Health Care and Nursing and Measurement of Patient Education Outcomes Self Efficacy
Measurement of Patient Education Outcomes
One of the most significant recent advances in patient education is
expansion of the number of measurement tools. Most of the 86 currently used
measurement instruments included in a recent compilation (Redman, 2003)
originated as research instruments or as part of validated and standardized
programs of patient education, such as the Arthritis Self-Efficacy Scale
developed for use in the Arthritis Self Management course.
Most have limited
amounts of psychometric data available to aid in their interpretation and to
have confidence in their use. Little evidence suggests that measurement
instruments are used in routine patient care, either to assess patients’ need
for education or to evaluate the outcomes of interventions.
What Is Being Measured In Patient Outcomes
Of the perhaps 200 instruments with some psychometric data and
relevant to patient education, most are measures of self-efficacy, knowledge or
need for information, and beliefs representing theoretical models (as in “lay”
models or related to self management).
What Is Self efficacy and Scales of Measurement
Because self-efficacy (SE) is believed to be behavior specific,
measures are needed for each behavior of interest. For example, there is the
Children’s Arthritis SE Scale (Barlow, Shaw, & Wright, 2001) and one for
parents (Barlow, Shaw, & Wright, 2000), as well as one for rheumatoid
arthritis (Hewlett et al., 2001) .
There is the Childbirth SE Scale (Lowe,
1993) and the Breastfeeding SE Scale (Creedy et al., 2003). In diabetes, the
Confidence in Diabetes Self Care Scale (van Der Ven et al., 2003), the Diabetes
Management SE Scale for Adolescents with Type I Diabetes (Moens, Grypdonck,
& van der Bijl, 2001) and the Foot Care Confidence Scale (Sloan, 2002) test
confidence in specific behaviors necessary for diabetes self-management.
There
is the Seizure SE Scale for Children (Caplin, Austin, Dunn, Shen, &
Perkins, 2002), the Epilepsy SE. Scale (Dilorio & Yeager, 2003), and the
Sickle Cell SE Scale (Edwards, Telfair, Cecil, & Lenoci, 2000). Barnason,
Zimmerman, Atwood, Neveen, and Schmaderer (2002) have developed and tested an
SE instrument for coronary artery bypass graft (CABG) recovery.
Scales for
women include the Perimenopausal Health SE Scale (Reece & Harkless, 2002),
the English-Spanish SE Scale for Breast Self-Examination (Gonzalez &
Gonzalez, 1990), and the Contraceptive SE Scale (Levinson, 1986).
For pain
there is the Chronic Pain SE Scale (Anderson, Dowds, Pelletz, Edwards, &
Peeters-Asdourian, 1995) and the Back Pain SE Scale (Levin, Lofland, Cassisi,
Poreh, & Blonsky, 1996). For respiratory diseases there is the Asthma SE
Scale (Tobin, Wigal, Winder, Holroyd, & Creer, 1987) and the COPD SE Scale
(Wigal, Creer, & Kotses, 1991).
For parenting, the Infant Care Survey
(Froman & Owen, 1989) tests SE in care of infants and the Toddler Care Questionnaire
(Gross & Rocissano, 1988) for that age range.
Other SE instruments include
the Macular Degeneration SE Scale (Brody et al., 1999), the Preoperative SE
Scale (Oetker-Black & Kauth, 1995), the Endoscopy Confidence Questionnaire
(Gattuso, Litt, & Fitzgerald, 1992), the Depression Coping SE Scale
(Perraud, 2000), the Cancer Behavior Inventory (Merluzzi & Martinez, 1997),
and the Medication Adherence SE Scale specifically developed for African
Americans with hypertension (Ogedeghe, Mancuso, Allegrante, & Charlson,
2003) and others. Many of these instruments are reviewed elsewhere (Redman,
2003, 2004).
Self-efficacy scales are used to identify individuals who have low
confidence in their ability to carry out essential behaviors and to evaluate
the effectiveness of interventions designed to develop that confidence
(persuasion, identification with an-other who is successful, and successful
trial of the behavior).
Item scores provide a way to precisely target areas in
which SE is low. For example, several studies show breast-feeding confidence to
be a significant factor related to early discontinuation of breast-feeding,
indeed, mothers with higher antenatal Breast feeding SE Scale scores were
significantly more likely to be breast feeding at I week and at 4 months
postpartum (Creedy, Dennis, Blyth, Moyle, Pratt, & Vries, 2003).
Behaviors
of interest in disease entities include ability to cope, accomplish activities
of daily living; obtain and sustain social support; control symptoms such as
pain, fatigue, and the uncertainty of chronic disease; obtain and take
medication; avoid an asthma attack in multiple situations; and carry out
self-management activities.
Usable scales must have been demonstrated to be
sensitive to intervention. In general, a higher SE score is considered better.
Outcomes from higher SE can include a better experience with fewer symptoms,
improvement in health status, and de creased health care costs.