SC-CHDI v3 (English)

Translated by

Dr. Barbara Riegel

Steinbright Chair of Gerontology

School of Nursing
Claire M. Fagin Hall 418 Curie Boulevard Philadelphia, PA
19104-4217
briegel@nursing.upenn.edu
Phone 215-898-9927
eFax 240-282-7707

Victoria V. Dickson, PhD, RN, FAHA, FAAN

Director, Pless Center for Research
NYU Rory Meyers College of Nursing
433 First Avenue
New York, NY 10010
p +1 212 998 5300
e vdickson@nyu.edu

SELF-CARE OF CORONARY HEART DISEASE INVENTORY

(SC-CHDI V3)

All answers are confidential.

Think about how you have been feeling in the last month as you complete these items.

SECTION A:

Listed below are common instructions given to persons with heart disease. How routinely do you do the following?

Never or rarely

Sometimes

Always or daily

1. Keep appointments with your healthcare provider?

1

2

3

4

5

2. Take aspirin or other blood thinner?

1

2

3

4

5

3. Do something to relieve stress (e.g. medication, yoga, music)?

1

2

3

4

5

4. Do physical activity (e.g. take a brisk walk, use the stairs)?

1

2

3

4

5

5. Take prescribed medicines without missing a dose?

1

2

3

4

5

6. Ask for low fat items when eating out or visiting others?

1

2

3

4

5

7. Try to avoid getting sick (e.g. flu shot, wash your hands)?

1

2

3

4

5

8. Eat fruits and vegetables?

1

2

3

4

5

9. Avoid cigarettes and/or smokers?

1

2

3

4

5

Section B:

Listed below are common things that people with coronary heart disease monitor. How often do you do the following?

Never or rarely

Sometimes

Always or daily

10. Monitor your condition?

1

2

3

4

5

11. Pay attention to changes in how you feel?

1

2

3

4

5

12. Check your blood pressure?

1

2

3

4

5

13. Monitor whether you tire more than usual doing normal activities?

1

2

3

4

5

14. Monitor for medication side-effects?

1

2

3

4

5

15. Monitor for symptoms?

1

2

3

4

5

16. Monitor your weight?

1

2

3

4

5

SYMPTOM RECOGNITION:

Many people with heart disease have symptoms of chest pain, chest pressure, burning, heaviness, shortness of breath, and fatigue . The last time you had a symptom …

Have not had symptoms

I did not recognize the symptom

Not Quickly

Somewhat Quickly

Very Quickly

17. … how quickly did you recognize it as a heart symptom?

N/A

0

1

2

3

4

5

SECTION C:

Listed below are actions that people with heart disease use. If you have a symptom, how likely are you to try one of these actions?

Not Likely

Somewhat Likely

Very Likely

18. Change your activity level (slow down, rest)

1

2

3

4

5

19. Take an aspirin

1

2

3

4

5

20. Take a medicine to make the symptom decrease or go away

1

2

3

4

5

21. Call your healthcare provider for guidance

1

2

3

4

5

22. Tell your healthcare provider about the symptom at the next office visit

1

2

3

4

5

Think of a treatment you used the last time you had a symptom of heart disease.
(circle one number)

I did not do anything

Not Sure

Somewhat Sure

Very Sure

23. Did the treatment you used make you feel better?

0

1

2

3

4

5

© Copyright held by Dr. Barbara Riegel