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Health and Quality of Life Outcomes

, 7:86

First Online: 26 September 2009Received: 01 July 2009Accepted: 26 September 2009


BackgroundMeasurement of self-efficacy requires carefully developed and validated instruments. It is currently unclear whether available self-efficacy instruments for chronic diseases fulfill these requirements. Our aim was to systematically identify all existing self-efficacy scales for five major chronic diseases and to assess their development and validation process.

MethodsWe conducted a systematic literature search in electronic databases MEDLINE, PSYCHINFO, and EMBASE to identify studies describing the development and-or validation process of self-efficacy instruments for the five chronic diseases diabetes, chronic obstructive pulmonary disease COPD, asthma, arthritis, and heart failure. Two members of the review team independently selected articles meeting inclusion criteria. The self-efficacy instruments were evaluated in terms of their development aim of instrument, a priori considerations, identification of items, selection of items, development of domains, answer options and validation test-retest reliability, internal consistency reliability, validity, responsiveness process.

ResultsOf 584 potentially eligible papers we included 25 13 for diabetes, 5 for asthma, 4 for arthritis, 3 for COPD, 0 for heart failure which covered 26 different self-efficacy instrument versions. For 8 instruments 30.8%, the authors described the aim before the scales were developed whereas for the other instruments the aim was unclear. In one study 3.8% a priori considerations were specified. In none of the studies a systematic literature search was carried out to identify items. The item selection process was often not clearly described 38.5%. Test-retest reliability was assessed for 9 instruments 34.6%, validity using a correlational approach for 18 69.2%, and responsiveness to change for 3 11.5% instruments.

ConclusionThe development and validation process of the majority of the self-efficacy instruments had major limitations. The aim of the instruments was often not specified and for most instruments, not all measurement properties that are important to support the specific aim of the instrument for example responsiveness for evaluative instruments were assessed. Researchers who develop and validate self-efficacy instruments should adhere more closely to important methodological concepts for development and validation of patient-reported outcomes and report their methods more transparently. We propose a systematic five step approach for the development and validation of self-efficacy instruments.

Electronic supplementary materialThe online version of this article doi:10.1186-1477-7525-7-86 contains supplementary material, which is available to authorized users.

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Autor: Anja Frei - Anna Svarin - Claudia Steurer-Stey - Milo A Puhan


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