measures of self-efficacy, helplessness, mastery, and control: the arthritis helplessness index...

Measures of Self-Efficacy, Helplessness,Mastery, and ControlThe 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), andSelf-Efficacy Scale (SES)

Teresa J. Brady

ARTHRITIS HELPLESSNESS INDEX(AHI)/RHEUMATOLOGY ATTITUDESINDEX (RAI)General Description

Purpose. The Arthritis Helplessness Index (AHI)and its variants were designed to assess patients’perceptions of helplessness in coping with arthritisas delineated by learned helplessness theory.Helplessness is considered a psychological state inwhich individuals expect their efforts will beineffective and become more passive and morelikely to be depressed. Learned helplessness theorypostulates that this helplessness results fromexperiencing unpredictable and uncontrollableaversive events. Helplessness has also beenpostulated to mediate relationships betweendisease or treatment and health outcomes.

The Rheumatology Attitudes Index (RAI) isconceptually identical to the AHI. Item wordingand response format were modified slightly toreduce respondent confusion when the instrumentwas used with individuals with other rheumaticconditions such as fibromyalgia or bursitis.

Four variants of arthritis helplessnessmeasures are available: the original 15-itemArthritis Helplessness Index (1), a 5-item AHI

Helplessness Subscale (2), the 15-itemRheumatology Attitudes Index (RAI) (3), and a 5-item RAI helplessness subscale (4).

Content. The AHI/RAI consists of 2 types ofitems: items measuring patients’ perceptions oftheir abilities (“I can reduce my pain by stayingcalm and relaxed”), and their inabilities (“Nomatter what I do or how hard I try, I just can’t getrelief from my pain”), to control their arthritis.

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

Developer/contact information. (AHI) Perry M.Nicassio, PhD, Daley Hall, Room 104, CSPP SDAIU,10455 Pomerado Road, San Diego, CA 92131.E-mail: [email protected]. (RAI) Leigh F.Callahan, PhD, Thurston Arthritis Research Center,University of North Carolina, 3310 ThurstonBuilding CB#7280, Chapel Hill, NC 27599-7280.E-mail: [email protected].

Versions. Four versions are available, theoriginal 15 item AHI and its 5-item helplessnesssubscale, and the 15 item RAI and its 5-itemhelplessness subscale. RAI items are identical toAHI items except the word arthritis was replacedby the word condition. This change affected 12 ofthe original 15 items. The 5-item subscales areconsidered conceptually cleaner because eachconsists of a single factor. They are also easier andfaster to complete. A Spanish language version ofthe 5-item RAI-helplessness subscale has been

Teresa J. Brady, PhD: Arthritis Program, Centers for Dis-ease Control and Prevention, Atlanta, Georgia.

Address correspondence to Teresa J. Brady, PhD, Arthri-tis Program, Centers for Disease Control and Prevention,4770 Buford Hwy NE, MS K-45, Atlanta, GA 30341. E-mail:[email protected].

Submitted for publication March 30, 2003; accepted April4, 2003.

Arthritis & Rheumatism (Arthritis Care & Research)Vol. 49, No. 5S, October 15, 2003, pp S147–S164DOI 10.1002/art.11413© 2003, American College of Rheumatology

MEASURES OF PSYCHOLOGICAL STATUS AND WELL-BEING

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evaluated for cross-cultural equivalence (5). RAIhas 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 helplessnesssubscale and 7-item internality subscale. The RAIhas a 5-item helplessness subscale. A factoranalysis revealed an internality subscale on theRAI as well, but no other information is provided.

Populations. Developmental/target. Allpsychometric work on the AHI and RAI was doneon individuals with physician-confirmedrheumatoid arthritis.

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

WHO ICF Components. Environmental factor.

AdministrationMethod. Self-administered written self-report

questionnaire. Easy to administer.

Training. No training required.

Time to administer/complete. The 5-itemhelplessness scales estimated to take less than aminute. The 15-item scales may take up to 3minutes.

Equipment needed. None.

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

ScoringResponses. Scale. Original AHI has a 4-point

Likert scale (1 � strongly disagree, 2 � disagree,3 � agree, 4 � strongly agree); AHI Helplessnesssubscale has a 6-point Likert scale (1 � stronglydisagree, 2 � moderately disagree, 3 � disagree,4 � agree, 5 � moderately agree, 6 � stronglyagree); RAI has a 4-point Likert scale with 5response options (1 � strongly disagree, 2 �disagree, 2.5 � do not agree or disagree, 3 � agree,4 � strongly agree); RAI Helplessness Subscale hasa 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 scoresindicate greater helplessness. Original AHI 15–60,AHI Helplessness subscale 5–30, RAI 15–60, RAIHelplessness Subscale 5–30.

Interpretation of scores. For the AHIHelplessness subscale, empirically derived cut-points, which demonstrated statistically significantdifferences among groups on psychological,behavioral, and symptom severity measures havebeen published. The “low helplessness” groupachieved better scores while “high helplessness”group scored worse on psychological, behavioral,and symptom severity scales. Cut-points are Lowhelplessness (� 11), Normal ( 11–19, combines lownormal, normal and high normal), Highhelplessness (� 20). In other versions there is noguidance in interpretation of scores; since the RAIitems are identical except for the substitution of“condition” for “arthritis” in 4 items, it is likely tohave similar cut-points but this has not beentested.

Method of scoring. All versions can be scored byhand. In the AHI/RAI reverse the 9 itemsindicating perceived control (items 2, 3, 5, 6, 8, 9,11, 13, 15) and sum all items for total score. In theAHI/RAI helplessness subscale reverse scoring onitem 4; sum all items for total score.

Time to score. Not documented, likely to be verybrief, but requires score conversion.

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

Training to interpret. None required; theseinstruments have been used primarily in research.Clinicians who use them have relied on clinicaljudgment.

Norms available. No formal norms have beenpublished. Cut-points scores used to determinelow, midrange, and high helplessness scores usingthe AHI helplessness subscale were empiricallyderived to categorize 20% of the sample as lowhelplessness, and 20% as high helplessness.

Psychometric InformationReliability. AHI. Internal consistency reliability,

Cronbach’s alpha 0.69 (borderline acceptable for apresumed unidimensional scale). The 12-monthtest-retest reliability was 0.53.

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AHI helplessness subscale. Internal consistencyreliability 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 subscalesto the number of items on the full scale) was 0.84.The 6-month test-retest reliability was 0.64.

AHI internality subscale. Internal consistencyreliability 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 subscalesto the number of items on the full scale) was 0.88and the 6-month test-retest reliability was 0.59.

RAI. Internal consistency reliability viaCronbach’s alpha was 0.68. Two items had weakcorrelations with the parallel item on the AHI (Ihave considerable ability to control my pain”, and“If I do all the right things, I can successfullymanage my condition.”)

RAI helplessness subscale. Internal consistencyreliability via Cronbach’s alpha was 0.70 Sample Aand 0.67 Sample B.

Validity. AHI construct validity. AHI correlatesin expected ways with theoretically relevantvariables such as health locus of control, selfesteem, anxiety, and depression measures. Allcorrelations were significant and remainedsignificant when age- and education level-adjusted.AHI also significantly correlated with measures offunctional status (Modified Health AssessmentQuestionnaire), dissatisfaction with functionalstatus, pain, and general rating of perceivedlimitations.

AHI helplessness subscale construct validity.Subscale correlated in expected ways withtheoretically relevant measures including chance-and powerful other-health locus of control,depression, non-compliance, information seeking,pain rating, and Arthritis Impact MeasurementScales physical, pain, depression and global healthstatus subscales. The 5-item subscale accounted formore variance in these measures than did the 15-item measure. Changes in the helplessnesssubscale were more strongly associated withchanges in pain and depression than were changesin the scores on the 15-item scale.

AHI internality subscale construct validity.Scores were associated with internal health locusof control scores. High scores were associated withless pain, depression, and behavioral

ineffectiveness. Changes in the full scale weremore strongly associated with changes inpsychological and disease impact measures thanwere changes in the internality subscale.

RAI construct/criterion validity. Correlation of0.78 between RAI and AHI completed 1–24 hoursapart. Validation article (3) presents a variety ofcorrelations of RAI with 4 measures of diseaseactivity, 3 measures of physical performance, and 3self- report measures of functional status. Norelationships between RAI and these measures arehypothesized a priori, so it is difficult to evaluatethese as evidence of validity. RAI scores weresignificantly correlated with physical performancescores, and self-report measures of function; thelatter had larger correlations.

RAI helplessness subscale construct/criterionvalidity. Correlations of 0.79 between full RAI andRAI helplessness scale. Brief measure hadsignificantly higher correlations to measures ofself-reported functional status than did the fullRAI.

Sensitivity/responsiveness to change. AHI. Anobservational study found a 1-point decrease inhelplessness on 12- month retesting. Changes inthe AHI were significantly correlated with changesin functional status at 12 months.

AHI helplessness subscale. The 6-monthretesting indicated changes over time, and thesewere more strongly related to changes in pain anddepression than were changes in the full AHI.

RAI and RAI Helplessness Subscale. Unknown.

Comments and CritiqueThe original 15-item AHI was developed to

capture the construct of learned helplessness, thepsychological state in which individuals believetheir efforts will be ineffective. These perceptionsare hypothesized to produce affective,motivational, and behavioral deficits. The original15-item AHI has been correlated with theoreticallyrelevant variables and has demonstrated constructvalidity. True criterion validity is not possiblebecause there is no pre-existing gold standardhelplessness measure in the literature. The 15-itemAHI had modest internal-consistency reliability,however, suggesting it was not a uni-dimensionalmeasure. Factor analysis found 2 factors orsubscales, internality and helplessness. Theinternality subscale has received little attention,but the helplessness subscale has been

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demonstrated to be more conceptually clear and toaccount for more variance in variables of interestthan does the full AHI. In addition, Stein et al (6)empirically developed a classification schema forthe helplessness subscale that has predicted scoreson psychological, behavioral, and symptomseverity measures even after 2 years.

The RAI is a modification of the AHI, createdby replacing the word arthritis with the wordcondition in 9 items, and creating a fifth responsecategory (“do not agree or disagree”). The RAIappears to behave fairly similarly to the AHI buttrue psychometric data are thin. There is a 0.78correlation between the AHI and its variant, theRAI. Factor analysis was also used to identifysubscales for the RAI. The same 2 factors emerged,internality and helplessness with items identical toAHI subscales. As with the AHI, the RAIhelplessness scale had a reasonably strongcorrelation with the full 15-item RAI and hadstronger correlations to measures of functionalstatus than did the full RAI.

As a measure of the construct of helplessness,the brief 5-item scales appear to be superior to the15-item scales, because of their speed and ease ofuse and because of stronger correlations with otherhealth status variables. The 5-item AHI has greaterpsychometric support than the 5-item RAI, and hasdemonstrated predictive utility. For these reasonsit may be preferable to use the AHI helplessnesssubscale in situations where having the wordarthritis in the item language is not problematic.

DeVellis and Callahan (4) note thatreliabilities of these measures are at the low end ofthe acceptable range, however, with 30% of thescore variance due to error. They suggest thesemeasures are adequate for research and generalscreening purposes but should not be used alonefor clinical decision-making.

References1. (Original AHI) Nicassio PM, Wallston KA, Callahan

LF, Herbert M, Pincus P. The measurement ofhelplessness in rheumatoid arthritis: the developmentof the Arthritis Helplessness Index. J Rheumatol 1985;12:462–7.

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

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

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

5. Escalante A, Cardiel MH, del Rincon I, Sudrez-Mendosa AA. Cross cultural equivance of a briefhelplessness scale for Spanish speaking rheumatologypatients 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 thearthritis 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 theycould perform specific tasks or behaviors to copewith the consequences of arthritis (1). It is basedon the theory of self-efficacy as postulated byBandura (2). Self-efficacy refers to personaljudgments of performance capabilities in a givendomain of activity, not to a generalized trait.

Content. Items are designed to capture howcertain the individual is that they can perform aspecific activity or achieve a result. Items includespecific behaviors such as “Walk 100 feet on flatground in 20 seconds,” or “Scratch your upperback with both your right and left hands; andperformance-results items such as “Decrease yourpain quite a bit,” or “Control your fatigue.”

Developer/contact information. Kate Lorig, RNDrPH, 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 andevaluated.

Number of items in scale. There are 20 items.

Subscales. The ASES consists of 3 subscalesSelf-efficacy Pain (PSE), 5 items; Self-efficacyFunction (FSE), 9 items; and Self-efficacy OtherSymptoms (OSE), 6 items.

Populations. Developmental/target.Psychometric study of the ASES was done withvolunteers recruited for the Arthritis Self-HelpCourse (development sample n � 97, replicationsample n � 144), more than 80% female, close toage 65, and average education level more than 14years.

Other uses. ASES has been widely used withadults of all ages, and with a variety of arthritis

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conditions, including lupus, fibromyalgia,scleroderma, and chronic fatigue syndrome.


AdministrationMethod. 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 availablefrom the literature (see references.) Copy availableat the Arthritis Care & Research Web site at http://www.interscience.wiley.com/jpages/0004-3591:1/suppmat/index.html.

ScoringResponses. 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 indicategreater confidence or self-efficacy. No cut pointsare indicated.

Method of scoring. Each subscale is scoredseparately, taking the mean of subscale items.

Time to score. Not reported; calculation of meanscores on subscales of 5, 6, and 9 items.

Training to score. None required except simplemathematical calculations.

Training to interpret. None required.

Norms available. None.

Psychometric InformationReliability. Internal reliability alpha estimates

are PSE 0.76, FSE 0.89, and OSE 0.87. Itemloadings (based on factor analysis or replicationsample) are PSE 0.48–0.75, FSE 0.55–0.84, andOSE 0.63– 0.81. Test-retest reliability (2–29 daysbetween retesting) are PSE 0.87, FSE 0.85, and OSE0.90.

Validity. No gold standard is available todetermine criterion validity. Since itsdevelopment, the ASES has become the goldstandard.

Construct. Validity was demonstrated by findingsignificant correlations among ASES subscales andmeasures of health status (pain, disability, anddepression).

Known groups validity. Participants in theArthritis Self-Management Course showed growthin ASES scores while the control group did not.

Sensitivity/responsiveness to change. Sensitivityis unknown. No criterion measure is available so itis unclear if changes in scores represent truechanges in self-efficacy. Participants in theArthritis Self-Management Course did demonstratechanges in ASES scores, although these changeswere not statistically significant.

Comments and CritiqueThe ASES is the dominant measure of self-

efficacy in the arthritis literature and has madesignificant contributions in measuring situation-specific perceptions of control, rather than moregeneralized or trait measures such as mastery orlocus of control.

The ASES subscales show good internalconsistency and test-retest reliability, andreasonable associations with measures of healthstatus. Other aspects of self-efficacy theory, such asprediction of initiation or persistence of behavioras predicted by self-efficacy theory, have not beenexamined, The authors recognize a need tocompare ASES results with theoretically distinctbut related concepts such as learned helplessnessand health-related locus of control to examinedivergent and convergent validity, but this has notyet been done.

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

Some investigators have modified the ASES tofit the needs of their studies (e.g., fitness infibromyalgia). Many of these modifications have


had no psychometric work done so it is impossibleto determine their reliability or validity.

The combination of items tapping specificbehaviors (walk 100 feet) and performance results(“decrease your pain quite a bit,” or “control yourfatigue”) have raised debate in the literature onwhat the ASES is actually measuring, task-specificself-efficacy or confidence in ability to achieveresults. See references 5 and 6 for moreinformation.

References1. (Original) Lorig K, Chastain RL, Ung E, Shoor S

Holman H. Development and evaluation of a scale tomeasure perceived self efficacy in people witharthritis. Arthritis Rheum 1989;32:37–44.

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

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

4. Gonzales VM, Steward A, Ritter PL, Lorig K.Translation and validation of arthritis outcomemeasures into Spanish. Arthritis Rheum1995;38:1429–46.

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

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

CHILDREN’S ARTHRITIS SELF-EFFICACY SCALE (CASE)General Description

Purpose. The Children’s Arthritis Self-EfficacyScale (CASE) was designed to measure children’sperceived ability to control or manage aspects oflife with juvenile arthritis. It is designed to capturebeliefs related to disease management as well associal and emotional issues (1).

Content. Items were developed after focusgroups of children with mild or severe juvenileidiopathic arthritis, parents of children with mildor severe juvenile idiopathic arthritis, and healthprofessionals, and were written in language thechildren used. Items tap symptoms (“hurt,”“tiredness”), emotions (“sad,” “annoyed or fed-up”), and social participation (“at school,” “withmy friends”).

Developer/contact information. Julie Barlow,BA, PhD, Interdisciplinary Research Centre inHealth, School of Health and Social Sciences,Coventry University, Priory Street, Coventry CV15FB, UK. E-mail: [email protected].

Versions. One.


Subscales. Factor analysis revealed 3 factors thataccount for 76.5% of the score variance. These areActivity (4 items), Symptoms (4 items), andEmotions (3 items).

Populations. Developmental/target. Eighty-ninechildren ages 7–17 years (average age 12.3) wererecruited from a children’s hospital database inBirmingham, UK.

Other uses. None.



Easy to administer.

Training. None required.

Time to administer/complete. Estimated at 5minutes.


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

ScoringResponses. 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 indicategreater efficacy. No cut points are available.

Method of scoring. Mean scores for eachsubscale, can be calculated manually. Authors alsocalculated standard scores on a 0–10 scale to allowcomparisons 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

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scores for the 3 subscales: Activity, mean 3.21 (SD1.36), 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 InformationReliability. Internal consistency of each subscale

via Cronbach’s alphas was Activity 0.90,Symptoms 0.87, Emotion 0.85.

Validity. Construct validity. CASE correlatedsignificantly with theoretically relevant variables:positive correlations were found with hope andphysical and psychological well-being, andnegative correlations with measures of function,anxiety, pain, fatigue, and stiffness.

Sensitivity/responsiveness to change. Unknown.

Comments and CritiqueThe CASE is a new measure designed to

assess self-efficacy to manage consequences ofarthritis among children ages 7–17 years.Psychometric data is limited (gathered from 89children recruited from a single hospital, on ahandful of health status measures) and the measurehas not yet been widely used.

It is not clear whether the self-efficacyconstruct in children is similar to the self-efficacyconstruct in adults. The age appropriateness ofitems was not assessed, but measure developmentwas guided by focus groups with children withjuvenile arthritis and with parents of children witharthritis, and the measure was pilot-tested withchildren.

Reference1. (Original) Barlow JH, Shaw KL, Wright CC.

Development and preliminary validation of aChildren’s Arthritis Self-Efficacy Scale. (ArthritisRheum) 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 copingcompetence, or “global confidence in one’s abilityto cope across a range of demanding situations”(2). In contrast to Bandura’s originalconceptualization of self-efficacy as a situation- orbehavior-specific belief, the GSES is conceived as atrait measure of “optimistic self beliefs” assumed

to be relatively stable over time and domains offunctioning. The GSES was originally developed inGerman by Jerusalem and Schwartzer (1).

Content. Items are designed to assess theindividual’s belief in his/her ability to respond tonovel or difficult situations. Items include “I amconfident that I could deal efficiently withunexpected events,” and “When I am confrontedwith a problem, I usually find several solutions.”

Developer/contact information. Englishadaptation by Julie Barlow, BA, PhD,Interdisciplinary Research Centre in Health, Schoolof Health and Social Sciences, CoventryUniversity, Priory Steet, Coventry CV1 5FB, UK.E-mail: [email protected].

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


Subscales. None; assumed to be a unitaryconstruct.

Populations. Developmental/target. Englishadaptation was participants in arthritis self-management programs in community settingsacross the United Kingdom. Primarily whitewomen in their 50s with longstanding rheumatoidarthritis or osteoarthritis; approximately half didnot have educational degrees.

Other uses. None.



Easy to administer.


Time to administer/complete. Estimated to be 3minutes.


Cost/availability. Items and scoring available inprimary reference (1). Copy available at theArthritis Care & Research Web site athttp://www.interscience.wiley.com/jpages/0004-3591:1/suppmat/index.html.


ScoringResponses. 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 indicategreater perceived competence to cope with difficultsituations, or generalized self-efficacy. No cutpoints 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.


Norms available. No norms are available, butmean scores from the three validation studies forthe English adaptation are published: 29.05 (SD5.1), 28.71 (SD 5.9), and 30.23 (SD 4.8). These aresimilar to the mean score for the accumulatedGerman sample of 29.98 (SD 4.6) for the Germanversion of the GSES.

Psychometric InformationReliability. The internal consistency via

Cronbach’s alpha estimates was 0.88, 0.91, and0.89 for validation studies 2, 3, and 4 respectively.The test-retest reliability over a 4-month periodwas 0.63. and the item-total correlations rangedfrom 0.31 to 0.81.

Validity. Construct validity. Factor analysisrevealed a single-factor solution, which explainedjust over 50% of the variance, supporting theunidimensional nature of the measure. Ashypothesized, the GSES was positively associatedwith positive affect and social support, andnegatively associated with depression and healthdistress.

Divergent validity. There were no significantassociations between GSES and physical healthstatus as measured by the Health AssessmentQuestionnaire, Visual Analog Scale-pain, andVisual analog Scale-fatigue.

Predictive validity. GSES at time 1 wassignificantly associated with depression at time 2,explaining an additional 8% of the variance aftercontrolling for demographic and physical health

status. GSES was also significantly associated withpositive affect, explaining an additional 15% of thevariance.

Sensitivity/responsiveness to change. Nonereported. Generalized self-efficacy isconceptualized as a dispositional characteristic ortrait, and would be expected to be more stable andless susceptible to change.

Comments and CritiqueThe English adaptation of the Generalized

Self-Efficacy Scale appears to be a valid andreliable measure of perceived competence to copewith difficult situations. As such, the title of thescale may be mis-leading because self-efficacy ismost frequently used to refer to more changeablesituation- or behavior-specific constructs. It maymore closely resemble personal mastery, althoughno investigation of the relationship between GSESand mastery or personal competence has beendone. The authors note the need to investigate therelationship between learned helplessness and theGSES.

The authors also caution that use of the GSESis inappropriate when the outcome of interest isperformance of a specific behavior such as anexercise program. They recommend use of theGSES when measuring global confidence in one’sability to cope as a trait, or general adaptation tocircumstances.

In contrast to a simple translation, Barlow andcolleagues (2) adapted the GSES for an Englishaudience. They modified 2 items to improvecomprehensibility for an English audience; theyreplicated the original validation studies. TheGSES is available in multiple other languages;before use it will be important to clarify if theseare simple translations relying on thepsychometrics of the original German scale, oradaptations for the specific language.

References1. (Original) Jerusalem M, Schwarzer R. Self efficacy as a

resource factor in stress appraisal process. In:Schwarzer R, editor. Self-Efficacy: thought control andaction. Washington (DC): Hemisphere; 1992.

2. (Original) Barlow BH, Williams B, Wright C. TheGeneralized 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 Chineseversions of the generalized self-efficacy scale. ApplPsychol Int Rev 1997;46:69–88.

4. Schwarzer R, Born A, Iwawaki S, Lee YE, Saito E,Yue. The assessment of optimistic self-beliefs:

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comparison of the Chinese, Indonesian, Japanese, andKorean versions of the generalized self-efficacy scale.Applied Psychol Int Rev 1997;40:1–13.

MASTERY SCALEGeneral Description

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

Mastery is conceived as a personalitycharacteristic that serves as a psychologicalresource individuals use to help them withstandstressors in their environment.

Content. Content consists of 7 items tappingsense of control, such as “I have little control overthe things that happen to me” and “I can do justabout anything I set my mind to do.” Two itemsare positively worded.

Developer/contact information. Leonard Pearlin,PhD, University of California, San FranciscoHuman Development and Aging Program, SanFrancisco, CA 94143.

Versions. One version. Scale has been translatedto Chinese, Czech, Dutch, German, Hebrew,Vietnamese, Swedish, and Spanish. Spanishtranslation found low item-total correlations for the2 positively-worded items.

Number of items in scale. Seven.

Subscales. None.

Populations. Developmental/target. Adults ofworking age (18–65 years) developed to gatherinformation in interviews of a sample designed tobe representative of census-defined urbanized areaof Chicago.

Other uses. Has been used by researchers inmany countries and with many populations, fromadolescents to older adults, and with mental andphysical health difficulties.

AdministrationMethod. Initial data collection performed using

scheduled interviews.


Time to administer/complete. Unknown,expected to be brief.


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

ScoringResponses. Scale. Scoring instructions are not

provided in the original publication. Variousinvestigators have used 4-, 5-, and 7-point Likertscales. Some investigators list 1 as strongly agreewhile others use 1 as strongly disagree.

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

Interpretation of scores. Unknown; no cutpoints are provided.

Method of scoring. Some investigators use sumof item scores, others use mean score across theseven items.

Time to score. Unknown, assumed to be brief.

Training to score. Minimal, selected items needto be reversed in scoring. (5 items wordednegatively, 2 items worded positively).

Training to interpret. Unknown, not likely.

Norms available. No.

Psychometric InformationReliability. Original publication (1) reports

factor loadings for the 7 items loading on themastery scale; these could be considered a form ofinternal consistency reliability. The 5 negativelyworded items have factor loadings ranging from0.76 and 0.56. The 2 positively worded items bothhave factor loadings of - 0.47. Correlation betweentime 1 and 2, four years later, was 0.44 (2). Thetime gap of 4 years negates the value of thiscorrelation as a measure of test-retest reliability,however.

Validity. No overt tests have been done toevaluate the validity of the Mastery scale. Thescale has been used concurrently with a variety ofother measures of psychological well-being orsense of control. The Mastery Scale has been


widely used and translated into multiple languagesdespite an absence of validity data. This suggestsstrong face validity.

Sensitivity/responsiveness to change. Unknown;as a trait measure it would be expected to bestable.

Comments and CritiqueAlthough widely used, the Mastery Scale

referred to as developed by either Pearlin andSchooler (1) or Pearlin et al (2) has not hadsignificant psychometric work done, so it is notclear how valid or reliable it is as a measure ofmastery. In addition, no standardized scoringrecommendations were provided, so investigatorsare left to develop their own scoring protocols.This absence of standardized scoring makes itdifficult to compare across studies.

The Mastery Scale has been incorporated intocombined measures of psychological resourcessuch as the Personal Resources Index and theCognitive Adaptation Index, but individualcomponents of these combination measures havenot been evaluated. The Mastery Scale has notbeen widely used in rheumatology research.

References1. 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 LOCUSOF CONTROL SCALE (MHLC)General Description

Purpose. The purpose of the Multi-DimensionalHealth Locus of Control Scale (MHLC) is toprovide information on 3 theoretically distinct andempirically differentiated dimensions of healthlocus of control (1). A secondary purpose was tocreate 2 equivalent forms (Form A and Form B) ofthe MHLC for use in repeated-measures studies.Later a third form (Form C) was created to be usedwith specific health conditions (2). The MHLC wasdeveloped to address the increased understandingof the locus of control and health locus of controlconstructs. The original health locus of controlscale was conceptualized as a unidimensionalconstruct (internal or external locus of control overhealth); later factor analysis of this measure, andnew research in more generalized locus of controlwork, identified the need to measure health locusof control in 3 dimensions.

Form C of the MHLC was created for boththeoretical and practical reasons. Theoretically, itwas hypothesized that health locus of controlbeliefs about a specific health condition maycorrelate with health outcomes differently thanmore general health locus of control beliefs.Practically, several researchers observed someitems on Forms A and B were problematic forindividuals with chronic medical conditions torespond to. Form C was designd as a general-purpose condition-specific locus of control scalethat could be easily adapted for use by individualswith specific medical conditions.

Content. On Forms A and B, items reflect the 3hypothesized dimensions of health locus ofcontrol: Internality (IHLC) (i.e., “I am in control ofmy own health), Powerful Others (PHLOC)(i.e.,“My family has a lot to do with my becomingsick 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 gradereading level.

On Form C items reflect similar dimensions,but factor analysis reveals that Powerful Others canrefer to either doctors or medically trainedprofessionals, and others. Initial Form C items referto condition, but this can be adapted to specifyArthritis.

Developer/contact information. Kenneth A.Wallston, PhD, School of Nursing, VanderbiltUniversity, 429 Godchaux Hall, Nashville, TN37240. E-mail: [email protected].

Versions. Three forms of the MHLC werecreated, Forms A, B, and C. Forms A and B weredesigned to be equivalent; items were paired inscale construction based on meaning, one assignedto Form A, the other to Form B. Form C wascreated 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 increasereliability if repeated measures are not necessary.Form C also has 18 items, 6 items on theInternality and Chance Subscales, 3 on PowerfulOthers—Doctors, 3 on Powerful Others—Otherpeople.

Subscales. Forms A and B each have 3 subscalesof 6 items each. Subscales are Internality, PowerfulOthers, and Chance. Form C has 4 subscales; thePowerful Others subscale is divided into a Doctorsubscale and an Other People subscale.

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Populations. Developmental/target. Designed foruse by adults; Forms A and B validated withadults waiting at airport. Form C was validatedwith groups of patients with rheumatoid arthritis,chronic pain, cancer, diabetes.

Other uses. Has been widely used with samplesinvolving pain, spinal cord injury, alcoholdependence, arthritis, and other chronicconditions.



Training. None indicated.

Time to administer/complete. Estimated 3–5minutes for each form.


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

ScoringResponses. Scale. Scale is a 6-point Likert scale,

from strongly disagree to strongly agree. One studyof 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-itemsubscale; 12 to 72 if two forms are combined toform 12-item subscales. The range for Form C 3item subscales is 3–18.

Interpretation of scores. Higher subscale scoresindicate greater belief in that locus of control.

Method of scoring. Manual scoring by summingitem scores on each subscale.

Time to score. Unknown, expected to be brief.

Training to score. None required.


Norms available. None. Means and StandardDeviations are available for Form C subscales in aRheumatoid Arthritis Sample: Mean (SD) Internal17.50 (5.89); Chance 16.60 (6.10); Doctors 13.43(3.28); Other People 7.48 (3.27).

Psychometric InformationReliability. Forms A and B. Cronbach’s alpha

for internal consistency ranges from 0.67 to 0.77for the 6-item subscales on Forms A and B. Meanscores for Forms A and B are nearly identical; forgreater internal consistency and reliability the 2forms can be combined. Cronbach’s alpha for thecombined 12-item subscales ranges from 0.83 to0.86.

Form C. Cronbach’s alpha for internalconsistency ranges from 0.87 to 0.79 for the 6-itemsubscales (Internality and Chance), and 0.71–0.70on the 3 item subscales (Powerful others—Doctors,and Powerful Others—Other People). In test-retestreliability, the stability coefficients ranged from0.66 to 0.54 for a 1 year retesting period with noactive intervention to change beliefs.

Validity. Forms A and B construct validity.Intercorrelations among the 6-item subscales, orthe 12-item subscales indicate that IHLC and PHLCare statistically independent, IHLC and CHLC arenegatively correlated, and PHLC and CHLC show asmall positive correlation, particularly on Form B.

Forms A and B construct/criterion validity.There are significant positive correlations betweenMHLC subscales and their theoretical counterparton Levenson’s Locus of Control Scale.

Preliminary predictive validity. As expected,health status, as measured by a two-item healthstatus measure, showed a positive and significantcorrelation with IHLC; (r � 0.403) a significantnegative correlation with CHLC (�0.275); and nocorrelation with PHLC (r �-0.055).

Form C concurrent validity. Form C showedmodest correlations with the appropriate subscalefrom Form A/B (correlations ranging from 0.59 to0.38 in a rheumatoid arthritis sample).

Form C construct validity. Form C subscalescorrelated in the theoretically expected directionswith distinct but related concepts of Pain,Depression, and Helplessness in a rheumatoidarthritis sample. Further evidence of consrructvalidity is demonstrated in a sample of individualswith chronic pain engaged in an interventiondesigned to change locus of control beliefs. Asexpected, Internality beliefs increased while theexternal subscales (Chance, Powerful Others—Doctors, and Powerful Others—Other people) alldecreased.



Comments and CritiqueThe MHLC was developed to measure health

locus of control after the evolution of the theory toconsider locus of control and health locus ofcontrol to be multidimensional rather thanunidimensional concepts. A strength of the MHLCForm A/B is the availability of alternate forms withnearly identical psychometric properties toaccommodate repeated measures research designs.Preliminary psychometric evaluation is promising.The authors suggest that not all 3 subscales need tobe used in a single investigation; depending onvariables of interest and time limitation, 1 or 2dimensions can be included in a research design.

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

Since publication, some replications havesupported the multidimensional nature of healthlocus of control, while others have failed tosupport the 3-factor solution and recommendreturning to the simple internal-external locus ofcontrol conceptualization. The authors caution thathealth locus of control is a health-specific indicatorof generalized expectation of control overreinforcement based on Rotter’s social learningtheory. As a generalized measure, it is notexpected to explain large amounts of variation inhealth behaviors if used in isolation. Only incombination with other contributing factors isMHLC likely to help explain health behavior.

References1. (Original) Wallston KA, Wallston BS, DeVellis R.

Development of the Multi-Dimensional Health Locusof Control Scales. Health Educ Monogr 1978;6:160–-70.

2. (Original) Wallston K, Stein MJ, Smith CA. Form C ofthe MHLOC Scales: a condition-specific measure oflocus 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 homeversus hospital care in the treatment of acute illness.Arch Intern Med 2000;160:1501–6.

Additional ReferencesCooper D, Framboni M. Toward a more valid and

reliable health locus of control scale. J Clin Psychol1988;44:536–40.

O’Looney BA, Barrett PT. A psychometric investigationof the multidimensional health locus of controlquestionnaire. Brit J Clin Psychol 1983;22:217–8.

Umlauf RL, Frank RG. Multi-dimensional health locus ofcontrol in a rehabilitation setting. J Clin Psychol1986;42:126–8.

Wallston K. Psychological control and its impact inmanagement of rheumatological disorders.Bailliere’s Clin Rheum 1993;7:281–95.

PARENT’S ARTHRITIS SELF-EFFICACYSCALE (PASE)General Description

Purpose. The Parent’s Arthritis Self EfficacyScale (PASE) was designed to measure parents’perceived ability to manage salient aspects of theirchild’s juvenile arthritis (1). At first glance, thisscale may seem misdirected. It is important to notethat the scale is based on the hypothesis that aparent’s health status is influenced by theirperceived ability to handle a specific parentingtask, that is, managing their child’s arthritis. It washypothesized, secondarily, that the parental senseof competence would influence psychosocialadaptation of the child with juvenile arthritis, butthe primary measures used to validate with scalewere correlations with measures of the parent’shealth status.

Content. Items reflect 14 issues found to besalient in preliminary research. These includemanagement of pain, stiffness, swelling, fatigue,sleep, loneliness, frustration, pleasure, andparticipation in school, family, and friendactivities. Where content was similar, items weremodifications of Arthritis Self-Efficacy Scale(ASES) items. Item example: “How certain are youthat you can keep arthritis pain from interferingwith your child’s sleep?”

Developer/contact information. Julie Barlow BA,PhD, Interdisciplinary Research Centre in Health,School of Health and Social Sciences, CoventryUniversity, Priory Street, Coventry CV1 5FB, UK.E-mail: [email protected].

Versions. One.


Subscales. There are 2, symptom subscale andpsychosocial subscale, both have 7 items.

Populations. Developmental/target. Parentsidentified from 2 hospital databases in the UK.Majority were white, married, some advancededucation, and working in paid employment.

Other uses. None.


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AdministrationMethod. Written, self-administered self-report.

Easy to administer.


Time to administer/complete. Estimated to be 3minutes.


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

ScoringResponses. Scale. Seven-point scale, from 1

(very uncertain) to 7 (very certain, and anonapplicable category.

Score range. Range is 7–49 for each subscale.

Interpretation of scores. Higher scores reflectgreater confidence in ability to manage or controlaspects of child’s juvenile arthritis. No cut pointsare provided.

Method of scoring. Sum of item scores on eachsubscale; can be done manually. Validation studyalso standardized scores to a 0–10 scale alloweasier comparison across subscales. This would belabor-intensive if attempted manually.

Time to score. Not reported, assumed to be brief.


Training to interpret. None reported.

Norms available. No; but mean scores arereported for validation studies: mother’s symptomsubscale 27.37, psychosocial subscale 33.89;father’s symptom subscale 23.22, psychosocialsubscale 33.18.

Psychometric InformationReliability. Internal consistency reliability via

Cronbach’s alphas: mother’s symptom subscale0.92, psychosocial subscale 0.96; father’s symptomsubscale 0.89, psychosocial subscale 0.93.

Validity. Criterion validity. Criterion wasdemonstrated by significant correlations with theGeneralized Self-Efficacy Scale with both subscalesof the PASE, for both mothers and fathers.

Construct validity. Validation was demonstratedfor mothers by significant negative association ofmother’s anxious and depressed mood with bothsubscales, and significant associations of mother’spsychosocial efficacy with her physical function,energy, pain, and general health perceptions. Theonly significant associations for fathers werepositive associations between father’s generalhealth perceptions and psychosocial subscale, andnegative association between father’s depressedmood and psychosocial subscale. Authors alsoinvestigated the associations between parent’s andchild’s ratings of child’s physical and psychosocialwell-being and parental self-efficacy ratings.Investigators specify that they expected parentalself efficacy to be reflected in child’s well being,but did not provide strong theoretical rationale forincluding this as evidence of construct validity.


Comments and CritiqueThe validation of the PASE has appeared in

the literature but it is not clear that it has beenused in clinical research by the authors or otherinvestigators. The original article providespreliminary psychometric evidence, but additionaluse of the measure is required to further determinevalidity and reliability. Psychometric data ispresented separately for mothers and fathers. Fromthe preliminary study, there is some evidence thatthe parental ratings on the psychosocial subscaleare related to parental health status, particularlyfor mothers, but there are no strong correlationsreported for the symptoms subscale. The merits ofcombining the 2 subscales into a single instrumentis not clear. Similar to the ASES on which it ismodeled, the PASE may combine both efficacyexpectations and expectations about results.

Reference1. Barlow JH, Shaw KL, Wright CC. Development and

preliminary validation of a self-efficacy measure foruse among juvenile idiopathic arthritis. Arthritis CareRes 2000;13:227–36.

RHEUMATOID ARTHRITISSELF-EFFICACY SCALE (RASE)General Description

Purpose. The Rheumatoid Arthritis Self-EfficacyScale (RASE) was developed to measure task-specific self-efficacy for the initiation of self-management related behavior (1). It was developedspecifically for rheumatoid arthritis patients in theUK.


Content. Items are designed to tap specific self-management behaviors. All items use the samestem: “Do you believe you could do these things tohelp your arthritis.” Items include: “Use relaxationtechniques to help with pain” or “Save energy forleisure activities, hobbies, or socializing.”

Developer/contact information. Sarah Hewlett,PhD, MA, RGN, RM, ARC Senior Lecturer inRheumatology (Health Professions), AcademicRheumatology, Bristol Royal Infirmary, Bristol BS28HW, UK. E-mail: [email protected].

Versions. One.


Subscales. No subscales are used, althoughfactor analysis showed 8 factors explaining 75% ofthe variance.

Populations. Developmental/target. Rheumatoidarthritis patients involved in self-managementprograms in several medical centers in the UK.

Other uses. None.


AdministrationMethod. Self-administered, written self-report.

Relatively easy to administer.

Training. None.

Time to administer/complete. Approximately 10minutes.


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

ScoringResponses. Scale. 1 (strongly disagree) to 5

(strongly agree), Likert scale.

Score range. Range is 28–140.

Interpretation of scores. Higher scores indicatehigher self-efficacy. No cut points are provided.

Method of scoring. Sum of scores can be donemanually.

Time to score. Not reported, likely to be quick.


Training to interpret. Not reported.

Norms available. No.

Psychometric InformationReliability. Internal consistency. Twenty-two of

28 items correlated significantly with the totalRASE score, suggesting that self-efficacy asmeasured by the RASE may not be aunidimensional construct.

Test-retest reliability. The 4-week test-retestcorrelation is 0.9.

Validity. Construct validity. As predicted byself-efficacy theory, the RASE is correlated withinitiation of self-management behaviors, modestcorrelations with Arthritis Self-Efficacy Scale, andindependent of mood and disease status.

Convergent validity. Modest correlations werefound with the Arthritis Self-Efficacy Scale (ASES).

Divergent validity. Neither the RASE or ASESshowed significant correlation with the GeneralSelf-Efficacy Scale (GSES), a trait measure ofoptimistic self beliefs and perceived copingcompetence (in contrast to the more behavior-specific concepts of the RASE and ASES).

Sensitivity/responsiveness to change. It is notclear that change in scores reflects changes in theconstruct, but the instrument is responsive tochange as indicated by changes following self-management programs.

Comments and CritiqueThe RASE is a measure of self-management

behavior-specific self-efficacy. It appears to havepromising psychometric characteristics, although ithas not been used by many other investigators atthis time. The RASE has been correlated withtheoretically relevant variables predicted by self-efficacy theory. Examinations of the relationshipsbetween RASE and related but distinct constructssuch as locus of control, mastery, and learnedhelplessness would strengthen the validation ofthis instrument.

The RASE was developed specifically for usein rheumatoid arthritis, and in patients from theUK. There is no information on its use with othertypes of arthritis, or in other geographic areas. The

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title of the RASE may be misleading. Rather thanbeing RA-specific, the RASE is self-managementbehavior specific. In contrast to the Arthritis Self-Efficacy Scales, which includes items addressingspecific functions (“walk 100 feet on flat ground in20 seconds”) and performance results (“decreaseyour pain quite a bit”), the RASE asks about abilityto perform specific self-management behaviors(“use relaxation techniques to help with pain”).

Reference1. (Original) Hewlett S, Cockshott Z, Kirwan J, Barrett J,

Stamp J, Haslock L. Development and validation of aself-efficacy scale for use in British patients withrheumatoid arthritis. Rheumatology 2001;40:1221–30.

SELF-EFFICACY SCALE (SES)General Description

Purpose. The Self-Efficacy Scale (SES) wasdesigned to be a measure of self-efficacy not tied toa specific situation or behavior (1). It is based onthe premise that personal mastery experiencesgeneralize across situations or behaviors. Theauthors intended the SES to be a dispositional, ortrait measure of self-efficacy. It is not intended toreplace specific self-efficacy measures that assessexpectations for specific target behaviors.

Content. Items were written to measure generalself-efficacy expectations in areas such as socialskills or vocational competence. Items tap 3dimensions in these areas, willingness to initiatebehavior, willingness to expend effort incompleting the behavior, and persistence in theface of adversity.

Developer/contact information. Mark Sherer,MD, Methodist Rehabilitation Center, Jackson, MS39216.

Versions. One. Several translations have beendone, including Dutch and Hebrew.

Number of items in scale. Final instrument has23 items.

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

Social self-efficacy subscale has 6 items andexplains 8.5% of the variance. Items include “Ihave acquired my friends through my personalabilities at making friends,” and “I do not handlemyself well in social gatherings.”

Populations. Developmental/target. Instrumentwas developed using college students. Criterionvalidity was evaluated at a VeteransAdministration Medical Center ChemicalDependency Unit.

Other uses. None.



Easy to administer.

Training. None needed.

Time to administer/complete. Not listed,assumed to be 5–7 minutes.


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

ScoringResponses. Scale. 14-point Likert scale from

strongly disagree to strongly agree.

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

Interpretation of scores. Higher scores indicatehigher self-efficacy expectations. No cut points areprovided.

Method of scoring. Reversed items areconverted. The score on each subscale is total ofitem responses.

Time to score. Unknown, but likely to be brief.

Training to score. Not needed, but selecteditems must be reversed before scoring.

Training to interpret. Not needed.

Norms available. No norms available. On initialdevelopment, means score for general self-efficacysubscale was 172.65 (SD 27.31); mean score forsocial self efficacy was 57.99 (SD 12.08).


Psychometric InformationReliability. Cronbach’s alpha for internal

consistency was 0.86 for General self-efficacysubscale, and 0.71 for Social self-efficacy subscale.

Validity. Construct validity. Validity wasdemonstrated by moderate correlations betweenSES subscales and related constructs such asPersonal Control Scale of Rotter’s Internal-ExternalLocus of Control Scale, and Holland and Baird’sInterpersonal Competency Scale. All correlationswere of moderate magnitude in the hypothesizeddirection.

A second study was performed to “provideevidence of criterion validity.” As expected, theGeneral Self-Efficacy Scale scores predicted pastsuccess in vocational educational and militarygoals among veterans on a Veterans AdministrationMedical Center Chemical Dependency Unit. SocialSelf-Efficacy Scale scores were negativelycorrelated with numbers of jobs quit and numberof times fired.

Sensitivity/responsiveness to change. Unknown,but is designed to measure a trait so is expected tobe stable.

Comments and CritiqueAlthough scale is labeled as a “self-efficacy

scale,” the title of the instrument may be

misleading. Rather than the domain or behaviorspecific confidence usually referred to as self-efficacy, the authors developed the SES based onthe premise that mastery experiences wouldgeneralize across situations or behaviors, and theyassumed it would measure a stable trait. The typesof items included however (initiation orpersistence of behavior, willingness to expendeffort) are reflective of self-efficacy theory.

The SES is composed of 2 subscales, onetapping a non-situation specific sense ofcompetence, the other tapping competence insocial situations. Although the 2 sets of items areintertwined into a single measure, all psychometricwork is reported by subscale and there does notappear to be good rationale to combine them; theycould easily be 2 separate measures of generalperception of competence, similar to mastery, anda domain-specific measure related to socialsituations.

Preliminary validation work is unlikely togeneralize because it was conducted with patientsin a Veterans Administration Medical Centeraddictions unit. This sample is not likely to berepresentative.

Reference1. (Original) Sherer M, Maddux JE, Mercandante B,

Prentice-Dunn S, Jacobs B, Rogers RW. The Self-Efficacy Scale: construction and validation. PsycholRep 1982;51:663–71.

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982)

that

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atio

ns.

Lim

ited

vali

dit

yd

ata

avai

labl

e.

S164 Brady

measures of self-efficacy, helplessness, mastery, and control: the arthritis helplessness index...

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