Measuring self-care in chronic heart failure : a review of the psychometric properties of clinical instruments

Background : Improved self-care skills and behaviors are an important outcome of patient education and counseling. Both researchers and health professionals need to utilize instruments that are reliable and valid at measuring this outcome to advance our understanding as to the efficacy of clinical practice directed toward improving self-care.

Objective : The aim of this study was to identify instruments that measure chronic heart failure (CHF) self-care and demonstrate their psychometric properties.

Methods : A search of Medline, Cumulative Index to Nursing and Allied Health Literature, Medline, PsycArticles, Psychology and Behavioral Sciences Collection, and PsycINFO databases elucidated studies published between January 1980 and February 2009 that measure CHF self-care. The clinical instruments selected were disease-specific measures of CHF self-care behaviors that are promoted in best practice guidelines. Only instruments that reported estimates of reliability and validity were included in this review. Psychometric properties of the instruments were evaluated according to practice guidelines.

Results : The literature search identified 14 instruments published in peer-reviewed journals that measured constructs that predict or correlate to self-care rather than self-care itself. Only 2 disease-specific measures of self-care were identified (Self-care Heart Failure Index [SCHFI] and European Heart Failure Self-care Behavior Scale [EHFScBS]) that have undergone rigorous psychometric testing in CHF populations. Five aspects of validity had been demonstrated with EHFScBS, and 6 aspects of validity had been demonstrated with SCHFI. Two of 3 aspects of reliability have been demonstrated in both instruments.

Conclusion : Only 2 reliable and valid tools have been developed to specifically measure CHF self-care. Further use of these instruments in the research arena may reduce gaps in our understanding of CHF self-care and further shape clinical practice directed at improving it.

Fear of self and obsessionality: development and validation of the Fear of Self Questionnaire

Obsessions – particularly those directly relating to causing harm – often contain or imply evaluative dimensions about the self, reflecting a fear as to who the person might be – or might become. Following from research indicating that such beliefs are relevant to OCD, and the wider literature in social psychology regarding ‘feared’ or ‘undesired’ self-guides, the current study describes the development and validation of a new questionnaire—the Fear of Self Questionnaire, in 8- and 20-item versions.

The questionnaire was piloted in two non-clinical samples (n=258; n=292). Exploratory and confirmatory factor analyses supported the unidimensionality of the measure. The questionnaire showed a strong internal inconsistency, and good divergent and convergent validity, including strong relationships to obsessional symptoms and with other processes implicated in cognitive models of OCD (e.g. obsessive beliefs, inferential confusion). Implications are discussed.

Persona studies: mapping the proliferation of the public self

Celebrity has developed into a particularly powerful and pervasive trope for contemporary culture. It works at organising what we perceive as significant and this is made evident through its permeation of what constitutes news. Similarly, celebrity has been well documented in terms of its capacity to shape our entertainment: stardom is at least one of the cultural economies in which our stories and fictions are selected or read and recreated in popular culture. This article argues for the development of persona studies, where research on the celebrity is a subset of a wider study of how the self and public intersect and produce versions and identities that in some way continue to support the wider demands of our work economies.

The self-efficacy of gifted students : an investigation into the written English self-efficacy of verbal and non-verbally gifted adolescents

Self-efficacy is a belief. It can encourage or hamper students from learning to their full potential. Students who are efficacious are more motivated, more persistent to meet their goals and are more likely to take learning risks. The research into the self-efficacy of students classified as verbally or non-verbally gifted is in its infancy. This book details a Doctoral dissertation that investigated the written English self-efficacy of adolescent students. Results identified verbally gifted students had higher written English self-efficacy, were more intrinsically motivated, had higher levels of creativity and wrote superior essays compared to non-verbally gifted and non-gifted students. Findings highlighted differences between gender as female student?s recorded higher self-efficacy and written English performance scores and interestingly, students from lower socio-economic backgrounds reported higher self-efficacy compared to students from higher socio-economic backgrounds. Pedagogical implications are considered with teachers encouraged to realise the impact of self-efficacy upon student learning, motivation and persistence regardless of their academic ability.

Diet and physical activity in the self-management of type 2 diabetes: barriers and facilitators identified by patients and health professionals

Aim: 

Measurement of stable changes of self-management skills after rehabilitation: a latent state-trait analysis of the Health Education Impact Questionnaire (heiQ™)

To assess stable effects of self-management programs, measurement instruments should primarily capture the attributes of interest, for example, the self-management skills of the measured persons. However, measurements of psychological constructs are always influenced by both aspects of the situation (states) and aspects of the person (traits). This study tests whether the Health Education Impact Questionnaire (heiQ™), an instrument assessing a wide range of proximal outcomes of self-management programs, is primarily influenced by person factors instead of situational factors. Furthermore, measurement invariance over time, changes in traits and predictors of change for each heiQ™ scale were examined.

Measurement of stable changes of self-management skills after rehabilitation: a latent state–trait analysis of the Health Education Impact Questionnaire (heiQ™)

Methods: Subjects were N = 580 patients with rheumatism, asthma, orthopedic conditions or inflammatory bowel disease, who filled out the heiQ™ at the beginning, the end of and 3 months after a disease-specific inpatient rehabilitation program in Germany. Structural equation modeling techniques were used to estimate latent trait-change models and test for measurement invariance in each heiQ™ scale. Coefficients of consistency, occasion specificity and reliability were computed.

The role of a self-report measure in athlete preparation

Athlete self-report measures (ASRM) are a common and cost-effective method of athlete monitoring. It is purported that ASRM be used to detect athletes at risk of overtraining, injury or illness, allowing intervention through training modification. However it is not known whether ASRM are actually being used for or are achieving these objectives in the applied sport setting. Therefore the aim of this study was to better understand how ASRM are being used in elite sports and their role in athletic preparation. Semi-structured interviews were conducted one-on-one with athletes, coaches and sports science and medicine staff (n=30) at a national sporting institute. Interview recordings were transcribed and analysed for emergent themes. Twelve day-to-day and seven longer-term practices were identified which contributed to a four-step process of ASRM use (record data, review data, contextualize, act). In addition to the purported uses, ASRM facilitated information disclosure and communication amongst athletes and staff and between staff, and improved the understanding and management of athlete preparation. These roles of ASRM are best achieved through engagement of athletes, coaches and support staff in the systematic, cyclic process.