FTP

Arthritis & Rheumatism (Arthritis Care & Research)
Vol. 49, No. 5S, October 15, 2003, pp S147S164

DOI 10.1002/art.11413
2003, American College of Rheumatology
MEASURES OF PSYCHOLOGICAL STATUS AND WELL-BEING
Measures of Self-Efcacy, Helplessness,

Mastery, and Control
The Arthritis Helplessness Index (AHI)/Rheumatology Attitudes Index (RAI),
Arthritis Self-Efcacy Scale (ASES), Childrens Arthritis Self-Efcacy Scale
(CASE), Generalized Self-Efcacy Scale (GSES), Mastery Scale, MultiDimensional Health Locus of Control Scale (MHLC), Parents Arthritis SelfEfcacy Scale (PASE), Rheumatoid Arthritis Self-Efcacy Scale (RASE), and
Self-Efcacy Scale (SES)
Teresa J. Brady
ARTHRITIS HELPLESSNESS INDEX
(AHI)/RHEUMATOLOGY ATTITUDES
INDEX (RAI)
General Description
Purpose. The Arthritis Helplessness Index (AHI)
and its variants were designed to assess patients
perceptions of helplessness in coping with arthritis
as delineated by learned helplessness theory.
Helplessness is considered a psychological state in
which individuals expect their efforts will be
ineffective and become more passive and more
likely to be depressed. Learned helplessness theory
postulates that this helplessness results from
experiencing unpredictable and uncontrollable
aversive events. Helplessness has also been
postulated to mediate relationships between
disease or treatment and health outcomes.
The Rheumatology Attitudes Index (RAI) is
conceptually identical to the AHI. Item wording
and response format were modied slightly to
reduce respondent confusion when the instrument
was used with individuals with other rheumatic
conditions such as bromyalgia or bursitis.
Four variants of arthritis helplessness
measures are available: the original 15-item
Arthritis Helplessness Index (1), a 5-item AHI
Teresa J. Brady, PhD: Arthritis Program, Centers for Disease Control and Prevention, Atlanta, Georgia.
Address correspondence to Teresa J. Brady, PhD, Arthritis Program, Centers for Disease Control and Prevention,
4770 Buford Hwy NE, MS K-45, Atlanta, GA 30341. E-mail:
tob9@cdc.gov.
Submitted for publication March 30, 2003; accepted April
4, 2003.
Helplessness Subscale (2), the 15-item

Rheumatology Attitudes Index (RAI) (3), and a 5item RAI helplessness subscale (4).
Content. The AHI/RAI consists of 2 types of
items: items measuring patients perceptions of
their abilities (I can reduce my pain by staying
calm and relaxed), and their inabilities (No
matter what I do or how hard I try, I just cant get
relief from my pain), to control their arthritis.
Further investigation revealed 2 distinct
factors on both the AHI and RAI, internality
(Managing my arthritis is largely my
responsibility, 7 items) and helplessness
(Arthritis is controlling my life, 5 items).
Developer/contact information. (AHI) Perry M.
Nicassio, PhD, Daley Hall, Room 104, CSPP SD
AIU,10455 Pomerado Road, San Diego, CA 92131.
E-mail: pnicassio@alliant.edu. (RAI) Leigh F.
Callahan, PhD, Thurston Arthritis Research Center,
University of North Carolina, 3310 Thurston
Building CB#7280, Chapel Hill, NC 27599-7280.
E-mail: leigh_callahan@med.unc.edu.
Versions. Four versions are available, the
original 15 item AHI and its 5-item helplessness
subscale, and the 15 item RAI and its 5-item
helplessness subscale. RAI items are identical to
AHI items except the word arthritis was replaced
by the word condition. This change affected 12 of
the original 15 items. The 5-item subscales are
considered conceptually cleaner because each
consists of a single factor. They are also easier and
faster to complete. A Spanish language version of
the 5-item RAI-helplessness subscale has been
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evaluated for cross-cultural equivalence (5). RAI

has 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 helplessness
subscale and 7-item internality subscale. The RAI
has a 5-item helplessness subscale. A factor
analysis revealed an internality subscale on the
RAI as well, but no other information is provided.
Populations. Developmental/target. All
psychometric work on the AHI and RAI was done
on individuals with physician-conrmed
rheumatoid arthritis.
Other uses. RAI has been widely used, including
with patients with osteoarthritis, bromyalgia,
systemic lupus erythematosis, and scleroderma.
WHO ICF Components. Environmental factor.
Administration
Method. Self-administered written self-report
questionnaire. Easy to administer.
Training. No training required.
Time to administer/complete. The 5-item
helplessness scales estimated to take less than a
minute. The 15-item scales may take up to 3
minutes.
Equipment needed. None.
Cost/availability. Items and scoring available
from the literature (see references.) Copy available
at the Arthritis Care & Research Web site at http://
www.interscience.wiley.com/jpages/0004-3591:1/
suppmat/index.html.
Scoring
Responses. Scale. Original AHI has a 4-point
Likert scale (1 strongly disagree, 2 disagree,
3 agree, 4 strongly agree); AHI Helplessness
subscale has a 6-point Likert scale (1 strongly
disagree, 2 moderately disagree, 3 disagree,
4 agree, 5 moderately agree, 6 strongly
agree); RAI has a 4-point Likert scale with 5
response options (1 strongly disagree, 2
disagree, 2.5 do not agree or disagree, 3 agree,
4 strongly agree); RAI Helplessness Subscale has
a 5-point Likert scale (1 strongly disagree, 2
disagree, 3 do not agree or disagree, 4 agree,
5 strongly agree).
Brady
Score range. For all versions, higher scores

indicate greater helplessness. Original AHI 15 60,
AHI Helplessness subscale 530, RAI 15 60, RAI
Helplessness Subscale 530.
Interpretation of scores. For the AHI
Helplessness subscale, empirically derived cutpoints, which demonstrated statistically signicant
differences among groups on psychological,
behavioral, and symptom severity measures have
been published. The low helplessness group
achieved better scores while high helplessness
group scored worse on psychological, behavioral,
and symptom severity scales. Cut-points are Low
helplessness ( 11), Normal ( 1119, combines low
normal, normal and high normal), High
helplessness ( 20). In other versions there is no
guidance in interpretation of scores; since the RAI
items are identical except for the substitution of
condition for arthritis in 4 items, it is likely to
have similar cut-points but this has not been
tested.
Method of scoring. All versions can be scored by
hand. In the AHI/RAI reverse the 9 items
indicating perceived control (items 2, 3, 5, 6, 8, 9,
11, 13, 15) and sum all items for total score. In the
AHI/RAI helplessness subscale reverse scoring on
item 4; sum all items for total score.
Time to score. Not documented, likely to be very
brief, but requires score conversion.
Training to score. Need instructions or template
to reverse the appropriate items before scoring (9
items on the 15-item scales, 1 item on the 5-item
scales).
Training to interpret. None required; these
instruments have been used primarily in research.
Clinicians who use them have relied on clinical
judgment.
Norms available. No formal norms have been
published. Cut-points scores used to determine
low, midrange, and high helplessness scores using
the AHI helplessness subscale were empirically
derived to categorize 20% of the sample as low
helplessness, and 20% as high helplessness.
Psychometric Information
Reliability. AHI. Internal consistency reliability,
Cronbachs alpha 0.69 (borderline acceptable for a
presumed unidimensional scale). The 12-month
test-retest reliability was 0.53.
Self-Efcacy and Helplessness
AHI helplessness subscale. Internal consistency

reliability with Cronbachs alpha was 0.63 (item-tototal correlations ranging from 0.29 to 0.47).
Internal consistency alpha via the SpearmanBrown prophecy formula (used to equate subscales
to the number of items on the full scale) was 0.84.
The 6-month test-retest reliability was 0.64.
AHI internality subscale. Internal consistency
reliability via Cronbachs alpha was 0.75 (item-tototal correlations ranging from 0.38 to 0.58).
Internal consistency alpha via the SpearmanBrown prophecy formula (used to equate subscales
to the number of items on the full scale) was 0.88
and the 6-month test-retest reliability was 0.59.
RAI. Internal consistency reliability via
Cronbachs alpha was 0.68. Two items had weak
correlations with the parallel item on the AHI (I
have considerable ability to control my pain, and
If I do all the right things, I can successfully
manage my condition.)
RAI helplessness subscale. Internal consistency
reliability via Cronbachs alpha was 0.70 Sample A
and 0.67 Sample B.
Validity. AHI construct validity. AHI correlates
in expected ways with theoretically relevant
variables such as health locus of control, self
esteem, anxiety, and depression measures. All
correlations were signicant and remained
signicant when age- and education level-adjusted.
AHI also signicantly correlated with measures of
functional status (Modied Health Assessment
Questionnaire), dissatisfaction with functional
status, pain, and general rating of perceived
limitations.
AHI helplessness subscale construct validity.
Subscale correlated in expected ways with
theoretically relevant measures including chanceand powerful other-health locus of control,
depression, non-compliance, information seeking,
pain rating, and Arthritis Impact Measurement
Scales physical, pain, depression and global health
status subscales. The 5-item subscale accounted for
more variance in these measures than did the 15item measure. Changes in the helplessness
subscale were more strongly associated with
changes in pain and depression than were changes
in the scores on the 15-item scale.
AHI internality subscale construct validity.
Scores were associated with internal health locus
of control scores. High scores were associated with
less pain, depression, and behavioral
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ineffectiveness. Changes in the full scale were

more strongly associated with changes in
psychological and disease impact measures than
were changes in the internality subscale.
RAI construct/criterion validity. Correlation of
0.78 between RAI and AHI completed 124 hours
apart. Validation article (3) presents a variety of
correlations of RAI with 4 measures of disease
activity, 3 measures of physical performance, and 3
self- report measures of functional status. No
relationships between RAI and these measures are
hypothesized a priori, so it is difcult to evaluate
these as evidence of validity. RAI scores were
signicantly correlated with physical performance
scores, and self-report measures of function; the
latter had larger correlations.
RAI helplessness subscale construct/criterion
validity. Correlations of 0.79 between full RAI and
RAI helplessness scale. Brief measure had
signicantly higher correlations to measures of
self-reported functional status than did the full
RAI.
Sensitivity/responsiveness to change. AHI. An
observational study found a 1-point decrease in
helplessness on 12- month retesting. Changes in
the AHI were signicantly correlated with changes
in functional status at 12 months.
AHI helplessness subscale. The 6-month
retesting indicated changes over time, and these
were more strongly related to changes in pain and
depression than were changes in the full AHI.
RAI and RAI Helplessness Subscale. Unknown.
Comments and Critique

The original 15-item AHI was developed to
capture the construct of learned helplessness, the
psychological state in which individuals believe
their efforts will be ineffective. These perceptions
are hypothesized to produce affective,
motivational, and behavioral decits. The original
15-item AHI has been correlated with theoretically
relevant variables and has demonstrated construct
validity. True criterion validity is not possible
because there is no pre-existing gold standard
helplessness measure in the literature. The 15-item
AHI had modest internal-consistency reliability,
however, suggesting it was not a uni-dimensional
measure. Factor analysis found 2 factors or
subscales, internality and helplessness. The
internality subscale has received little attention,
but the helplessness subscale has been
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demonstrated to be more conceptually clear and to

account for more variance in variables of interest
than does the full AHI. In addition, Stein et al (6)
empirically developed a classication schema for
the helplessness subscale that has predicted scores
on psychological, behavioral, and symptom
severity measures even after 2 years.
The RAI is a modication of the AHI, created
by replacing the word arthritis with the word
condition in 9 items, and creating a fth response
category (do not agree or disagree). The RAI
appears to behave fairly similarly to the AHI but
true psychometric data are thin. There is a 0.78
correlation between the AHI and its variant, the
RAI. Factor analysis was also used to identify
subscales for the RAI. The same 2 factors emerged,
internality and helplessness with items identical to
AHI subscales. As with the AHI, the RAI
helplessness scale had a reasonably strong
correlation with the full 15-item RAI and had
stronger correlations to measures of functional
status than did the full RAI.
As a measure of the construct of helplessness,
the brief 5-item scales appear to be superior to the
15-item scales, because of their speed and ease of
use and because of stronger correlations with other
health status variables. The 5-item AHI has greater
psychometric support than the 5-item RAI, and has
demonstrated predictive utility. For these reasons
it may be preferable to use the AHI helplessness
subscale in situations where having the word
arthritis in the item language is not problematic.
DeVellis and Callahan (4) note that
reliabilities of these measures are at the low end of
the acceptable range, however, with 30% of the
score variance due to error. They suggest these
measures are adequate for research and general
screening purposes but should not be used alone
for clinical decision-making.
References
1. (Original AHI) Nicassio PM, Wallston KA, Callahan
LF, Herbert M, Pincus P. The measurement of
helplessness in rheumatoid arthritis: the development
of the Arthritis Helplessness Index. J Rheumatol 1985;
12:4627.
2. (Original AHI Helplessness) Stein MJ, Wallston KA,
Nicassio PM. Factor structure of the Arthritis
Helplessness Index. J Rheumatol 1988;15:42732.
3. (Original RAI) Callahan LF, Brooks RH, Pincus T.
Further analysis of learned helplessness in
rheumatoid arthritis using a Rheumatology Attitudes
Index. J Rheumatol 1988;15:418 26.
4. (Original RAI Helplessness) Devellis RF, Callahan LF.
A brief measure of helplessness in rheumatoid
disease: the helplessness subscale of the
Rheumatology Attitudes Index. J Rheumatol 1993;20:
866 69.
Brady
5. Escalante A, Cardiel MH, del Rincon I, SudrezMendosa AA. Cross cultural equivance of a brief
helplessness scale for Spanish speaking rheumatology
patients in the United States. Arthritis Care Res 1999;
12:34150.
6. Stein MJ, Wallston KA, Nicassio PM, Castner CM.
Correlates of a clinical classication schema for the
arthritis helplessness subscale. Arthritis Rheum 1988;
31:876 81.
ARTHRITIS SELF-EFFICACY SCALE

(ASES)
General Description
Purpose. The Arthritis Self-Efcacy Scale (ASES)
was developed to measure patients arthritisspecic self-efcacy, or patients beliefs that they
could perform specic tasks or behaviors to cope
with the consequences of arthritis (1). It is based
on the theory of self-efcacy as postulated by
Bandura (2). Self-efcacy refers to personal
judgments of performance capabilities in a given
domain of activity, not to a generalized trait.
Content. Items are designed to capture how
certain the individual is that they can perform a
specic activity or achieve a result. Items include
specic behaviors such as Walk 100 feet on at
ground in 20 seconds, or Scratch your upper
back with both your right and left hands; and
performance-results items such as Decrease your
pain quite a bit, or Control your fatigue.
Developer/contact information. Kate Lorig, RN
DrPH, 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 and
evaluated.
Number of items in scale. There are 20 items.
Subscales. The ASES consists of 3 subscales
Self-efcacy Pain (PSE), 5 items; Self-efcacy
Function (FSE), 9 items; and Self-efcacy Other
Symptoms (OSE), 6 items.
Populations. Developmental/target.
Psychometric study of the ASES was done with
volunteers recruited for the Arthritis Self-Help
Course (development sample n 97, replication
sample n 144), more than 80% female, close to
age 65, and average education level more than 14
years.
Other uses. ASES has been widely used with
adults of all ages, and with a variety of arthritis
conditions, including lupus, bromyalgia,

scleroderma, and chronic fatigue syndrome.
Administration
Method. Self-administered written self-report.
Easy to administer.
Training. None.
Time to administer/complete. Not reported,
assumed to be brief.
Equipment needed. None
from the literature (see references.) Copy available
suppmat/index.html.
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Validity. No gold standard is available to

determine criterion validity. Since its
development, the ASES has become the gold
standard.
Construct. Validity was demonstrated by nding
signicant correlations among ASES subscales and
measures of health status (pain, disability, and
depression).
Known groups validity. Participants in the
Arthritis Self-Management Course showed growth
in ASES scores while the control group did not.
Sensitivity/responsiveness to change. Sensitivity
is unknown. No criterion measure is available so it
is unclear if changes in scores represent true
changes in self-efcacy. Participants in the
Arthritis Self-Management Course did demonstrate
changes in ASES scores, although these changes
were not statistically signicant.

Scoring
Responses. Scale. Items are rated on a 10 (very
uncertain) to 100 (very certain) rating scale, in 10point increments.
Score range. Range is 10 100 on each subscale.
Interpretation of scores. Higher scores indicate
greater condence or self-efcacy. No cut points
are indicated.
Method of scoring. Each subscale is scored
separately, taking the mean of subscale items.
Time to score. Not reported; calculation of mean
scores on subscales of 5, 6, and 9 items.
Training to score. None required except simple
mathematical calculations.
Training to interpret. None required.
Norms available. None.
Reliability. Internal reliability alpha estimates
are PSE 0.76, FSE 0.89, and OSE 0.87. Item
loadings (based on factor analysis or replication
sample) are PSE 0.48 0.75, FSE 0.55 0.84, and
OSE 0.63 0.81. Test-retest reliability (229 days
between retesting) are PSE 0.87, FSE 0.85, and OSE
0.90.
The ASES is the dominant measure of selfefcacy in the arthritis literature and has made
signicant contributions in measuring situationspecic perceptions of control, rather than more
generalized or trait measures such as mastery or
locus of control.
The ASES subscales show good internal
consistency and test-retest reliability, and
reasonable associations with measures of health
status. Other aspects of self-efcacy theory, such as
prediction of initiation or persistence of behavior
as predicted by self-efcacy theory, have not been
examined, The authors recognize a need to
compare ASES results with theoretically distinct
but related concepts such as learned helplessness
and health-related locus of control to examine
divergent and convergent validity, but this has not
yet been done.
The ASES, as published, consists of 20 items
that fall into 3 subscales. The initial development
analysis produced a 2-factor scale (function and
other symptoms) with 25 items. On replication, the
factor analysis utilized 20 items with a 3-factor
solution. Developers state that the choice between
the 2-factor or 3-factor instrument was arbitrary,
based on the perceived value of a pain measure,
and the correlations of the other symptom measure
with depression. While the factor subscales have
been widely used, further replication of the factor
structure has not been published.
Some investigators have modied the ASES to
t the needs of their studies (e.g., tness in
bromyalgia). Many of these modications have
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had no psychometric work done so it is impossible

to determine their reliability or validity.
The combination of items tapping specic
behaviors (walk 100 feet) and performance results
(decrease your pain quite a bit, or control your
fatigue) have raised debate in the literature on
what the ASES is actually measuring, task-specic
self-efcacy or condence in ability to achieve
results. See references 5 and 6 for more
information.
References
1. (Original) Lorig K, Chastain RL, Ung E, Shoor S
Holman H. Development and evaluation of a scale to
measure perceived self efcacy in people with
arthritis. Arthritis Rheum 1989;32:37 44.
2. Bandura A. Self-efcacy: toward a unifying theory of
behavior change. Psychol Rev 1977;84:191215.
3. Lomi C, Nordholm LA. Validation of a Swedish
version of the Arthritis Self-Efcacy Scale. Scand
J Rheumatol 1992;21:2317.
4. Gonzales VM, Steward A, Ritter PL, Lorig K.
Translation and validation of arthritis outcome
measures into Spanish. Arthritis Rheum
1995;38:1429 46.
5. Brady TJ. Do common arthritis self efcacy measures
really measure self efcacy? Arthritis Care Res 1997;
10:1 8.
6. Lorig K, Holman H. Arthritis self-efcacy scales
measure self-efcacy. Arthritis Care Res 1988;11:155
7.
CHILDRENS ARTHRITIS SELFEFFICACY SCALE (CASE)

General Description
Purpose. The Childrens Arthritis Self-Efcacy
Scale (CASE) was designed to measure childrens
perceived ability to control or manage aspects of
life with juvenile arthritis. It is designed to capture
beliefs related to disease management as well as
social and emotional issues (1).
Content. Items were developed after focus
groups of children with mild or severe juvenile
idiopathic arthritis, parents of children with mild
or severe juvenile idiopathic arthritis, and health
professionals, and were written in language the
children used. Items tap symptoms (hurt,
tiredness), emotions (sad, annoyed or fedup), and social participation (at school, with
my friends).
Brady
Versions. One.
Subscales. Factor analysis revealed 3 factors that
account for 76.5% of the score variance. These are
Activity (4 items), Symptoms (4 items), and
Emotions (3 items).
Populations. Developmental/target. Eighty-nine
children ages 717 years (average age 12.3) were
recruited from a childrens hospital database in
Birmingham, UK.
Other uses. None.
Administration
Easy to administer.
Training. None required.
Time to administer/complete. Estimated at 5
minutes.
Cost/availability. Items and scoring are available
in the literature. Copy available at the Arthritis
Care & Research Web site at http://www.interscience.
wiley.com/jpages/0004-3591:1/suppmat/index.html.
Scoring
Responses. Scale. The 5-point scale ranges from
1 (not at all sure) to 5 (very sure).
Score range. The range is 15 for each subscale.
greater efcacy. No cut points are available.
Method of scoring. Mean scores for each
subscale, can be calculated manually. Authors also
calculated standard scores on a 0 10 scale to allow
comparisons across scales.
Time to score. Not reported; assumed to be brief
(simple addition and division).
Training to score. None.
Developer/contact information. Julie Barlow,

BA, PhD, Interdisciplinary Research Centre in
Health, School of Health and Social Sciences,
Coventry University, Priory Street, Coventry CV1
5FB, UK. E-mail: j.barlow@coventry.ac.uk.
Training to interpret. None.

Norms available. No norms are available;
original publication provided mean and standard
scores for the 3 subscales: Activity, mean 3.21 (SD

1.36), 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).
Reliability. Internal consistency of each subscale
via Cronbachs alphas was Activity 0.90,
Symptoms 0.87, Emotion 0.85.
Validity. Construct validity. CASE correlated
signicantly with theoretically relevant variables:
positive correlations were found with hope and
physical and psychological well-being, and
negative correlations with measures of function,
anxiety, pain, fatigue, and stiffness.
Sensitivity/responsiveness to change. Unknown.

The CASE is a new measure designed to
assess self-efcacy to manage consequences of
arthritis among children ages 717 years.
Psychometric data is limited (gathered from 89
children recruited from a single hospital, on a
handful of health status measures) and the measure
has not yet been widely used.
It is not clear whether the self-efcacy
construct in children is similar to the self-efcacy
construct in adults. The age appropriateness of
items was not assessed, but measure development
was guided by focus groups with children with
juvenile arthritis and with parents of children with
arthritis, and the measure was pilot-tested with
children.
Reference
1. (Original) Barlow JH, Shaw KL, Wright CC.
Development and preliminary validation of a
Childrens Arthritis Self-Efcacy Scale. (Arthritis
Rheum) Arthritis Care Res 2001;45:159 66.
GENERALIZED SELF-EFFICACY SCALE

(GSES)
General Description
Purpose. The Generalized Self Efcacy Scale
(GSES) (1) is a measure of perceived coping
competence, or global condence in ones ability
to cope across a range of demanding situations
(2). In contrast to Banduras original
conceptualization of self-efcacy as a situation- or
behavior-specic belief, the GSES is conceived as a
trait measure of optimistic self beliefs assumed
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to be relatively stable over time and domains of

functioning. The GSES was originally developed in
German by Jerusalem and Schwartzer (1).
Content. Items are designed to assess the
individuals belief in his/her ability to respond to
novel or difcult situations. Items include I am
condent that I could deal efciently with
unexpected events, and When I am confronted
with a problem, I usually nd several solutions.
Developer/contact information. English
adaptation by Julie Barlow, BA, PhD,
Interdisciplinary Research Centre in Health, School
of Health and Social Sciences, Coventry
University, Priory Steet, Coventry CV1 5FB, UK.
E-mail: j.barlow@coventry.ac.uk.
Versions. Original measure is in German; Barlow
validated an English adaptation (2). Spanish,
French, Hebrew, Hungarian, Turkish, Czech,
Slovak, Chinese, Indonesian, Japanese, and Korean
adaptations or translations are available (3, 4).
Subscales. None; assumed to be a unitary
construct.
Populations. Developmental/target. English
adaptation was participants in arthritis selfmanagement programs in community settings
across the United Kingdom. Primarily white
women in their 50s with longstanding rheumatoid
arthritis or osteoarthritis; approximately half did
not have educational degrees.
Other uses. None.
Administration
Easy to administer.
Time to administer/complete. Estimated to be 3
minutes.
Cost/availability. Items and scoring available in
primary reference (1). Copy available at the
Arthritis Care & Research Web site at
http://www.interscience.wiley.com/jpages/00043591:1/suppmat/index.html.
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Scoring
Responses. 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.
greater perceived competence to cope with difcult
situations, or generalized self-efcacy. No cut
points 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, but
mean scores from the three validation studies for
the English adaptation are published: 29.05 (SD
5.1), 28.71 (SD 5.9), and 30.23 (SD 4.8). These are
similar to the mean score for the accumulated
German sample of 29.98 (SD 4.6) for the German
version of the GSES.
Reliability. The internal consistency via
Cronbachs alpha estimates was 0.88, 0.91, and
0.89 for validation studies 2, 3, and 4 respectively.
The test-retest reliability over a 4-month period
was 0.63. and the item-total correlations ranged
from 0.31 to 0.81.
Validity. Construct validity. Factor analysis
revealed a single-factor solution, which explained
just over 50% of the variance, supporting the
unidimensional nature of the measure. As
hypothesized, the GSES was positively associated
with positive affect and social support, and
negatively associated with depression and health
distress.
Divergent validity. There were no signicant
associations between GSES and physical health
status as measured by the Health Assessment
Questionnaire, Visual Analog Scale-pain, and
Visual analog Scale-fatigue.
Predictive validity. GSES at time 1 was
signicantly associated with depression at time 2,
explaining an additional 8% of the variance after
controlling for demographic and physical health
Brady
status. GSES was also signicantly associated with

positive affect, explaining an additional 15% of the
variance.
Sensitivity/responsiveness to change. None
reported. Generalized self-efcacy is
conceptualized as a dispositional characteristic or
trait, and would be expected to be more stable and
less susceptible to change.

The English adaptation of the Generalized
Self-Efcacy Scale appears to be a valid and
reliable measure of perceived competence to cope
with difcult situations. As such, the title of the
scale may be mis-leading because self-efcacy is
most frequently used to refer to more changeable
situation- or behavior-specic constructs. It may
more closely resemble personal mastery, although
no investigation of the relationship between GSES
and mastery or personal competence has been
done. The authors note the need to investigate the
relationship between learned helplessness and the
GSES.
The authors also caution that use of the GSES
is inappropriate when the outcome of interest is
performance of a specic behavior such as an
exercise program. They recommend use of the
GSES when measuring global condence in ones
ability to cope as a trait, or general adaptation to
circumstances.
In contrast to a simple translation, Barlow and
colleagues (2) adapted the GSES for an English
audience. They modied 2 items to improve
comprehensibility for an English audience; they
replicated the original validation studies. The
GSES is available in multiple other languages;
before use it will be important to clarify if these
are simple translations relying on the
psychometrics of the original German scale, or
adaptations for the specic language.
References
1. (Original) Jerusalem M, Schwarzer R. Self efcacy as a
resource factor in stress appraisal process. In:
Schwarzer R, editor. Self-Efcacy: thought control and
action. Washington (DC): Hemisphere; 1992.
2. (Original) Barlow BH, Williams B, Wright C. The
Generalized self-efcacy 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 Chinese
versions of the generalized self-efcacy scale. Appl
Psychol Int Rev 1997;46:69 88.
4. Schwarzer R, Born A, Iwawaki S, Lee YE, Saito E,
Yue. The assessment of optimistic self-beliefs:

comparison of the Chinese, Indonesian, Japanese, and
Korean versions of the generalized self-efcacy scale.
Applied Psychol Int Rev 1997;40:113.
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Time to administer/complete. Unknown,

expected to be brief.
MASTERY SCALE
General Description
Purpose. The Mastery Scale, initially developed
by Pearlin and Schooler, is designed to measure
the extent to which one regards ones life chances
as being under ones own control in contrast to
being fatalistically ruled (1, p. 5) or the extent to
which people see themselves as being in control of
the forces that importantly affect their lives (2, p.
340).
Mastery is conceived as a personality
characteristic that serves as a psychological
resource individuals use to help them withstand
stressors in their environment.
Content. Content consists of 7 items tapping
sense of control, such as I have little control over
the things that happen to me and I can do just
about anything I set my mind to do. Two items
are positively worded.
Developer/contact information. Leonard Pearlin,
PhD, University of California, San Francisco
Human Development and Aging Program, San
Francisco, CA 94143.
Versions. One version. Scale has been translated
to Chinese, Czech, Dutch, German, Hebrew,
Vietnamese, Swedish, and Spanish. Spanish
translation found low item-total correlations for the
2 positively-worded items.
Number of items in scale. Seven.
Subscales. None.
Populations. Developmental/target. Adults of
working age (18 65 years) developed to gather
information in interviews of a sample designed to
be representative of census-dened urbanized area
of Chicago.
Other uses. Has been used by researchers in
many countries and with many populations, from
adolescents to older adults, and with mental and
physical health difculties.
Administration
Method. Initial data collection performed using
scheduled interviews.
Cost/availability. Items available in literature,

although no scoring directions are provided. Copy
available at http://www.bsos.umd.edu/socy/
faculty/word/Pearlin/Mastery.doc.
Scoring
Responses. Scale. Scoring instructions are not
provided in the original publication. Various
investigators have used 4-, 5-, and 7-point Likert
scales. Some investigators list 1 as strongly agree
while others use 1 as strongly disagree.
Score range. Depends on number of points on
Likert Scale. A 4-point scale ranges 4 28, a 5-point
scale ranges 535, a 7-point scale ranges 7 49.
Interpretation of scores. Unknown; no cut
points are provided.
Method of scoring. Some investigators use sum
of item scores, others use mean score across the
seven items.
Time to score. Unknown, assumed to be brief.
Training to score. Minimal, selected items need
to be reversed in scoring. (5 items worded
negatively, 2 items worded positively).
Training to interpret. Unknown, not likely.
Norms available. No.
Reliability. Original publication (1) reports
factor loadings for the 7 items loading on the
mastery scale; these could be considered a form of
internal consistency reliability. The 5 negatively
worded items have factor loadings ranging from
0.76 and 0.56. The 2 positively worded items both
have factor loadings of - 0.47. Correlation between
time 1 and 2, four years later, was 0.44 (2). The
time gap of 4 years negates the value of this
correlation as a measure of test-retest reliability,
however.
Validity. No overt tests have been done to
evaluate the validity of the Mastery scale. The
scale has been used concurrently with a variety of
other measures of psychological well-being or
sense of control. The Mastery Scale has been
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widely used and translated into multiple languages

despite an absence of validity data. This suggests
strong face validity.
Sensitivity/responsiveness to change. Unknown;
as a trait measure it would be expected to be
stable.

Although widely used, the Mastery Scale
referred to as developed by either Pearlin and
Schooler (1) or Pearlin et al (2) has not had
signicant psychometric work done, so it is not
clear how valid or reliable it is as a measure of
mastery. In addition, no standardized scoring
recommendations were provided, so investigators
are left to develop their own scoring protocols.
This absence of standardized scoring makes it
difcult to compare across studies.
The Mastery Scale has been incorporated into
combined measures of psychological resources
such as the Personal Resources Index and the
Cognitive Adaptation Index, but individual
components of these combination measures have
not been evaluated. The Mastery Scale has not
been widely used in rheumatology research.
References
1. Pearlin LI, Schooler I. The structure of coping.
J Health Soc Behav 1981;19:221.
2. Pearlin LI, Liberman MA, Menaghan EG, Mullin JT.
The stress process. J Health Soc Behav 1981;22:337
56.
MULTI-DIMENSIONAL HEALTH LOCUS

OF CONTROL SCALE (MHLC)
General Description
Purpose. The purpose of the Multi-Dimensional
Health Locus of Control Scale (MHLC) is to
provide information on 3 theoretically distinct and
empirically differentiated dimensions of health
locus of control (1). A secondary purpose was to
create 2 equivalent forms (Form A and Form B) of
the MHLC for use in repeated-measures studies.
Later a third form (Form C) was created to be used
with specic health conditions (2). The MHLC was
developed to address the increased understanding
of the locus of control and health locus of control
constructs. The original health locus of control
scale was conceptualized as a unidimensional
construct (internal or external locus of control over
health); later factor analysis of this measure, and
new research in more generalized locus of control
work, identied the need to measure health locus
of control in 3 dimensions.
Brady
Form C of the MHLC was created for both

theoretical and practical reasons. Theoretically, it
was hypothesized that health locus of control
beliefs about a specic health condition may
correlate with health outcomes differently than
more general health locus of control beliefs.
Practically, several researchers observed some
items on Forms A and B were problematic for
individuals with chronic medical conditions to
respond to. Form C was designd as a generalpurpose condition-specic locus of control scale
that could be easily adapted for use by individuals
with specic medical conditions.
Content. On Forms A and B, items reect the 3
hypothesized dimensions of health locus of
control: Internality (IHLC) (i.e., I am in control of
my own health), Powerful Others (PHLOC)
(i.e.,My family has a lot to do with my becoming
sick 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 grade
reading level.
On Form C items reect similar dimensions,
but factor analysis reveals that Powerful Others can
refer to either doctors or medically trained
professionals, and others. Initial Form C items refer
to condition, but this can be adapted to specify
Arthritis.
Developer/contact information. Kenneth A.
Wallston, PhD, School of Nursing, Vanderbilt
University, 429 Godchaux Hall, Nashville, TN
37240. E-mail: ken.wallston@Vanderbilt.edu.
Versions. Three forms of the MHLC were
created, Forms A, B, and C. Forms A and B were
designed to be equivalent; items were paired in
scale construction based on meaning, one assigned
to Form A, the other to Form B. Form C was
created to be used with specic 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 increase
reliability if repeated measures are not necessary.
Form C also has 18 items, 6 items on the
Internality and Chance Subscales, 3 on Powerful
OthersDoctors, 3 on Powerful OthersOther
people.
Subscales. Forms A and B each have 3 subscales
of 6 items each. Subscales are Internality, Powerful
Others, and Chance. Form C has 4 subscales; the
Powerful Others subscale is divided into a Doctor
subscale and an Other People subscale.
Populations. Developmental/target. Designed for

use by adults; Forms A and B validated with
adults waiting at airport. Form C was validated
with groups of patients with rheumatoid arthritis,
chronic pain, cancer, diabetes.
Other uses. Has been widely used with samples
involving pain, spinal cord injury, alcohol
dependence, arthritis, and other chronic
conditions.
Administration
Training. None indicated.
Time to administer/complete. Estimated 35
minutes for each form.
from the literature, or on website: http://www.
vanderbilt.edu/nursing/kwallston/mhlcscales.htm.
Scoring
Responses. Scale. Scale is a 6-point Likert scale,
from strongly disagree to strongly agree. One study
of 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-item
subscale; 12 to 72 if two forms are combined to
form 12-item subscales. The range for Form C 3
item subscales is 318.
Interpretation of scores. Higher subscale scores
indicate greater belief in that locus of control.
Method of scoring. Manual scoring by summing
item scores on each subscale.
Time to score. Unknown, expected to be brief.
Training to score. None required.
Norms available. None. Means and Standard
Deviations are available for Form C subscales in a
Rheumatoid Arthritis Sample: Mean (SD) Internal
17.50 (5.89); Chance 16.60 (6.10); Doctors 13.43
(3.28); Other People 7.48 (3.27).
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Reliability. Forms A and B. Cronbachs alpha
for internal consistency ranges from 0.67 to 0.77
for the 6-item subscales on Forms A and B. Mean
scores for Forms A and B are nearly identical; for
greater internal consistency and reliability the 2
forms can be combined. Cronbachs alpha for the
combined 12-item subscales ranges from 0.83 to
0.86.
Form C. Cronbachs alpha for internal
consistency ranges from 0.87 to 0.79 for the 6-item
subscales (Internality and Chance), and 0.71 0.70
on the 3 item subscales (Powerful othersDoctors,
and Powerful OthersOther People). In test-retest
reliability, the stability coefcients ranged from
0.66 to 0.54 for a 1 year retesting period with no
active intervention to change beliefs.
Validity. Forms A and B construct validity.
Intercorrelations among the 6-item subscales, or
the 12-item subscales indicate that IHLC and PHLC
are statistically independent, IHLC and CHLC are
negatively correlated, and PHLC and CHLC show a
small positive correlation, particularly on Form B.
Forms A and B construct/criterion validity.
There are signicant positive correlations between
MHLC subscales and their theoretical counterpart
on Levensons Locus of Control Scale.
Preliminary predictive validity. As expected,
health status, as measured by a two-item health
status measure, showed a positive and signicant
correlation with IHLC; (r 0.403) a signicant
negative correlation with CHLC (0.275); and no
correlation with PHLC (r -0.055).
Form C concurrent validity. Form C showed
modest correlations with the appropriate subscale
from Form A/B (correlations ranging from 0.59 to
0.38 in a rheumatoid arthritis sample).
Form C construct validity. Form C subscales
correlated in the theoretically expected directions
with distinct but related concepts of Pain,
Depression, and Helplessness in a rheumatoid
arthritis sample. Further evidence of consrruct
validity is demonstrated in a sample of individuals
with chronic pain engaged in an intervention
designed to change locus of control beliefs. As
expected, Internality beliefs increased while the
external subscales (Chance, Powerful Others
Doctors, and Powerful OthersOther people) all
decreased.
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The MHLC was developed to measure health
locus of control after the evolution of the theory to
consider locus of control and health locus of
control to be multidimensional rather than
unidimensional concepts. A strength of the MHLC
Form A/B is the availability of alternate forms with
nearly identical psychometric properties to
accommodate repeated measures research designs.
Preliminary psychometric evaluation is promising.
The authors suggest that not all 3 subscales need to
be used in a single investigation; depending on
variables of interest and time limitation, 1 or 2
dimensions can be included in a research design.
A further strength of MHLC is the presence
and validation of Form C, designed to be a generalpurpose condition-specic health locus of control
measures that can be easily adapted to a variety of
chronic conditions in a standardized manner.
Since publication, some replications have
supported the multidimensional nature of health
locus of control, while others have failed to
support the 3-factor solution and recommend
returning to the simple internal-external locus of
control conceptualization. The authors caution that
health locus of control is a health-specic indicator
of generalized expectation of control over
reinforcement based on Rotters social learning
theory. As a generalized measure, it is not
expected to explain large amounts of variation in
health behaviors if used in isolation. Only in
combination with other contributing factors is
MHLC likely to help explain health behavior.
References
1. (Original) Wallston KA, Wallston BS, DeVellis R.
Development of the Multi-Dimensional Health Locus
of Control Scales. Health Educ Monogr 1978;6:160 70.
2. (Original) Wallston K, Stein MJ, Smith CA. Form C of
the MHLOC Scales: a condition-specic measure of
locus of control. J Pers Assess 1994;63:534 53.
3. Fried TR, van Doorn C, OLeary JR, Tinetti ME,
Drickamer MA. Older persons preferences for home
versus hospital care in the treatment of acute illness.
Arch Intern Med 2000;160:1501 6.
Additional References
Cooper D, Framboni M. Toward a more valid and
reliable health locus of control scale. J Clin Psychol
1988;44:536 40.
OLooney BA, Barrett PT. A psychometric investigation
of the multidimensional health locus of control
questionnaire. Brit J Clin Psychol 1983;22:217 8.
Umlauf RL, Frank RG. Multi-dimensional health locus of
control in a rehabilitation setting. J Clin Psychol
1986;42:126 8.
Brady
Wallston K. Psychological control and its impact in
management of rheumatological disorders.
Baillieres Clin Rheum 1993;7:28195.
PARENTS ARTHRITIS SELF-EFFICACY

SCALE (PASE)
General Description
Purpose. The Parents Arthritis Self Efcacy
Scale (PASE) was designed to measure parents
perceived ability to manage salient aspects of their
childs juvenile arthritis (1). At rst glance, this
scale may seem misdirected. It is important to note
that the scale is based on the hypothesis that a
parents health status is inuenced by their
perceived ability to handle a specic parenting
task, that is, managing their childs arthritis. It was
hypothesized, secondarily, that the parental sense
of competence would inuence psychosocial
adaptation of the child with juvenile arthritis, but
the primary measures used to validate with scale
were correlations with measures of the parents
health status.
Content. Items reect 14 issues found to be
salient in preliminary research. These include
management of pain, stiffness, swelling, fatigue,
sleep, loneliness, frustration, pleasure, and
participation in school, family, and friend
activities. Where content was similar, items were
modications of Arthritis Self-Efcacy Scale
(ASES) items. Item example: How certain are you
that you can keep arthritis pain from interfering
with your childs sleep?
Developer/contact information. Julie Barlow BA,
PhD, Interdisciplinary Research Centre in Health,
School of Health and Social Sciences, Coventry
University, Priory Street, Coventry CV1 5FB, UK.
E-mail: j.barlow@coventry.ac.uk.
Versions. One.
Subscales. There are 2, symptom subscale and
psychosocial subscale, both have 7 items.
Populations. Developmental/target. Parents
identied from 2 hospital databases in the UK.
Majority were white, married, some advanced
education, and working in paid employment.
Other uses. None.
Administration
Method. Written, self-administered self-report.
Easy to administer.
Time to administer/complete. Estimated to be 3
minutes.
Cost/availability. Items and scoring listed in
original article. Copy available at the Arthritis Care
& Research Web site at http://www.interscience.
wiley.com/jpages/0004-3591:1/suppmat/index.html.
Scoring
Responses. Scale. Seven-point scale, from 1
(very uncertain) to 7 (very certain, and a
nonapplicable category.
Score range. Range is 7 49 for each subscale.
Interpretation of scores. Higher scores reect
greater condence in ability to manage or control
aspects of childs juvenile arthritis. No cut points
are provided.
Method of scoring. Sum of item scores on each
subscale; can be done manually. Validation study
also standardized scores to a 0 10 scale allow
easier comparison across subscales. This would be
labor-intensive if attempted manually.
Time to score. Not reported, assumed to be brief.
Training to interpret. None reported.
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Construct validity. Validation was demonstrated

for mothers by signicant negative association of
mothers anxious and depressed mood with both
subscales, and signicant associations of mothers
psychosocial efcacy with her physical function,
energy, pain, and general health perceptions. The
only signicant associations for fathers were
positive associations between fathers general
health perceptions and psychosocial subscale, and
negative association between fathers depressed
mood and psychosocial subscale. Authors also
investigated the associations between parents and
childs ratings of childs physical and psychosocial
well-being and parental self-efcacy ratings.
Investigators specify that they expected parental
self efcacy to be reected in childs well being,
but did not provide strong theoretical rationale for
including this as evidence of construct validity.

The validation of the PASE has appeared in
the literature but it is not clear that it has been
used in clinical research by the authors or other
investigators. The original article provides
preliminary psychometric evidence, but additional
use of the measure is required to further determine
validity and reliability. Psychometric data is
presented separately for mothers and fathers. From
the preliminary study, there is some evidence that
the parental ratings on the psychosocial subscale
are related to parental health status, particularly
for mothers, but there are no strong correlations
reported for the symptoms subscale. The merits of
combining the 2 subscales into a single instrument
is not clear. Similar to the ASES on which it is
modeled, the PASE may combine both efcacy
expectations and expectations about results.
Norms available. No; but mean scores are

reported for validation studies: mothers symptom
subscale 27.37, psychosocial subscale 33.89;
fathers symptom subscale 23.22, psychosocial
subscale 33.18.
Reference
RHEUMATOID ARTHRITIS
SELF-EFFICACY SCALE (RASE)
General Description
Reliability. Internal consistency reliability via

Cronbachs alphas: mothers symptom subscale
0.92, psychosocial subscale 0.96; fathers symptom
subscale 0.89, psychosocial subscale 0.93.
Validity. Criterion validity. Criterion was
demonstrated by signicant correlations with the
Generalized Self-Efcacy Scale with both subscales
of the PASE, for both mothers and fathers.
1. Barlow JH, Shaw KL, Wright CC. Development and

preliminary validation of a self-efcacy measure for
use among juvenile idiopathic arthritis. Arthritis Care
Res 2000;13:22736.
Purpose. The Rheumatoid Arthritis Self-Efcacy

Scale (RASE) was developed to measure taskspecic self-efcacy for the initiation of selfmanagement related behavior (1). It was developed
specically for rheumatoid arthritis patients in the
UK.
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Content. Items are designed to tap specic selfmanagement behaviors. All items use the same
stem: Do you believe you could do these things to
help your arthritis. Items include: Use relaxation
techniques to help with pain or Save energy for
leisure activities, hobbies, or socializing.
Brady
Time to score. Not reported, likely to be quick.

Training to interpret. Not reported.
Norms available. No.
Developer/contact information. Sarah Hewlett,

PhD, MA, RGN, RM, ARC Senior Lecturer in
Rheumatology (Health Professions), Academic
Rheumatology, Bristol Royal Inrmary, Bristol BS2
8HW, UK. E-mail: Sarah.Hewlett@bristol.ac.uk.
Versions. One.
Subscales. No subscales are used, although
factor analysis showed 8 factors explaining 75% of
the variance.
Populations. Developmental/target. Rheumatoid
arthritis patients involved in self-management
programs in several medical centers in the UK.
Other uses. None.
Administration
Method. Self-administered, written self-report.
Relatively easy to administer.
Training. None.
Time to administer/complete. Approximately 10
minutes.
from the literature (see reference.) Copy available
suppmat/index.html.
Scoring
Responses. Scale. 1 (strongly disagree) to 5
(strongly agree), Likert scale.
Score range. Range is 28 140.
higher self-efcacy. No cut points are provided.
Method of scoring. Sum of scores can be done
manually.
Reliability. Internal consistency. Twenty-two of
28 items correlated signicantly with the total
RASE score, suggesting that self-efcacy as
measured by the RASE may not be a
unidimensional construct.
Test-retest reliability. The 4-week test-retest
correlation is 0.9.
Validity. Construct validity. As predicted by
self-efcacy theory, the RASE is correlated with
initiation of self-management behaviors, modest
correlations with Arthritis Self-Efcacy Scale, and
independent of mood and disease status.
Convergent validity. Modest correlations were
found with the Arthritis Self-Efcacy Scale (ASES).
Divergent validity. Neither the RASE or ASES
showed signicant correlation with the General
Self-Efcacy Scale (GSES), a trait measure of
optimistic self beliefs and perceived coping
competence (in contrast to the more behaviorspecic concepts of the RASE and ASES).
Sensitivity/responsiveness to change. It is not
clear that change in scores reects changes in the
construct, but the instrument is responsive to
change as indicated by changes following selfmanagement programs.

The RASE is a measure of self-management
behavior-specic self-efcacy. It appears to have
promising psychometric characteristics, although it
has not been used by many other investigators at
this time. The RASE has been correlated with
theoretically relevant variables predicted by selfefcacy theory. Examinations of the relationships
between RASE and related but distinct constructs
such as locus of control, mastery, and learned
helplessness would strengthen the validation of
this instrument.
The RASE was developed specically for use
in rheumatoid arthritis, and in patients from the
UK. There is no information on its use with other
types of arthritis, or in other geographic areas. The
title of the RASE may be misleading. Rather than

being RA-specic, the RASE is self-management
behavior specic. In contrast to the Arthritis SelfEfcacy Scales, which includes items addressing
specic functions (walk 100 feet on at ground in
20 seconds) and performance results (decrease
your pain quite a bit), the RASE asks about ability
to perform specic self-management behaviors
(use relaxation techniques to help with pain).
Reference
1. (Original) Hewlett S, Cockshott Z, Kirwan J, Barrett J,
Stamp J, Haslock L. Development and validation of a
self-efcacy scale for use in British patients with
rheumatoid arthritis. Rheumatology 2001;40:122130.
S161
Populations. Developmental/target. Instrument

was developed using college students. Criterion
validity was evaluated at a Veterans
Administration Medical Center Chemical
Dependency Unit.
Other uses. None.
Administration
Easy to administer.
Training. None needed.
SELF-EFFICACY SCALE (SES)

General Description
Purpose. The Self-Efcacy Scale (SES) was
designed to be a measure of self-efcacy not tied to
a specic situation or behavior (1). It is based on
the premise that personal mastery experiences
generalize across situations or behaviors. The
authors intended the SES to be a dispositional, or
trait measure of self-efcacy. It is not intended to
replace specic self-efcacy measures that assess
expectations for specic target behaviors.
Content. Items were written to measure general
self-efcacy expectations in areas such as social
skills or vocational competence. Items tap 3
dimensions in these areas, willingness to initiate
behavior, willingness to expend effort in
completing the behavior, and persistence in the
face of adversity.
Developer/contact information. Mark Sherer,
MD, Methodist Rehabilitation Center, Jackson, MS
39216.
Versions. One. Several translations have been
done, including Dutch and Hebrew.
Number of items in scale. Final instrument has
23 items.
Time to administer/complete. Not listed,

assumed to be 57 minutes.
from the literature (see reference.) Copy available
suppmat/index.html.
Scoring
Responses. Scale. 14-point Likert scale from
strongly disagree to strongly agree.
Score range. General self-efcacy subscale (17
items), range 14 238. Social self-efcacy subscale
(6 items), range 6 84.
higher self-efcacy expectations. No cut points are
provided.
Method of scoring. Reversed items are
converted. The score on each subscale is total of
item responses.
Time to score. Unknown, but likely to be brief.
Subscales. General self-efcacy subscale has 17

items and explains 26.5% of the variance in scores.
Items include When I make plans, I am certain I
can make them work, and I give up on things
before completing them.
Social self-efcacy subscale has 6 items and
explains 8.5% of the variance. Items include I
have acquired my friends through my personal
abilities at making friends, and I do not handle
myself well in social gatherings.
Training to score. Not needed, but selected

items must be reversed before scoring.
Training to interpret. Not needed.
Norms available. No norms available. On initial
development, means score for general self-efcacy
subscale was 172.65 (SD 27.31); mean score for
social self efcacy was 57.99 (SD 12.08).
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Reliability. Cronbachs alpha for internal
consistency was 0.86 for General self-efcacy
subscale, and 0.71 for Social self-efcacy subscale.
Validity. Construct validity. Validity was
demonstrated by moderate correlations between
SES subscales and related constructs such as
Personal Control Scale of Rotters Internal-External
Locus of Control Scale, and Holland and Bairds
Interpersonal Competency Scale. All correlations
were of moderate magnitude in the hypothesized
direction.
A second study was performed to provide
evidence of criterion validity. As expected, the
General Self-Efcacy Scale scores predicted past
success in vocational educational and military
goals among veterans on a Veterans Administration
Medical Center Chemical Dependency Unit. Social
Self-Efcacy Scale scores were negatively
correlated with numbers of jobs quit and number
of times red.
Sensitivity/responsiveness to change. Unknown,
but is designed to measure a trait so is expected to
be stable.

Although scale is labeled as a self-efcacy
scale, the title of the instrument may be
Brady
misleading. Rather than the domain or behavior

specic condence usually referred to as selfefcacy, the authors developed the SES based on
the premise that mastery experiences would
generalize across situations or behaviors, and they
assumed it would measure a stable trait. The types
of items included however (initiation or
persistence of behavior, willingness to expend
effort) are reective of self-efcacy theory.
The SES is composed of 2 subscales, one
tapping a non-situation specic sense of
competence, the other tapping competence in
social situations. Although the 2 sets of items are
intertwined into a single measure, all psychometric
work is reported by subscale and there does not
appear to be good rationale to combine them; they
could easily be 2 separate measures of general
perception of competence, similar to mastery, and
a domain-specic measure related to social
situations.
Preliminary validation work is unlikely to
generalize because it was conducted with patients
in a Veterans Administration Medical Center
addictions unit. This sample is not likely to be
representative.
Reference
1. (Original) Sherer M, Maddux JE, Mercandante B,
Prentice-Dunn S, Jacobs B, Rogers RW. The SelfEfcacy Scale: construction and validation. Psychol
Rep 1982;51:66371.
Construct/content
Rheumatoid Arthritis SelfEfcacy Scale (RASE)
Parents Arthritis SelfEfcacy Scale (PAS)
Perceived ability of parents to

manage childs arthritis
symptoms or ability to
participate in selected
activities
Specic beliefs about ability to
perform dened arthritisspecic self-management
behaviors
Generalized competence beliefs
and beliefs about competence
in social situations. Not
arthritis specic
Arthritis Helplessness Index General belief/perceptions

(AHI)/Rheumatology
about ability to control
Attitudes Index (RAI)
arthritis (AHI) or condition
(RAI)
Arthritis Self-Efcacy Scale Specic beliefs that the
(ASES)
individual could perform
specic behaviors or achieve
results to cope with the
consequences of arthritis
Childrens Arthritis SelfArthritis-specic beliefs about
Efcacy Scale (CASE)
ability to manage or control
aspects of life with juvenile
arthritis
Generalized Self-Efcacy
Perceived coping competence
Scale (GSES)
or generalized condence in
ability to cope across a range
of demanding situations and
setbacks. Not arthritis
specic.
Mastery Scale
Personality characteristic; the
extent to which people see
themselves as being in
control of forces that affect
their lives. Not arthritis
specic.
Multi-Dimensional Health
Generalized expectation of
Locus of Control Scale
control over reinforcement in
(MHLC)
relation to health. Not
arthritis specic.
Measure/scale
Total 28
Scored by subscale. Total 23; Subscales

General efcacy 14 General 17, Social 6
238
Social Efcacy 684
Total score range

28140
Scored by subscale Total 18 (6 on each

6-item subscale
subscale)
(636)
Two forms can be
If 2 forms combined
combined for 12 item
for 12-item
subscales
subscales (1272)
Scored by subscale Total 14; 7 on each
Score range 749 on
subscale
each subscale
Not published.
I believe I could. . .
How certain are you

that you can. . .?
Not stated
How strongly do you

agree or disagree
with these
statements about
yourself?
Varies by Likert
scale used
4-point scale (428)
5-point scale (535)
7-point scale (749)
I can nd ways to. . .
Rate how true. . .
Total 7
Response format
14-point Likert
Scale; strongly
disagree to
strongly agree
5-point Likert Scale

strongly agree to
strongly agree.
7-point scale, very

uncertain to
very certain
6-point Likert scale;

1 strongly
disagree, 6
strongly agree.
Not provided;
investigators have
used 4-, 5-, and 7point Likert
scales.
4-point scale 1
not at all true, 4
exactly true
90-point scale, in
increments of 10.
10 very uncertain,
100 very
certain
5-point scale 1
not at all sure, 5
very sure.
Describe how you feel Likert scale, strongly

about the
disagree to
statement.
strongly agree
Item stem
Total 20; Subscales Pain 5, How certain are you

Function 9, Other
that you can. . .?
symptoms 6
Total AHI/RAI 15;

Helplessness 5
Internality 7
No. of items
Scored by subscale Total 11; Subscales:

Activity 4, Symptoms 4,
Subscale means 15
Emotion 3
Subscale standard
scores 010
Total score: 1040
Total 10
AHI/RAI total score

1560 AHI/RAI.
Helplessness score
530
Scored by subscale
Each subscale score
10100
Measure outputs
Summary Table for Self-Efcacy, Helplessness, Mastery, and Control Measures
Written
Written
Written
Written
Written
Written
Written
Written
Written
Method of
administration
Not reported
estimated 10
minutes
Estimated 10
minutes
Estimated 3
minutes
Estimated 35
minutes per
form
Not reported,
estimated 2
minutes
Estimated 3
minutes
Estimated 5
minutes
Total 3 minutes
5-item
subscale 1
minute
Not reported,
estimate 5
minutes
Time for
administration

S163
Individuals with physiciandiagnosed rheumatoid arthritis

Swedish; Spanish translations.
Participants in community-based
arthritis education.
Swedish, Norwegian, Spanish
translations.
Children with juvenile arthritis
(ages 717)
Participants in community-based
arthritis education in UK.
English adaptation of original
German scale. Also in
Spanish, Chinese, Indonesian,
Japanese, and Korean.
Working-age adults, Chinese,
Czech, Dutch, German,
Hebrew, Vietnamese, Spanish,
Swedish translations.
Adults, Spanish translation
Mothers and fathers of children

with juvenile arthritis
Individuals with rheumatoid

arthritis involved in medical
center-based self management
programs in the UK
Chemically dependent veterans
being treated at a Veterans
Administration Medical Center
Arthritis Helplessness Index

(AHI)/Rheumatology
Attitudes Index (RAI)
Arthritis Self-Efcacy Scale

(ASES)
Generalized Self-Efcacy
Scale (GSES)
Multi-Dimensional Health
Locus of Control Scale
(MHLOC)
Parents Arthritis SelfEfcacy Scale (PASE)
Rheumatoid Arthritis SelfEfcacy Scale (RASE)
Mastery Scale
Childrens Arthritis SelfEfcacy Scale (CASE)
Validated populations
Measure/scale
Internal consistency
General selfefcacy very
good.
Social self-efcacy
good.
Test-retest excellent
Internal
consistency fair
Internal
consistency, by
subscale excellent
Internal
consistency: good
to very good
Fair
Preliminary,
Internal
consistency:
excellent
Internal
consistency:
excellent, testretest good
Excellent
Good for all

variants
Reliability
Fair
Preliminary evidence
acceptable
acceptable
Acceptable
Not reported
Good
Preliminary, very
good
AHI very good, AHIHelplessness very

good, RAI fair, RAI
helplessness fair
Good
Validity
Responsiveness
Unknown, designed as a
trait measure so expected
to be stable
acceptable
Not reported
Not reported
Unknown; designed as a
to be stable
Unknown; designed as a
to be stable
Unknown
Unknown
AHI good, AHI-Helplessness

good, RAI unknown, RAI
helplessness: unknown
Psychometric properties
Early measure (1982) that has not been used

frequently. Contrary to self-efcacy theory,
attempts to measure self-efcacy as a trait,
which makes it closer to mastery. Measure
combines general estimate of competence
with measure of competence in social
situations. Limited validity data available.
Minimal psychometric information in the

literature, yet the measure has been widely
used. Lack of standardized scoring
information makes it difcult to compare
across studies.
Used to measure expectations about control
over health; some debate as to need to
divide external locus of control into chance
and powerful others.
Modeled after ASES. Reason for combining
these two subscales into a single measure is
not clear; preliminary data show modest
validity for psychosocial subscale, very few
signicant correlations for symptom
subscale.
Promising measure of self-management
behavior-specic self-efcacy; has had little
use in the literature.
In contrast to title of scale, this is a measure of

perceived competence to cope with difcult
situations and is assumed to be a stable trait.
Most widely used measure of situation-specic

beliefs used in arthritis research. Additional
validation would be helpful. Subscales can
be used independently.
New scale with small amount of preliminary
data; too early to judge
RAI and RAI helplessness scale more

frequently used; AHI may have stronger
psychometric evidence
Comments
S164
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Arthritis & Rheumatism (Arthritis Care & Research)

Vol. 49, No. 5S, October 15, 2003, pp S147S164

MEASURES OF PSYCHOLOGICAL STATUS AND WELL-BEING

Measures of Self-Efcacy, Helplessness,

Helplessness Subscale (2), the 15-item

evaluated for cross-cultural equivalence (5). RAI

Score range. For all versions, higher scores

Self-Efcacy and Helplessness

AHI helplessness subscale. Internal consistency

ineffectiveness. Changes in the full scale were

Comments and Critique

demonstrated to be more conceptually clear and to

ARTHRITIS SELF-EFFICACY SCALE

Self-Efcacy and Helplessness

conditions, including lupus, bromyalgia,

Validity. No gold standard is available to

Comments and Critique

had no psychometric work done so it is impossible

CHILDRENS ARTHRITIS SELFEFFICACY SCALE (CASE)

Developer/contact information. Julie Barlow,

Training to interpret. None.

Self-Efcacy and Helplessness

scores for the 3 subscales: Activity, mean 3.21 (SD

Comments and Critique

GENERALIZED SELF-EFFICACY SCALE

to be relatively stable over time and domains of

status. GSES was also signicantly associated with

Comments and Critique

Self-Efcacy and Helplessness

Time to administer/complete. Unknown,

Cost/availability. Items available in literature,

widely used and translated into multiple languages

Comments and Critique

MULTI-DIMENSIONAL HEALTH LOCUS

Form C of the MHLC was created for both

Self-Efcacy and Helplessness

Populations. Developmental/target. Designed for

Comments and Critique

PARENTS ARTHRITIS SELF-EFFICACY

Self-Efcacy and Helplessness

Construct validity. Validation was demonstrated

Comments and Critique

Norms available. No; but mean scores are

Reliability. Internal consistency reliability via

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

Purpose. The Rheumatoid Arthritis Self-Efcacy

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

Developer/contact information. Sarah Hewlett,

Comments and Critique

Self-Efcacy and Helplessness

title of the RASE may be misleading. Rather than

Populations. Developmental/target. Instrument

SELF-EFFICACY SCALE (SES)

Time to administer/complete. Not listed,

Subscales. General self-efcacy subscale has 17

Training to score. Not needed, but selected

Comments and Critique

misleading. Rather than the domain or behavior

Self-Efcacy Scale (SES)

Rheumatoid Arthritis SelfEfcacy Scale (RASE)

Parents Arthritis SelfEfcacy Scale (PAS)

Perceived ability of parents to

Arthritis Helplessness Index General belief/perceptions