Date Presented 03/28/20
Although there are various measurements of self-efficacy, most of them are disease-specific or not specifically aimed at measuring symptom management. PROMIS self-efficacy can examine the current level of confidence in managing symptoms for patients with chronic conditions. We used Rasch analysis to examine the psychometrics of the PROMIS self-efficacy for managing symptoms. Clinicians can evaluate their patients’ self-efficacy for symptom management and provide evidence-based treatments.
Primary Author and Speaker: Jaewon Kang
Contributing Authors: Sergio Romero
BACKGROUND: Managing chronic diseases, which are long-lasting conditions, is one of the most challenging goals of occupational therapy. These chronic conditions could change individuals’ self-efficacy. Individuals with chronic disease should manage daily symptoms that affect the quality of life. Instruments for measuring self-efficacy is an essential indicator in occupational therapy to predict health outcomes such as hospital admission or health-related quality of life. Although there is a variety of measurement of self-efficacy, most of them are disease-specific or not specifically aimed to measure symptom management. The self-efficacy for managing symptoms is necessary to occupational therapists since one of the goals of occupational therapy is focusing on symptom management and client-centered approaches to help patients return to community or work. Self-efficacy for managing symptoms is a patient’s subjective experience. The patient-reported outcome is more efficient in measuring an individual’s self-efficacy for symptom management because patients report on their self-efficacy for managing symptoms earlier and more frequently than clinicians who fail to detect the patients’ self-efficacy. The Patient-Reported Outcome Measurement Information System (PROMIS) self-efficacy for managing symptom is the only one that measures behavior-specific self-efficacy for managing chronic disease. In this regard, the validation of PROMIS self-efficacy for managing symptoms is required for occupational therapists who are well suited to helping the patients’ symptom management at all stages of illness.
PURPOSE: Before using a measurement in occupational therapy practice, an examination of its characteristics is recommended. The purpose of this study is to investigate the psychometrics of the PROMIS self-efficacy for managing symptoms.
METHODS: A total of 1,087 participants were recruited from the University of Maryland Neurology Ambulatory Center (n=837) and through Op4G, a private online research panel company (n=250). Participants had to be 18 years or older, reside in the community, and diagnosed with chronic neurologic disorders. All participants completed the PROMIS self-efficacy for managing symptoms. Rasch analysis was used to investigate the psychometric properties of the rating scale, item fit, and reliability. The interaction between item difficulty and person ability was examined as well as the separation reliability.
RESULTS: The 5-category rating scale structure was appropriate. The item difficulty of the 28 items ranged from -0.89 to 0.9 logit. Item 4 and 13 were misfit items which might be poorly written or may represent a construct different from the remaining construct. However, it was not serious, so we decided not to delete the questions. The mean person ability (1.05 ± 0.28 logit) was slightly higher than the mean item difficulty (0.00 ± 0.04 logit). The person separation (3.79) and item separation (11.97) were acceptable with high reliability (person reliability = 0.93 and item reliability = 0.99).
CONCLUSION: This study provides evidence that PROMIS self-efficacy for managing symptoms can be used with acceptable psychometrics. The items in this self-reported measure identify an individual’s challenging situations related to symptom management and reliably measure his/her self-efficacy for managing symptoms. Occupational therapists can evaluate the clients’ level of confidence to manage/control their symptoms in a different setting (home, public place, or unfamiliar place) and to keep symptoms from interfering with work, sleep, relationships, or recreational activities. Clinicians can provide evidence-based treatments with clinical reasoning.
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