The COPD

Joan

K. Wigal,

Many

Self-Efficacy

Pb D. ; T1monta,

individuals

with

their

ability

regarding
participating

COPD

demands

the

activities
individuals

activity

those

and

situations

elf-efficacy

refers

the
O)Vfl

a1)ility

niines
to)

an

tio)ns

or

with

CO)I)C

in his

Thtms,

which

self-judgments

activities
which

activities

causes

severe

sholrtness
develolp

a lack

dence

regarding

their

ability

to) avoid

i)reathing

This

participating

the
lack

As

patients

niay

daily

in certain

physical

deniamids

of confidence

efficacy.

from

many

tholugh

of engaging

in the

with

COPD

who

may

develop

their

ability

tion.

Thus,

they

activities.

low

are

essary

activity

of

capable
individuals
of 1)reath

disease

experience

inforniation
*Fro)u,

time Departnmemit
W1IS

Lung

enable

su)poIrte(l
I)iseases,

imm I)art
National

Ohio
11)

with

Manuscript

University,

received

requests:

Athens

August

Dr

Wigal,

CSES

to) increase

iii

olfthe

COPD

that

enal)leS

individuals

folllowing

)5ychoIfl1et

assessed:

test-retest

reliability,

study

Self-Efficacy
assessment

(If

COPD

with

dis-

mic properties

of the

reliability,

the

ai1(i

thereby

present

the

afflicteol

The

through

sittmatioms,

internal

dimensiolmiality

the

of

factor analysis.

Subjects

were
were

WhOI

re(rllite(l

referreol

timeraf)ists

I IoI\vover,
(If

exclmm(led

fronmm

their

having

either

their

cmmditiomm

chron,ic

sent

thanks

directors,

Ohiol.

to l)2mrti(iil2mtt

vithm(lrev

eight

their

imm(livi(hmals

Fromim

these

iii the

sttmd:

Parti(iP;ltimm

failed

retmmrmm

to

(lat2o fom timose eight

immdividmmals isere
Timims, o total of 54 mmmemmamid 48 ssomnemm

stmmdv. these
immdividmmals ramlge(l
in age
(NI = 66.8,
SI) = 8.6).
All subjects
reported

years

to) 85

following:

data;
the
analyses.

of

state

ii) time emitire

1)articil)ated
44

tilV

time

smmilseqmmelmtlv

2Sf) immdividmmals with

(If

lmmmmg assoxiatioln

agreed

1mmadolitiomm,

health.

pIrt)t)s

\Ve

immitiallv

14 immdividmmals
O)OI

1)imysiciamms,

2icrOIsS

124 imidividimals

(lime to)

frommm o groimp
iIv

ilrormchitis,

1121(1heemm

oocim

smmilject

timt olrigimmal

set

40-itemmm

immstructio)ns
for

ertmpim

diagmmo)se(l

for

1)2mrti(ih)otio1ml,

liv

of

colmflpletim)g

or

2(11(1 that

both

siciaII.

mmmoterials

COPI)

amid

s(mmma,

a ph

that

contained

Sel1Ef1icacv

a list

time (hmmestionnaire

a retimrmi,

the

Scale.
,

of

letter

emmvelo)pc.

poIstage-xud

is important.

This

scientists,

phy-

i(lemmtical

1Tmmiversit

I I L 32538

grant

I leart

Athens.

Lung,

froimm the
an(l

Blooxi

Institute.

Reprint

disease;

Twol weeks
after
immdividmmals
co)mnl)leteol
amid retmmrmmed the niaterials
v(. sent
tiiemmm . \o
mmmaileol themim a secomid
set (If mmmaterials that
was

1)ehavio)ral

of PsycholoIg

99:1193-96)

designed

The

were

me-

amid unmiec-

individuals

lo)w self-efficacy

Woltmld

This research
Division
(If

which

1991;

to) institute

in activits

CSES

(If

COPD

instrument

step-iIv-step

in

behavioral

I)erSoIIlmiel

in specific

developnient

colnsistency

arousal,

and

interventions

orders.

frolmu

regarding

a qtmantifiable

respiratory

situations

an

referrals,

COPD

restnctio)n.

Identifying

the

:1,1(1 respiratory

shortness

represents

chronic

care

t1i increase

describes

self-

expectations

health

self-efficacy

to)

as lo)\\

physically

severe

self-efficacy

self-efficacy

I)atieflts

.77),
excellent
.95), and a five-

emotional

pulmonary

The

Scale

other

Time subjects

to) miianage

between

treatniemit

the

(:OPI)

o)r to) avoid 1)reathimig

difficimlty
in certaimi
situations
or during
certain
activities;
this
low self-efficacy
contril)tmteS
to) their
activity
restricdiator

sPecific

he.3

activities

Specifically,

experience

and

niay

some

routine

obstructive

Self-Efficacy

sicians,

however

expressed

intense

to

COPD.

NI mmi 10)1)

diffi-

activity

of lo)\\ self-efficacy;

refrain
even

he

chronic

(r

(Chest

of confi-

activities,

ofthe

may

a result

living,

or

affect,

(CSES)

with

weather/environmental,

factors).

COPD
COPD

Scale

afflicted

l)reath,

(If

COPD

(negative

exertion,

CSES

with

while

situa-

or

individuals

minimal

risk

Self-Efficacy

test-retest
reliability
(Cronbachs
alpha

structure

physical

self-efficacy

will avolid.2

COPD

factor

Scale,

attenipt

COPD
in individuals

has good
consistency

leading

deter-

even

many
ctmlty

to)

or her

oltmtcomiie

will

and

can

iii olrder

a certain

attemiipt

they

a 34-item
self-efficacy

CSES
internal

We

to) Bandtmra,

imiolividtmal

sittmatiomi.

vill

t 1)C50)1i

in

p#{128}
)ple

feel

conviction

deterniine

a person

they

According

the

diffictmlt

Because

of

activity.

behaviors

aI)olmt

not

partly

situations

the
lack

convictiolmis

or not

individuals

to) bring

whether

of efficacy

persolmial

to) the

o)tmtcolnles.

(If

assess

As a result
from many

increase

particular

certain

strength

minimal
This

be.

Ph.D.

developed

while

however

Kotses,

of specific
treatment
interthe patients
self-efficacy
in

whether

execute

produce

of confidence
difficulty

may

consequently

regarding

stmccessfimllv

Harry

D. ; and

of daily
living.
Identifying
situations
with COPD
experience
low self-efficacy
development
to increase

have

a lack

as low self-efficacy.
patients
may refrain

would
allow
the
ventions
designed

Pb

breathing

activities,

of

confidence
may be expressed
of low self-efficacy,
COPD
routine
which

Greer,

develop

to avoid

in certain

physical

L.

Scale*

13; revisiOn
accepted
Departinsnt
of

October

Psychology,

4.5701

Statistical
Two
test-retest

15.

Ohio

reliability
i)etv?(.en

to) time first

set.

?%1(t!U)(l.s
forms

reliailility

(If

reliability
was

the

and

evaluated

first

were
internal
ily

amid second

for

assesse(l
colnsistemmcv

Pearsolmm

reliallilit\:

J)roldmmct-mflolflmelmt

aolmnimmistratio)mms

CHEST/99/5/MAY,1991

Downloaded From: http://journal.publications.chestnet.org/ on 03/19/2015

time CSES:

(If

the

two-week
Test-retest
correlations

CSES.

Cromi-

1193

alpha

iIachs
ofthe

procedure

CSES

alpha

the

represents

comparing

the

the

performed;

first

the

any

mean

to) assess
second

Studemmts

assessed

the

in

colmisistemmcy
rehiallility

a Student

the

of

whether

or

respondents

exertiomi,
breathing

Crommhachs

split-half

analyses,

administratiomms

t-test

change

intermial

possible

alxve

second

the

admimiistratiomms.

all

of

the

to

and

significant

two-week

used

first and

In addition

c()efficients.

ileen

was

for iIoIth

stmch

1-test

was

objects.

there

had

The
ment,

wIt

answers

over

the

the

first

interval.

A factor

Six

analysis

administration

perfolrmed

of the

structure

of

framework

CSES:

was

the

CSES

(a)

from

to

determine

the

folhlolwing

criteria

of factolrs

1;

than

variance

responses

number

greater

total

the

order

The
the

eigenvalues
(If

in

instrument.

for determining

percemitage

(In

to) retaimm

(II) a scree

accounted

fllr;

test;

(d)

and

eluded

(c)

the

stmch

imiter-

pretai)ihity.#{176}

coefficient
between
tions
of the CSES
alpha

was

.95

the
was

for

the

first amid second

r = .77, p< .001

first

administration

Students

t-test

CSES

between

revealed

that

two)

there

were

compolnents

factor

analysis

of these

factors

solution

offered

variance

were

retained

the

meaningfulness

best

of

accounted
Items
that

The

the CSES.
presented

terms

of

factor

of that factor.
If arm
than one factor,
the
for inclusion
simple
struc-

accounted
for 17.87
items
loading
highly
feelings

ofdepression

dysphoria,

labeled
negative
affect,
of the variance.
The 12
factor
are associated
with

extracted,

percent
on this
and

helplessness,

anxiety,

such

as detachment,

incompetence

and

The
tists,

CSES
and

anxious-

tional

factor

arousal,

variance.

acco)unted

Eight

second

extracted,

items

factor.

The

components

ofstrong

excitement,

feelings

labeled

for

obtained

items

arousal

under

of the

loadings

sul)scale

on

or to) manage
patients

10.38
significant

third

percent

factor

of the
loadings.

extracted,

variance,
This

factor

which

had

tion,

was

labeled

factors,

with

l)ehaviors

diet,

techmiiqtmes.

on the

five

factors

omi the

items

version

original

of the

CSES

is

lack

with

physical

1194

Downloaded From: http://journal.publications.chestnet.org/ on 03/19/2015

ability
to) avoid
in certaimi
situations.

sholuld

offer

advice

manage

ignore

their

such
that

prolvided

may not be
or to manage

the

in their

conclude

instructions

scien-

to) assess

repeatedly

they
may

the problem
how to avoid

behavioral

personnel

difficulty

frequently

understamid

advice.

Somedid

patients

to them

not

However,

. #{176}

a lack of knowledge
breathing
difficulty,

(If self-efficacy

to

condi-

about
but a

the

in applying

knowl-

CSES
can be used
to measure
patients
confidence
that they can transform
their
knowledge
into effective
action
to avoid
breathing
difficulty.
In
this respect,
the CSES
may be helpful
in planning
edge.

The

his

or

treatment

self-efficacy
her

breathing
innocuous

successful

items

physicians,

may

physicians

Corrective

for

i.i SSIO)N

patiemits

how

patients

times

intense

accounted

five

Six

care

breathimig

aboltmt

as anger,

and

fear.
The

risk

as improper

loaded

allow

physicians

to) the

represent

such

stress,

often

significantly
0)11 any factor;
thus,
deleted
from the fimial version
of

COPD

individualized

emo-

percent

significant

in this

emotional

ofbeing

imitemise

1 1 .87

this

are

variance.
Three
omi this factor.
The

such

that

health

of

Low
second

will

other

confidence

ness.
The

items
loa(1
were

the

breathing

Dm sc

perceived
first

these

associated

The final 34-item

in the Appendix.

Although

factors

ture.
The

it is
on

nimie

five

from consideration
this interfered
with

influenza;

as

difliculty,

imi Table

did not
six items

in-

infections

highly

loadings

improper

34 CSES

presente(l

CSES
these

of the total
variance.
of .40 or greater
omi one

retained
as members
significantly
on more

item was eliminated

in a factor
because

in

clusters.

amid

and

(If

are

to) breathimig

The

for,9 only five

the five-factor

interpretability

item

lead

Also

with

behavioral

percent

7.23

were

olvereatimig,

significance,
test,5 amid the

becaimse

for 57.40
percent
obtained
loadings

factor
were
item loaded

Although

accounted

for

These

temperature

changes.

that

varimax

heavy

factor.

loaded

extracted,

and

significant

to

exertion,

pollution.

such

weather

factor

retained

with
.

infections

with

this
and

colds,

significamit

are

related

lifting

dealing

item

o)1)tained

self-efficacy

was performed
on the CSES
on the CSES
reached
statistical
on Kaisers
criterion,7
the scree
of total

because
fifth

on

item

this

that

(If

and

weather

infections,
that

items

no

the
subjects
perceived
two test administrations.

the

percentage

the

sinus

items

admimiistratiomis

in

A principal
rotation
factors
based

the

exercise,

is an

Coefficiemit

the

as

accounted

.96 for

are

physical

environmental

factor

admninistra.

factor

with

with

with

hypothesized

The

amid internally
correlation

the second
administration
ofthe
CS E S demomistratimig
that the CSES
is imiternally
consistent.
A twol-taileol

differences
between

and

assolciated

The CSES
proved
to) be both reliable
consistent.
The Pearson
prodtmct-momemit

this

significantly

associated

in this

factor
RES U LTS

stairs,

loaded

are

changes

the

factor

climbing

items

for

in

associated

fourth
factor
extracted,
weather/environaccounted
for 10.05
percent
of the variance.

items

intermial

provided

items

difficulty

as

CSES

because

past

a patient

situations

acquire

patients

past

learning

occurs

emotional
are

identified
those

via

the

situations

The COPD

property

Self-efficacy

due

situations.

the

individuals

vicarious

persuasion,
Once

(eg,

or activity;

in similar
through

iii

situation

through

verbal

situation

an aversive

difficulties

accomplishments,

creased

generalizes

in a certain

to) a similar

through

self-efficacy

when

experience

difficumlty)

riences,
activities

regimens.

arises

or
problem
CSES,
may
Scale

expe-

through

de-

areas
the

be
(Wiga!,

or

patients

increased
Cree

Kotses)

Table

1 -CSES

Factor

Structure:
Rotation

Factor
17.87

Five

1 : Negative

Percemmt

Factors,

Varimax

through

Affect
the

olf

utilization

\oriance

of
Number

23.

Item

\Vhen

feel

detache(l

Loading

from

procedures

such

or self-management
supervised
training

amid

evervomme

of self-efficacy

breathing

management
The

.80

as systematic

training.
exercises

behaviors

descriptions

behaviors,

and

avoidance

of helpful

support

provided

the

for

difficulty,

information

desensitization

The latter
may include
involving
the successful
self-

therapy.

by the

CSES

may

assist

everything.
27.

\%Then

20.

%7hen

I feel dolwmm olr

I feel helpless.

:32.

\Vhemm there

24.

\Vhemm

.33.

are

depressed.

prolillenis

I experiemice

78

immtime home.

ammxiety:

31

Whemm I feel immco)mpetent.

\Vhemm I experience
the 10155 ofa

21

\\1mtn

or a lolved

1 1.

\Then

6.

\ihen

physician

ways.

.70)

patients

.08

Patients
is high

valued

the

176

or behavioral
scientist
in a miumber
of
the information
may serve
to explain
why
engage
in some
activities
but hot in olthers.
tend to repeat
behaviors
for which
self-efficacy

First,

and

avoid

low. Secomid,

oi)ject

behaviors

for

the information

which

self-efficacy

will provide

is

the physician

Olmie.

I drimmk alcoholic
iwverages.
I feel seximallv immadeqimate
I try to) deny that I have

or impotent.
respiratory

.55
.54
.50

with
they

a basis
believe

.45

be

.41

useful

away

from

for directing
patients
toward
activities
the patient
can perform
successftmlly
and
activities
they believe
the patient
will not

difficumlties.

in l)ed.

16.

\Vhemm

12.

\Vhemm I aiim frimstrated.

ammi lying

2: I mmtemmse Emoltional

Factor

1 1.87

Percemmt

11071)
Number
\Vhen

10.

When

I experiemice

Ilecolnme

enultio)nal

too

8.

Whemm

I hecolmime

\Vimeim

I hlegimm to feel

30.

get me.
\Vhemi
I aiim afraid.

18.

\Vhen

1.

Loathnj.,
.75

\Vhemi

or

upset.

14.

15.

stress

I laugh

mmmcii

.63

excitemiment.

align:

.62
that

sonmeone

is onmt to

57

tired.

tool

Factor

3: Pimvsical

10.38 Percemmt

5.

13.

was

9.

I go

imp stairs

tool

When

I hurry

\hemi

I exercise

or rush
iii

on

.46

of other

populations

.46

gations.

I.oa(ling
.79

fast.

exert

.74
.72

myself.

aroummd.

.59

that

a roslnm

Percent

of

is poorly

Read

how

.53

time

oriammce

Itez
\Vhemm I get an
time fit,,

infectiolmm

Loading
(throl2ot,

sinus,

colds,

During

very

25.

\Vimon

I inn

2.

\Vhen

there

7.

When

I omn around

3.

When

I go) into)

hmolt or

around

((lId weather.

very

polllmmtiolmm.
irm the

is htmmiditv
cigarette
cold

weather

7.23
ltem
Number

5: Behavioral
Percent

102)

psychometric

involve

normative

studies

reliability

investi-

19.

\Vhemm I do) not follow

a proper
When
I breathe
improperly.

Very confident
Pretty
confident

(c)

Somewhat

(d)

Not

very

(e)

Not

at all confident
too

When
upset.

I experience

into

cold

I go up stairs

6.

When

7.

difficulties.
When
I am around

8.

When

I become

try

in the

weather

breathing

to)

a warm

place.

stress

or

becme

have

respiratory

too fast.
deny

that

cigarette

smoke.

amigry.

9.

When

I exercise

10.

When

I feel

distressed

or physically

.64

11.

When

I feel

sexually

12.

When

I am frustrated.

abotmt

exert
my

inadequate

CHEST/99/5/MAV,1991

Downloaded From: http://journal.publications.chestnet.org/ on 03/19/2015

determine

air.

from

emotional

.68
.59

amid

manage

tired.

is humidity

()

below,

you could

confident

4.

5. When

SCALE

confident

.65

Loading
diet.

Factors

I overeat.

(a)

When

.50

SCALE

breathing
difficulty
in that situation.
scale as a basis for your answers:

3.

Variance

item
When

or avoid
following

.68
.64

item

you are that

(b)

SELF-EFFICACY

numbered

there

.59
a warnm

each

I become

air.

Risk
olfthe

26.

28.

(ii

implications

SELF-EFFICACY

When

smoke.
frolm

COPD

When

place.
Factor

have

individual

COPD

2.

.76

etc).

17.

number

may

Additional

may
and

THE

confident

difficulty
Use the

Ito,,,
Number

scores.

CSES

APPENDIX.

4: \Veather/Emmvironnment

10.05

the

a small

which

individual
Ofl the

ventilated.
Factolr

with

the
CSES,
the
reliability
of the

olf

for generalizing
to other
populations.
Also, the reliability
of the CSES
was established
on a group
basis;
therefore,
caution
is needed
in interpreting
results

\4uriamice

Whemm I lift heavy olljects.

\hen
I exercise
or physically

29.

also be
folilowimig

interventioln.

aspects
in that

subjects,

THE

34.

22.

established

wotmld

Exertioln
the

(If

Itenm
\Vhemm

CSES

in self-efficacy

positive
is limited

of self-selected

Ite;im
Number

the

or self-management

research

.47

bIt.

I VeIl or scream.

\hemm I hecolnie

CSES

based
.49

Third,
increases

Despite
the
present
research

It(lfl

1 experience

4.

to perform.
in measuring

an educational

Arousal

time \oriammce

(If

able

myself.
life.

or impotent.

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13.

When

I lift heavy

14.

When

I begin

15.

me.
When

I yell

16.

When

I amn lyimig

17.

Dtmring

very

hot

When

I latmgh

19.

When

I do) not

When

I feel

When

I drink

When

I get

21

22.

flu,

that

someone

is out

to get

or very

cold

weather.

a lot.
follow

a proper

2 OLeary

diet.

beverages.

infection

(throat,

thing.
When

I experience

anxiety.

25.

When

I am

pollution.

26.

When

I overeat.

27.

When

I feel

28.

When

I breathe

29.

When

I exercise

sinus,

colds,

the

detached

from

everyone

and

every-

a loved
When

or rush

around.

Social learning
mc, 1977:79-81
Self-efficacy
and

theory.

Englewood

health.

Behav

Cliffs,

Res

Ther

NJ:
1985;

RM,

exercise
3:223-42
4 Mertens
therapy

Atkins

CJ.

compliance

Specific

efficacy

in patients

PJ, Shephard
for chronic

with

RJ, Cavanaugh
obstructive

expectations

COPD.

lung

mediate

Health

Psy

T. Long-term
disease.

1984;

exercise

Respiration

1978;

35:96-107

5 American
around
down

Thoracic
Society. Standards
for the diagnosis
and care
with chronic obstructive
pulmonary
disease (COPD)
and asthma.
Am Rev Respir Dis 1986; 136:225-49
6 Cronbach
U. Coefficient
alpha and the internal
structure
of
tests. Psychometrika
1951; 16:297-334
7 Kaiser
HF. The varimax
criterion
for analytic
rotation in factor
ofpatients

or depressed.

improperly.
in a room

analysis.

that

is poorly

venti-

8 Cattehl

Behav
9 Dillon

lated.

32.

A.

3 Kaplan

alcoholic

24.

When

incompetent.

23:437-51

helpless.
an

AB.

Prentice-Hail,

I feel

I hurry

REFERENCES

When

31

I feel

When

1 Bandura

etc).

When

When

34.

in bed.

23.

30.

33.

or scream.

18.
20.

objects.

to feel

I am afraid.
I experience

the

loss

of a valued

object

one.
there

or

Sons,

problems

in the

home.

1196

Downloaded From: http://journal.publications.chestnet.org/ on 03/19/2015

asthma

The

1958;

scree

test

Res 1966; 1:140-61

WR, Goldstein
M.

analysis:

10 Tobin
are

Psychometrika
RB.

methods

and

for

23:187-200

the

number

Factor

applications.

of factors.

analysis.
New

In:
York:

Multivar
Muitivariate

John

Wiley

&

1984:53-99

DL,

Wigal

self-efficacy

JK, Winder
JA, Holroyd
KA, Creer
scale.
Ann Allergy 1987; 59:273-77

The COPD

Self-efficacy

Scale

(Wiga!,

TL. The

Cree

Kotses)