 hypothesized dimensions of health locus of control: Internality (IHLC) (i.e., “I am in control of my own health), Powerful Others (PHLOC) (i.e.,“My family has a lot to do with my becoming sick or staying healthy”), and Chance (CHLOC) (i.e., “No matter what I do, if I am gong to get sick, I get sick”). Items are written on an 8th grade reading level.

On Form C items reflect similar dimensions, but factor analysis reveals that Powerful Others can refer to either doctors or medically trained professionals, and others. Initial Form C items refer to condition, but this can be adapted to specify Arthritis.

Developer/contact information.

Kenneth A. Wallston, PhD, School of Nursing, Vanderbilt University, 429 Godchaux Hall, Nashville, TN 37240. E-mail: ken.wallston@Vanderbilt.edu.

Versions.

Three forms of the MHLC were created, Forms A, B, and C. Forms A and B were designed to be equivalent; items were paired in scale construction based on meaning, one assigned to Form A, the other to Form B. Form C was created to be used with specific health conditions.

Number of items in scale.

On Forms A and B, each form has 18 items, 6 items for each subscale. Forms A and B can be combined to increase reliability if repeated measures are not necessary. Form C also has 18 items, 6 items on the Internality and Chance Subscales, 3 on Powerful Others—Doctors, 3 on Powerful Others—Other people.

Subscales.

Forms A and B each have 3 subscales of 6 items each. Subscales are Internality, Powerful Others, and Chance. Form C has 4 subscales; the Powerful Others subscale is divided into a Doctor subscale and an Other People subscale.

Populations.

Developmental/target.

Designed for use by adults; Forms A and B validated with adults waiting at airport. Form C was validated with groups of patients with rheumatoid arthritis, chronic pain, cancer, diabetes.

Other uses.

Has been widely used with samples involving pain, spinal cord injury, alcohol dependence, arthritis, and other chronic conditions.

WHO ICF Components.

Environmental factor.

Administration

Method.

Self-administered written self-report.

Training.

None indicated.

Time to administer/complete.

Estimated 3–5 minutes for each form.

Equipment needed.

None.

Cost/availability.

Items and scoring available from the literature, or on website: http://www.vanderbilt.edu/nursing/kwallston/mhlcscales.htm.

Scoring

Responses.

Scale.

Scale is a 6-point Likert scale, from strongly disagree to strongly agree. One study of Forms A and B used a 3-point Likert scale (disagree, neither agree nor disagree, and agree), but psychometric data was not provided (3).

Score range.

The range is 6–36 for each 6-item subscale; 12 to 72 if two forms are combined to form 12-item subscales. The range for Form C 3 item subscales is 3–18.

Interpretation of scores.

Higher subscale scores indicate greater belief in that locus of control.

Method of scoring.

Manual scoring by summing item scores on each subscale.

Time to score.

Unknown, expected to be brief.

Training to score.

None required.

Training to interpret.

None.

Norms available.

None. Means and Standard Deviations are available for Form C subscales in a Rheumatoid Arthritis Sample: Mean (SD) Internal 17.50 (5.89); Chance 16.60 (6.10); Doctors 13.43 (3.28); Other People 7.48 (3.27).

Psychometric Information

Reliability.

Forms A and B.

Cronbach's alpha for internal consistency ranges from 0.67 to 0.77 for the 6-item subscales on Forms A and B. Mean scores for Forms A and B are nearly identical; for greater internal consistency and reliability the 2 forms can be combined. Cronbach's alpha for the combined 12-item subscales ranges from 0.83 to 0.86.

Form C.

Cronbach's alpha for internal consistency ranges from 0.87 to 0.79 for the 6-item subscales (Internality and Chance), and 0.71–0.70 on the 3 item subscales (Powerful others—Doctors, and Powerful Others—Other People). In test-retest reliability, the stability coefficients ranged from 0.66 to 0.54 for a 1 year retesting period with no active intervention to change beliefs.

Validity.

Forms A and B construct validity.

Intercorrelations among the 6-item subscales, or the 12-item subscales indicate that IHLC and PHLC are statistically independent, IHLC and CHLC are negatively correlated, and PHLC and CHLC show a small positive correlation, particularly on Form B.

Forms A and B construct/criterion validity.

There are significant positive correlations between MHLC subscales and their theoretical counterpart on Levenson's Locus of Control Scale.

Preliminary predictive validity.

As expected, health status, as measured by a two-item health status measure, showed a positive and significant correlation with IHLC; (r = 0.403) a significant negative correlation with CHLC (−0.275); and no correlation with PHLC (r =-0.055).

Form C concurrent validity.

Form C showed modest correlations with the appropriate subscale from Form A/B (correlations ranging from 0.59 to 0.38 in a rheumatoid arthritis sample).

Form C construct validity.

Form C subscales correlated in the theoretically expected directions with distinct but related concepts of Pain, Depression, and Helplessness in a rheumatoid arthritis sample. Further evidence of consrruct validity is demonstrated in a sample of individuals with chronic pain engaged in an intervention designed to change locus of control beliefs. As expected, Internality beliefs increased while the external subscales (Chance, Powerful Others—Doctors, and Powerful Others—Other people) all decreased.

Sensitivity/responsiveness to change.

Unknown.

Comments and Critique

The MHLC was developed to measure health locus of control after the evolution of the theory to consider locus of control and health locus of control to be multidimensional rather than unidimensional concepts. A strength of the MHLC Form A/B is the availability of alternate forms with nearly identical psychometric properties to accommodate repeated measures research designs. Preliminary psychometric evaluation is promising. The authors suggest that not all 3 subscales need to be used in a single investigation; depending on variables of interest and time limitation, 1 or 2 dimensions can be included in a research design.

A further strength of MHLC is the presence and validation of Form C, designed to be a general-purpose condition-specific health locus of control measures that can be easily adapted to a variety of chronic conditions in a standardized manner.

Since publication, some replications have supported the multidimensional nature of health locus of control, while others have failed to support the 3-factor solution and recommend returning to the simple internal-external locus of control conceptualization. The authors caution that health locus of control is a health-specific indicator of generalized expectation of control over reinforcement based on Rotter's social learning theory. As a generalized measure, it is not expected to explain large amounts of variation in health behaviors if used in isolation. Only in combination with other contributing factors is MHLC likely to help explain health behavior.

References

1. (Original) Wallston KA, Wallston BS, DeVellis R. Development of the Multi-Dimensional Health Locus of Control Scales. Health Educ Monogr 1978;6:160–70.

2. (Original) Wallston K, Stein MJ, Smith CA. Form C of the MHLOC Scales: a condition-specific measure of locus of control. J Pers Assess 1994;63:534–53.

3. Fried TR, van Doorn C, O'Leary JR, Tinetti ME, Drickamer MA. Older persons' preferences for home versus hospital care in the treatment of acute illness. Arch Intern Med 2000;160:1501–6.

Additional References

Cooper D, Framboni M. Toward a more valid and reliable health locus of control scale. J Clin Psychol 1988;44:536–40.

O'Looney BA, Barrett PT. A psychometric investigation of the multidimensional health locus of control questionnaire. Brit J Clin Psychol 1983;22:217–8.

Umlauf RL, Frank RG. Multi-dimensional health locus of control in a rehabilitation setting. J Clin Psychol 1986;42:126–8.

4. Wallston K. Psychological control and its impact in management of rheumatological disorders. Bailliere's Clin Rheum 1993;7:281–95.

PARENT'S ARTHRITIS SELF-EFFICACY SCALE (PASE)

General Description

Purpose.

The Parent's Arthritis Self Efficacy Scale (PASE) was designed to measure parents' perceived ability to manage salient aspects of their child's juvenile arthritis (1). At first glance, this scale may seem misdirected. 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 psychosocial adaptation of the child with juvenile arthritis, but the primary measures used to validate with scale were correlations with measures of the parent's health status.

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 (ASES) items. Item example: “How certain are you that you can keep arthritis pain from interfering with your child's sleep?”

Developer/contact information.

Julie Barlow BA, PhD, Interdisciplinary Research Centre in Health, School of Health and Social Sciences, Coventry University, Priory Street, Coventry CV1 5FB, UK. E-mail: j.barlow@coventry.ac.uk.

Versions.

One.

Number of items in scale.

There are 14 items.

Subscales.

There are 2, symptom subscale and psychosocial subscale, both have 7 items.

Populations.

Developmental/target.

Parents identified from 2 hospital databases in the UK. Majority were white, married, some advanced education, and working in paid employment.

Other uses.

None.

WHO ICF Components.

Environmental factor.

Administration

Method.

Written, self-administered self-report. Easy to administer.

Training.

None required.

Time to administer/complete.

Estimated to be 3 minutes.

Equipment needed.

None.

Cost/availability.

Items and scoring listed in original article. Copy available at the Arthritis Care & Research Web site at http:/www.interscience.wiley.com/jpages/0004-3591:1/suppmat/index.html.

Scoring

Responses.

Scale.

Seven-point scale, from 1 (very uncertain) to 7 (very certain, and a nonapplicable category.

Score range.

Range is 7–49 for each subscale.

Interpretation of scores.

Higher scores reflect greater confidence in ability to manage or control aspects of child's juvenile arthritis. No cut points are provided.

Method of scoring.

Sum of item scores on each subscale; can be done manually. Validation study also standardized scores to a 0–10 scale allow easier comparison across subscales. This would be labor-intensive if attempted manually.

Time to score.

Not reported, assumed to be brief.

Training to score.

None required.

Training to interpret.

None reported.

Norms available.

No; but mean scores are reported for validation studies: mother's symptom subscale 27.37, psychosocial subscale 33.89; father's symptom subscale 23.22, psychosocial subscale 33.18.

Psychometric Information

Reliability.

Internal consistency reliability via Cronbach's alphas: mother's symptom subscale 0.92, psychosocial subscale 0.96; father's symptom subscale 0.89, psychosocial subscale 0.93.

Validity.

Criterion validity.

Criterion was demonstrated by significant correlations with the Generalized Self-Efficacy Scale with both subscales of the PASE, for both mothers and fathers.

Construct validity.

Validation was demonstrated for mothers by significant negative association of mother's anxious and depressed mood with both subscales, and significant associations of mother's psychosocial efficacy with her physical function, energy, pain, and general health perceptions. The only significant associations for fathers were positive associations between father's general health perceptions and psychosocial subscale, and negative association between father's depressed mood and psychosocial subscale. Authors also investigated the associations between parent's and 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.

Sensitivity/responsiveness to change.

Unknown.

Comments and Critique

The validation of the PASE has appeared in the literature but it is not clear that it has been used in clinical research by the authors or other investigators. The original article provides preliminary psychometric evidence, but additional use of the measure is required to further determine validity and reliability. Psychometric data is presented separately for mothers and fathers. From the preliminary study, there is some evidence that the parental ratings on the psychosocial subscale are related to parental health status, particularly for mothers, but there are no strong correlations reported for the symptoms subscale. The merits of combining the 2 subscales into a single instrument is not clear. Similar to the ASES on which it is modeled, the PASE may combine both efficacy expectations and expectations about results.

Reference

1. Barlow JH, Shaw KL, Wright CC. Development and preliminary validation of a self-efficacy measure for use among juvenile idiopathic arthritis. Arthritis Care Res 2000;1 227–36.

RHEUMATOID ARTHRITIS SELF-EFFICACY SCALE (RASE)

General Description

Purpose.

The Rheumatoid Arthritis Self-Efficacy Scale (RASE) was developed to measure task-specific self-efficacy for the initiation of self-management related behavior (1). It was developed specifically for rheumatoid arthritis patients in the UK.

Content.

Items are designed to tap specific self-management behaviors. All items use the same stem: “Do you believe you could do these things to help your arthritis.” Items include: “Use relaxation techniques to help with pain” or “Save energy for leisure activities, hobbies, or socializing.”

Developer/contact information.

Sarah Hewlett, PhD, MA, RGN, RM, ARC Senior Lecturer in Rheumatology (Health Professions), Academic Rheumatology, Bristol Royal Infirmary, Bristol BS2 8HW, UK. E-mail: Sarah.Hewlett@bristol.ac.uk.

Versions.

One.

Number of items in scale.

There are 28 items.

Subscales.

No subscales are used, although factor analysis showed 8 factors explaining 75% of the variance.

Populations.

Developmental/target.

Rheumatoid arthritis patients involved in self-management programs in several medical centers in the UK.

Other uses.

None.

WHO ICF Components.

Environmental factor.

Administration

Method.

Self-administered, written self-report. Relatively easy to administer.

Training.

None.

Time to administer/complete.

Approximately 10 minutes.

Equipment needed.

None.

Cost/availability.

Items and scoring available from the literature (see reference.) Copy available at the Arthritis Care & Research Web site at http:/www.interscience.wiley.com/jpages/0004-3591:1/suppmat/index.html.

Scoring

Responses.

Scale.

1 (strongly disagree) to 5 (strongly agree), Likert scale.

Score range.

Range is 28–140.

Interpretation of scores.

Higher scores indicate higher self-efficacy. No cut points are provided.

Method of scoring.

Sum of scores can be done manually.

Time to score.

Not reported, likely to be quick.

Training to score.

None required.

Training to interpret.

Not reported.

Norms available.

No.

Psychometric Information

Reliability.

Internal consistency.

Twenty-two of 28 items correlated significantly with the total RASE score, suggesting that self-efficacy as measured by the RASE may not be a unidimensional construct.

Test-retest reliability.

The 4-week test-retest correlation is 0.9.

Validity.

Construct validity.

As predicted by self-efficacy theory, the RASE is correlated with initiation of self-management behaviors, modest correlations with Arthritis Self-Efficacy Scale, and independent of mood and disease status.

Convergent validity.

Modest correlations were found with the Arthritis Self-Efficacy Scale (ASES).

Divergent validity.

Neither the RASE or ASES showed significant correlation with the General Self-Efficacy Scale (GSES), a trait measure of optimistic self beliefs and perceived coping competence (in contrast to the more behavior-specific concepts of the RASE and ASES).

Sensitivity/responsiveness to change.

It is not clear that change in scores reflects changes in the construct, but the instrument is responsive to change as indicated by changes following self-management programs.

Comments and Critique

The RASE is a measure of self-management behavior-specific self-efficacy. It appears to have promising psychometric characteristics, although it has not been used by many other investigators at this time. The RASE has been correlated with theoretically relevant variables predicted by self-efficacy theory. Examinations of the relationships between RASE and related but distinct constructs such as locus of control, mastery, and learned helplessness would strengthen the validation of this instrument.

The RASE was developed specifically for use in rheumatoid arthritis, and in patients from the UK. There is no information on its use with other types of arthritis, or in other geographic areas. The title of the RASE may be misleading. Rather than being RA-specific, the RASE is self-management behavior specific. In contrast to the Arthritis Self- Efficacy Scales, 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”).

Reference

1. (Original) Hewlett S, Cockshott Z, Kirwan J, Barrett J, Stamp J, Haslock L. Development and validation of a self-efficacy scale for use in British patients with rheumatoid arthritis. Rheumatology 2001;40:1221–30.

SELF-EFFICACY SCALE (SES)

General Description

Purpose.

The Self-Efficacy Scale (SES) was designed to be a measure of self-efficacy not tied to a specific situation or behavior (1). It is based on the premise that personal mastery experiences generalize across situations or behaviors. The authors intended the SES to be a dispositional, or trait measure of self-efficacy. It is not intended to replace specific self-efficacy measures that assess expectations for specific target behaviors.

Content.

Items were written to measure general self-efficacy expectations in areas such as social skills or vocational competence. Items tap 3 dimensions in these areas, willingness to initiate behavior, willingness to expend effort in completing the behavior, and persistence in the face of adversity.

Developer/contact information.

Mark Sherer, MD, Methodist Rehabilitation Center, Jackson, MS 39216.

Versions.

One. Several translations have been done, including Dutch and Hebrew.

Number of items in scale.

Final instrument has 23 items.

Subscales.

General self-efficacy subscale has 17 items and explains 26.5% of the variance in scores. Items include “When I make plans, I am certain I can make them work,” and “I give up on things before completing them.”

Social self-efficacy subscale has 6 items and explains 8.5% of the variance. Items include “I have acquired my friends through my personal abilities at making friends,” and “I do not handle myself well in social gatherings.”

Populations.

Developmental/target.

Instrument was developed using college students. Criterion validity was evaluated at a Veterans Administration Medical Center Chemical Dependency Unit.

Other uses.

None.

WHO ICF Components.

Environmental factor.

Administration

Method.

Self-administered written self-report. Easy to administer.

Training.

None needed.

Time to administer/complete.

Not listed, assumed to be 5–7 minutes.

Equipment needed.

None.

Cost/availability.

Items and scoring available from the literature (see reference.) Copy available at the Arthritis Care & Research Web site athttp:/www.interscience.wiley.com/jpages/0004-3591:1/suppmat/index.html.

Scoring

Responses.

Scale.

14-point Likert scale from strongly disagree to strongly agree.

Score range.

General self-efficacy subscale (17 items), range 14–238. Social self-efficacy subscale (6 items), range 6–84.

Interpretation of scores.

Higher scores indicate higher self-efficacy expectations. No cut points are provided.

Method of scoring.

Reversed items are converted. The score on each subscale is total of item responses.

Time to score.

Unknown, but likely to be brief.

Training to score.

Not needed, but selected items must be reversed before scoring.

Training to interpret.

Not needed.

Norms available.

No norms available. On initial development, means score for general self-efficacy subscale was 172.65 (SD 27.31); mean score for social self efficacy was 57.99 (SD 12.08).

Psychometric Information

Reliability.

Cronbach's alpha for internal consistency was 0.86 for General self-efficacy subscale, and 0.71 for Social self-efficacy subscale.

Validity.

Construct validity.

Validity was demonstrated by moderate correlations between SES subscales and related constructs such as Personal Control Scale of Rotter's Internal-External Locus of Control Scale, and Holland and Baird's Interpersonal Competency Scale. All correlations were of moderate magnitude in the hypothesized direction.

A second study was performed to “provide evidence of criterion validity.” As expected, the General Self-Efficacy Scale scores predicted past success in vocational educational and military goals among veterans on a Veterans Administration Medical Center Chemical Dependency Unit. Social Self-Efficacy Scale scores were negatively correlated with numbers of jobs quit and number of times fired.

Sensitivity/responsiveness to change.

Unknown, but is designed to measure a trait so is expected to be stable.

Comments and Critique

Although scale is labeled as a “self-efficacy scale,” the title of the instrument may be misleading. Rather than the domain or behavior specific confidence usually referred to as self-efficacy, the authors developed the SES based on the premise that mastery experiences would generalize across situations or behaviors, and they assumed it would measure a stable trait. The types of items included however (initiation or persistence of behavior, willingness to expend effort) are reflective of self-efficacy theory.

The SES is composed of 2 subscales, one tapping a non-situation specific sense of competence, the other tapping competence in social situations. Although the 2 sets of items are intertwined into a single measure, all psychometric work is reported by subscale and there does not appear to be good rationale to combine them; they could easily be 2 separate measures of general perception of competence, similar to mastery, and a domain-specific measure related to social situations.

Preliminary validation work is unlikely to generalize because it was conducted with patients in a Veterans Administration Medical Center addictions unit. This sample is not likely to be representative ,  .

Table  . Summary Table for Self-Efficacy, Helplessness, Mastery, and Control Measures
Measure/scaleConstruct/contentMeasure outputsNo. of itemsItem stemResponse formatMethod of administrationTime for administration
Arthritis Helplessness Index (AHI)/Rheumatology Attitudes Index (RAI)General belief/perceptions about ability to control arthritis (AHI) or condition (RAI)AHI/RAI total score 15–60 AHI/RAI. Helplessness score 5–30Total AHI/RAI 15; Helplessness 5 Internality 7“Describe how you feel about the statement.”Likert scale, strongly disagree to strongly agreeWrittenTotal 3 minutes 5-item subscale 1 minute
Arthritis Self-Efficacy Scale (ASES)Specific beliefs that the individual could perform specific behaviors or achieve results to cope with the consequences of arthritisScored by subscale Each subscale score 10–100Total 20; Subscales Pain 5, Function 9, Other symptoms 6“How certain are you that you can … ?”90-point scale, in increments of 10. 10 = very uncertain, 100 = very certainWrittenNot reported, estimate < 5 minutes
Children's Arthritis Self-Efficacy Scale (CASE)Arthritis-specific beliefs about ability to manage or control aspects of life with juvenile arthritisScored by subscale Subscale means 1–5 Subscale standard scores 0–10Total 11; Subscales: Activity 4, Symptoms 4, Emotion 3“I can find ways to … ”5-point scale 1 = not at all sure, 5 = very sure.WrittenEstimated 5 minutes
Generalized Self-Efficacy Scale (GSES)Perceived coping competence or generalized confidence in ability to cope across a range of demanding situations and setbacks. Not arthritis specific.Total score: 10–40Total 10“Rate how true … ”4-point scale 1 = not at all true, 4 = exactly trueWrittenEstimated 3 minutes
Mastery ScalePersonality characteristic; the extent to which people see themselves as being in control of forces that affect their lives. Not arthritis specific.Varies by Likert scale used 4-point scale (4–28) 5-point scale (5–35) 7-point scale (7–49)Total 7“How strongly do you agree or disagree with these statements about yourself?”Not provided; investigators have used 4-, 5-, and 7- point Likert scales.WrittenNot reported, estimated < 2 minutes
Multi-Dimensional Health Locus of Control Scale (MHLC)Generalized expectation of control over reinforcement in relation to health. Not arthritis specific.Scored by subscale 6-item subscale (6–36) If 2 forms combined for 12-item subscales (12–72)Total 18 (6 on each subscale) Two forms can be combined for 12 item subscalesNot stated6-point Likert scale; 1 = strongly disagree, 6 = strongly agree.WrittenEstimated 3–5 minutes per form
Parent's Arthritis Self-Efficacy Scale (PAS)Perceived ability of parents to manage child's arthritis symptoms or ability to participate in selected activitiesScored by subscale Score range 7–49 on each subscaleTotal 14; 7 on each subscale“How certain are you that you can … ?”7-point scale, “very uncertain” to “very certain”WrittenEstimated 3 minutes
Rheumatoid Arthritis Self-Efficacy Scale (RASE)Specific beliefs about ability to perform defined arthritis-specific self-management behaviorsTotal score range 28–140Total 28“I believe I could … ”5-point Likert Scale strongly agree to strongly agree.WrittenEstimated 10 minutes
Self-Efficacy Scale (SES)Generalized competence beliefs and beliefs about competence in social situations. Not arthritis specificScored by subscale. General efficacy 14–238 Social Efficacy 6–84Total 23; Subscales General 17, Social 6Not published14-point Likert Scale; strongly disagree to strongly agreeWrittenNot reported estimated < 10 minutes
Table  . 
Measure/scaleValidated populationsPsychometric propertiesComments
ReliabilityValidityResponsiveness
Arthritis Helplessness Index (AHI)/Rheumatology Attitudes Index (RAI)Individuals with physician-diagnosed rheumatoid arthritis Swedish; Spanish translations.Good for all variantsAHI very good, AHI-Helplessness very good, RAI fair, RAI helplessness fairAHI good, AHI-Helplessness good, RAI unknown, RAI helplessness: unknownRAI and RAI helplessness scale more frequently used; AHI may have stronger psychometric evidence
Arthritis Self-Efficacy Scale (ASES)Participants in community-based arthritis education. Swedish, Norwegian, Spanish translations.ExcellentGoodUnknownMost widely used measure of situation-specific beliefs used in arthritis research. Additional validation would be helpful. Subscales can be used independently.
Children's Arthritis Self-Efficacy Scale (CASE)Children with juvenile arthritis (ages 7–17)Preliminary, Internal consistency: excellentPreliminary, very goodUnknownNew scale with small amount of preliminary data; too early to judge
Generalized Self-Efficacy Scale (GSES)Participants in community-based arthritis education in UK. English adaptation of original German scale. Also in Spanish, Chinese, Indonesian, Japanese, and Korean.Internal consistency: excellent, test-retest goodGoodUnknown; designed as a trait measure so expected to be stableIn contrast to title of scale, this is a measure of perceived competence to cope with difficult situations and is assumed to be a stable trait.
Mastery ScaleWorking-age adults, Chinese, Czech, Dutch, German, Hebrew, Vietnamese, Spanish, Swedish translations.FairNot reportedUnknown; designed as a trait measure so expected to be stableMinimal psychometric information in the literature, yet the measure has been widely used. Lack of standardized scoring information makes it difficult to compare across studies.
Multi-Dimensional Health Locus of Control Scale (MHLOC)Adults, Spanish translationInternal consistency: good to very goodAcceptableNot reportedUsed to measure expectations about control over health; some debate as to need to divide external locus of control into chance and powerful others.
Parent's Arthritis Self-Efficacy Scale (PASE)Mothers and fathers of children with juvenile arthritisInternal consistency, by subscale excellentPreliminary evidence acceptableNot reportedModeled after ASES. Reason for combining these two subscales into a single measure is not clear; preliminary data show modest validity for psychosocial subscale, very few significant correlations for symptom subscale.
Rheumatoid Arthritis Self-Efficacy Scale (RASE)Individuals with rheumatoid arthritis involved in medical center-based self management programs in the UKTest-retest excellent Internal consistency fairPreliminary evidence acceptablePreliminary evidence acceptablePromising measure of self-management behavior-specific self-efficacy; has had little use in the literature.
Self-Efficacy Scale (SES)Chemically dependent veterans being treated at a Veterans Administration Medical CenterInternal consistency General self- efficacy very good. Social self-efficacy good.FairUnknown, designed as a trait measure so expected to be stableEarly measure (1982) that has not been used frequently. Contrary to self-efficacy theory, attempts to measure self-efficacy as a trait, which makes it closer to mastery. Measure combines general estimate of competence with measure of competence in social situations. Limited validity data available.

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