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Cardiac Self-Efficacy Scale


Sullivan MD. Andrea Z, Russo J, Katon WJ (1998)

Background and Development:

The objective of the CSE is to examine the role of self-efficacy in the physical and role function for patients with coronary heart disease after controlling for the effects of anxiety and depression.

The initial Cardiac Self-Efficacy Questionnaire consisted of 16 items. Patients were asked to rate their confidence with knowing or acting on each of the 16 statements on a 5-point Likert scale (0 = not at all confident, 1 = somewhat confident; 2 = moderately confident, 3 = very confident, and 4 = completely confident). Patients could also rate an item as nonapplicable. Three items were rated as nonapplicable by more than 25% of the sample and were omitted from additional analyses: "Lose weight (if you are overweight)"; "Stop smoking (if you do smoke)"; and "Change your diet (if your doctor recommended this)." 

The Cardiac Self-Efficacy Scale has two factors (Control symptoms and Maintain function) with high internal consistency and good convergent and discriminant validity.  Cronbach alphas for the two factors were 0.90 and 0.87, respectively.  The Control Symptoms factor consists of eight items and the Maintain Function factor consists of the remaining five items.  The score for each of these sub-scales is the mean of the items for the scale except for any items rated as "Nonapplicable". 

Three outcomes were assessed at 6-month follow-up: SF-36 physical functioning scale and the two Sheehan disability scales.  In multiple regression models, the self-efficacy scales significantly predicted physical function, social function, and family function after controlling for baseline function, baseline anxiety, and other significant correlates.

Assessment in Elderly Populations:

The age range for the initial study was 45 to 85 years.

Assessment in Minority Populations:

Only 3% of the subject population during the development of the CSE were members of minority populations.

Subsequent Studies:

Gardner et al. (2003) found that self-efficacy improves during cardiac rehabilitation across gender and diagnoses. Female and revascularized patients present with low QOL and self-efficacy scores initially, but improvements in scores similar to or greater than the men can be expected. Because the self-efficacy scores of percutaneous coronary intervention patients are higher and their physical limitations are less prohibitive, these patients can be progressed more aggressively.   Arnold et al. (2005) found a highly significant relationship between the CSE Maintain Fuction subscale and the Rand-36 measure of physical functioning among patients with chronic osbstructive pulmonary disease or chronic heart failure.

Design Strengths and Weaknesses:

The two specific forms of self efficacy have an enduring effect over 6 months on self reported physical, social, and family function in patients with coronary heart disease. Furthermore, it demonstrates that this effect is significant even after controlling for distress (anxiety and depression symptoms).

Contact Information:

The 13 items of the SCE scale are listed in a table in Sullivan et al. (1998).


Arnold R, Ranchor AV, DeJongste MJL, Koeter GH, Ten Hacken NHT, Aalbers R, Sanderman R (2005) The relationship between self-efficacy and self-reported physical functioning in chronic obstructive pulmonary disease and chronic heart failure. Behavioral Medicine 31(3) 107-15.

Gardner JK, McConnell TR, Klinger TA, Herman CP, Hauck CA, Laubach CA Jr (2003) Quality of Life and Self-efficacy: GENDER AND DIAGNOSES CONSIDERATIONS FOR MANAGEMENT DURING CARDIAC REHABILITATION. Journal of Cardiopulmonary Rehabilitation. 23(4):299-306

Sullivan MD. Andrea Z, Russo J, Katon WJ (1998) Self-Efficacy and Self-Reported Functional Status in Coronary Heart Disease: A Six-Month Prospective Study. Psychosomatic Med 60(4) 473-478.

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