Patient Version Self-Care of Chronic Illness Inventory V4c (English)
Authored By
Tiny Jaarsma
Email: tiny.jaarsma@liu.se
Anna Stromberg
Email: anna.stromberg@liu.se
Barbara Riegel
Email: briegel@nursing.upenn.edu
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SC-CII version 3b after discussion with NL group administering the instrument 4/2022
SELF-CARE OF CHRONIC ILLNESS INVENTORY v.4c
All answers are confidential.
Think about how you have been feeling in the last month as you complete this survey.
SECTION A:
Listed below are common self-help behaviors that people with a chronic illness may do. How
often or routinely do you do the following?
Never Rarely Sometimes Often Always
1. Make sure to get enough sleep? 1 2 3 4 5
2. Try to avoid getting sick (e.g., flu shot,
wash your hands)?
1 2 3 4 5
3. Do physical activity (e.g., take a brisk
walk, use the stairs)?
1 2 3 4 5
4. Eat special foods or avoid certain foods? 1 2 3 4 5
5. Keep appointments for routine or regular
health care?
1 2 3 4 5
6. Take prescribed medicines without
missing a dose?
1 2 3 4 5
7. Do something to relieve stress (e.g.,
mindfulness, yoga, music)?
1 2 3 4 5
SECTION B:
Listed below are common things that people with chronic illness monitor. How often do you
do the following?
Never Rarely Sometimes Often Always
8. Monitor your health condition?
1 2 3 4 5
9. Monitor for medication side-effects? 1 2 3 4 5
10. Pay attention to changes in how you
feel?
1 2 3 4 5
11. Monitor whether you tire more than
usual doing normal activities?
1 2 3 4 5
12. Monitor for symptoms?
1 2 3 4 5
SC-CII version 4c after further discussion and cognitive interviews 6/15/2022
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13. Many patients have symptoms due to their health condition or due to the treatment they receive for
it. The last time you had a symptom, how quickly did you recognize it as a symptom of your
health condition?
I never had a symptom. If you check this box, skip to Section D below.
I had a symptom but did not recognize it as a symptom of my health condition
I had a symptom and recognized it as a symptom of my health condition (Circle one)
o Not Quickly
o Fairly Quickly
o Somewhat Quickly
o Moderately Quickly
o Very Quickly
SECTION C:
Listed below are behaviors that people with chronic illness use to control their symptoms.
When you have symptoms, how likely are you to use one of these?
(circle one number for each behavior)
Not
Likely
Somewhat
Likely
Moderately
Likely
Likely Very
Likely
14. Change what you eat or drink to make
the symptom decrease or go away?
1 2 3 4 5
15. Change your activity level (e.g., slow
down, rest)?
1 2 3 4 5
16. Take a medicine to make the
symptom decrease or go away?
1 2 3 4 5
17. Tell your healthcare provider about
the symptom at the next office visit?
1 2 3 4 5
18. Call your healthcare provider for
guidance?
1 2 3 4 5
SC-CII version 4c after further discussion and cognitive interviews 6/15/2022
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(circle one number)
I did not
do
anything
Not Sure Somewhat
sure
Moderately
Sure
Sure Very
Sure
19. Think of a treatment you used
the last time you had symptoms.
Did the treatment you used make
you feel better?
0 1 2 3 4 5
SECTION D: SELF-CARE CONFIDENCE SCALE
In general, how confident are you that you can:
(Circle one number for each statement)
Not
Confident
Somewhat
confident
Moderately
Confident
Confident Very
Confident
20. Keep yourself stable and free of
symptoms?
1 2 3 4 5
21. Follow the treatment advice you have
been given?
1 2 3 4 5
22. Persist in following the treatment even
when difficult?
1 2 3 4 5
23. Monitor your health condition routinely?
1 2 3 4 5
24. Persist in routinely monitoring your
health condition even when difficult?
1 2 3 4 5
25. Recognize changes in your health if they
occur?
1 2 3 4 5
26. Evaluate the importance of your
symptoms?
1 2 3 4 5
27. Do something to relieve your
symptoms?
1 2 3 4 5
28. Persist in finding a remedy for your
symptoms even when difficult?
1 2 3 4 5
29. Evaluate how well a remedy works? 1 2 3 4 5
THANK YOU FOR COMPLETING THIS SURVEY!