Original Article| Volume 67, ISSUE 11, P1265-1273, November 2014

The English and Spanish Self-Efficacy to Manage Chronic Disease Scale measures were validated using multiple studies



      Self-efficacy theory, as developed by Bandura, suggests that self-efficacy is an important predictor of future behavior. The Chronic Disease Self-Management Program was designed to enhance self-efficacy as one approach to improving health behaviors and outcomes for people with varying chronic diseases. The six-item Self-Efficacy to Manage Chronic Disease Scale (SEMCD) and the four-item Spanish-language version (SEMCD-S) were developed to measure changes in self-efficacy in program participants and have been used in a numerous evaluations of chronic disease self-management programs. This study describes the development of the scales and their psychometric properties.

      Study Design and Setting

      Secondary analyses of questionnaire data from 2,866 participants in six studies are used to quantify and evaluate the SEMCD. Data from 868 participants in two studies are used for the SEMCD-S. Subjects consisted of individuals with various chronic conditions, who enrolled in chronic disease self-management programs (either small group or Internet based). Subjects came from United States, England, Canada, Mexico, and Australia. Descriptive statistics are summarized, reliability tested (Cronbach alpha), and principal component analyses applied to items. Baseline and change scores are correlated with baseline and change scores for five medical outcome variables that have been shown to be associated with self-efficacy measures in past studies.


      Principal component analyses confirmed the one-dimensional structure of the scales. The SEMCD had means ranging from 4.9 to 6.1 and the SEMCD-S 6.1 and 6.2. Internal consistency was high (Cronbach alpha, 0.88–0.95). The scales were sensitive to change and significantly correlated with health outcomes.


      The SEMCD and SEMCD-S are reliable and appear to be valid instruments for assessing self-efficacy for managing chronic disease. There was remarkable consistency across a range of studies from varying countries using two languages.


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        • Bandura A.
        Self-efficacy: toward a unifying theory of behavioral change.
        Psychol Rev. 1977; 84: 191-215
        • Bandura A.
        Self-efficacy: the exercise of control.
        WH Freeman and Company, New York, NY1997
        • Lorig K.
        • Chastain R.L.
        • Ung E.
        • Shoor S.
        • Holman H.R.
        Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis.
        Arthritis Rheum. 1989; 32: 37-44
        • Lorig K.
        • Sobel D.S.
        • Stewart A.L.
        • Brown B.W.
        • Bandura A.
        • Ritter P.
        • et al.
        Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial.
        Med Care. 1999; 37: 5-14
        • Lorig K.
        • Stewart A.
        • Ritter P.
        • González V.
        • Laurent D.
        • Lynch J.
        Outcome measures for health education and other health care interventions.
        Sage Publications, Thousand Oaks, CA1996
      1. Stellefson M, Tennant B, Chaney JD. A critical review of effects of COPD self-management education on self-efficacy. ISRN Public Health. 2012; Article ID 152047.

        • Frei A.
        • Svarin A.
        • Steurer-Stey C.
        • Puhan M.A.
        Self-efficacy instruments for patients with chronic diseases suffer from methodological limitations—a systematic review.
        Health Qual Life Outcomes. 2009; 7: 86
        • Freund T.
        • Gensichen J.
        • Goetz K.
        • Szecsenyi J.
        • Mahler C.
        Evaluating self-efficacy for managing chronic disease: psychometric properties of the 6-item Self-Efficacy Scale in Germany.
        J Eval Clin Pract. 2011; 19: 39-43
        • Hays R.D.
        • Hayashi T.
        Beyond internal consistency reliability: rationale and user's guide for multitrait scaling analysis program on the microcomputer.
        Behav Res Methods Instrum Comput. 1990; 22: 167-175
        • Lorig K.R.
        • Sobel D.S.
        • Ritter P.L.
        • Laurent D.
        • Hobbs M.
        Effect of a self-management program for patients with chronic disease.
        Eff Clin Pract. 2001; 4: 256-262
        • Farrell K.
        • Wicks M.N.
        • Martin J.C.
        Chronic disease self-management improved with enhanced self-efficacy.
        Clin Nurs Res. 2004; 13: 289-308
        • Lorig K.
        • Ritter P.L.
        • Laurent D.D.
        • Plant K.
        Internet-based chronic disease self-management: a randomized trial.
        Med Care. 2006; 44: 964-971
        • Lorig K.R.
        • Ritter P.L.
        • Dost A.
        • Plant K.
        • Laurent D.D.
        • McNeil I.
        The expert patients programme online, a 1-year study of an Internet-based self-management programme for people with long-term conditions.
        Chronic Illn. 2008; 4: 247-256
        • González V.
        • Stewart A.
        • Ritter P.
        • Lorig K.
        Translation and validation of arthritis outcome measures into Spanish.
        Arthritis Rheum. 1995; 38: 1429-1446
        • Lorig K.
        • González V.M.
        • Ritter P.
        Community-based Spanish language arthritis education program: a randomized trial.
        Med Care. 1999; 37: 957-963
        • Lorig K.R.
        • Ritter P.L.
        • González V.M.
        Hispanic chronic disease self-management. A randomized community-based outcome trial.
        Nurs Res. 2003; 52: 361-369
        • Lorig K.
        • Ritter P.
        • Jacquez A.
        Outcomes of border health Spanish/English chronic disease self-management programs.
        Diabetes Educ. 2005; 31: 401-409
        • Lorig K.
        • Ritter P.L.
        • Plant K.
        • Laurent D.D.
        • Kelley P.
        • Rowe S.
        The south Australia health chronic disease self-management internet trial.
        Health Educ Behav. 2013; 40: 67-77
        • Lorig K.
        • Laurent D.D.
        • Plant K.
        • Krishnan E.
        • Ritter P.L.
        The components of action planning and their associations with behavior and health outcomes.
        Chronic Illn. 2014; 10: 50-59
        • Cronbach L.J.
        Coefficient alpha and the internal structure of tests.
        Psychometrika. 1951; 16: 297-334
        • Terwee C.B.
        • Bot S.D.M.
        • deBoer M.R.
        • van der Windt D.A.
        • Knol D.L.
        • Dekker J.
        • et al.
        Quality criteria were proposed for measurement properties of health status questionnaires.
        J Clin Epidemiol. 2007; 60: 34-42
        • Stewart A.L.
        • Hays R.D.
        • Ware J.E.
        Health perceptions, energy/fatigue, and health distress measures.
        in: Stewart A. Ware J.E. Measuring functioning and well being: the medical outcomes study approach. Duke University Press, Durham, NC1992: 143-172
        • Devins G.
        • Binik Y.
        • Hutchinson T.A.
        • Hollomby D.J.
        • Barré P.E.
        • Guttmann R.D.
        The emotional impact of end-stage renal disease: importance of patients' perceptions of intrusiveness and control.
        Int J Psychiatry Med. 1983; 13: 327-343
        • Devins G.M.
        • Mandin H.
        • Hons R.B.
        • Burgess E.D.
        • Klassen J.
        • Taub K.
        • et al.
        Illness intrusiveness and quality of life in end-stage renal disease: comparison and stability across treatment modalities.
        Health Psychol. 1990; 9: 117-142
        • Kroenke K.
        • Strine T.W.
        • Spitzer R.L.
        • Williams J.B.
        • Berry J.T.
        • Mokdad A.H.
        The PHQ-8 as a measure of current depression in the general population.
        J Affect Disord. 2009; 114: 163-173
        • Ritter P.
        • González V.
        • Laurent D.D.
        • Lorig K.R.
        Measurement of pain using the visual numeric scale.
        J Rheumatol. 2006; 44: 964-971
      2. Stanford Patient Education Research Center. Research instruments developed, adapted or used by the Stanford Patient Education Research Center. Available at Accessed February 24, 2012.

        • Reeves D.
        • Kennedy A.
        • Fullwood C.
        • Bower P.
        • Gardner C.
        • Gately C.
        • et al.
        Predicting who will benefit from an expert patients programme self-management course.
        Br J Gen Pract. 2008; 58: 198-203
        • Ritter P.L.
        • Lee J.
        • Lorig K.
        Moderators of chronic disease self-management programs: who benefits?.
        Chronic Illn. 2011; 7: 162-172
        • Amtmann D.
        • Bamer A.M.
        • Cook K.F.
        • Askew R.L.
        • Noonan V.K.
        • Brockway J.A.
        University of Washington self-efficacy scale: a new self-efficacy scale for people with disabilities.
        Arch Phys Med Rehabil. 2012; 93: 1757-1765
        • Bandura A.
        Guide for construction self-efficacy scales.
        in: Pajares F. Urdan T. Self-efficacy beliefs of adolescents. Information Age Publishing, Charlotte, NC2006: 307-337
        • Linnenbrink E.A.
        • Pintrich P.R.
        The role of self-efficacy beliefs in student engagement and learning in the classroom.
        Read Writ Q. 2003; 19: 119-137
        • Stellefson M.
        • Chaney B.H.
        • Chaney J.D.
        Examining the efficacy of DVD technology compared to print-based material in COPD self-management education of rural patients.
        Calif J Health Promot. 2009; 7: 26-42
        • Miller J.M.
        Managing HIV: self-efficacy, mindfulness, optimism, and meaning.
        UNT Digital Library, Denton, TX2011 (Available at) (Accessed March 12, 2014)