Patient Experience and Self-Efficacy Instruments
Measures of confidence in self-management, involvement in decisions, and patient-reported outcomes across conditions.
This group measures what the patient brings to their own care rather than what the disease does to them. Self-efficacy scales such as the Self-Efficacy for Managing Chronic Disease Scale, the Chronic Disease Self-Efficacy Scale, the General Self-Efficacy Scale, the Pain Self-Efficacy Questionnaire and the Return to Work Self-Efficacy Scale measure confidence in being able to do specific things. Confidence predicts behaviour better than knowledge does, which is why it is measured separately from education.
The Observing Patient Involvement in Decision Making instrument measures something different again: it is scored by an observer on the clinician's behaviour during a consultation, not on the patient. PROMIS sits apart from everything else here as a calibrated item bank system rather than a fixed questionnaire.
Patient experience instruments in this library
How these instruments are used
Self-efficacy is domain specific, and this is the most common error in using these instruments. Confidence in managing diabetes does not transfer to confidence in managing pain, and general self-efficacy predicts specific behaviours weakly. Choose the scale that matches the behaviour the intervention targets, and expect a general scale to show little movement even when a targeted intervention works.
PROMIS requires a decision that other instruments do not. It can be administered as a fixed short form or as a computer adaptive test, and the two produce scores on the same metric but with different precision and different numbers of items. The choice affects burden and sensitivity and has to be made and recorded at design time, because a study cannot mix them freely and still compare timepoints.
What to check before you choose one
Check that the self-efficacy scale matches the target behaviour. If it does not, the study will measure the wrong confidence.
Check who the instrument is scored on. The Observing Patient Involvement in Decision Making instrument scores the clinician, which means it needs a consultation recording or an in-room observer, and consent from both parties.
Be careful about interpreting these scores as outcomes in themselves. Self-efficacy is usually a mediator, meaning it explains how an intervention worked rather than showing that it worked. A study whose only positive finding is a rise in self-efficacy has evidence about mechanism and not about benefit, and should say so.
Common questions
Is self-efficacy general or specific?
Mostly specific. Confidence in one domain predicts behaviour in that domain and transfers poorly to others. Use a scale matched to the behaviour the intervention targets rather than a general measure.
What is the difference between a fixed short form and a computer adaptive test in PROMIS?
Both place scores on the same metric. A short form asks the same items of everyone; an adaptive test selects items based on previous answers, which gives similar precision from fewer questions. Choose one at design time and keep it, because switching changes the measurement properties.
Who completes the shared decision making instrument?
An observer, not the patient. It rates the clinician's behaviour during the consultation, so it needs either a recording or an in-room observer, and consent from clinician and patient.
Can self-efficacy be a primary endpoint?
It can, but be clear about what that claims. Self-efficacy usually functions as a mediator that explains how an intervention worked. A rise in confidence without a change in the clinical outcome is evidence about mechanism, not about benefit.
