Measurement of Patient Education Outcomes Self Efficacy In Health Care and Nursing

Health Care and Nursing and Measurement of Patient Education Outcomes Self Efficacy

Measurement of Patient Education Outcomes,What Is Being Measured In Patient Outcomes,What Is Self efficacy and Scales of Measurement.

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.