Caregiver Self-Efficacy in Contribution to Patient Self-Care Scale – English

CC-Self Efficacy Scale (English)

Adapted by

Ercole Vellone, PhD, RN, FESC

Associate Professor in Nursing Science

Department of Biomedicine and Prevention University of Rome “Tor Vergata”, Via Montpellier, 1 – 00133 Rome, Italy Phone + 39 06 72596802 Fax + 39 0672596961 Mobile + 393387491811 Skype: ercole.vellone email: ercole.vellone@uniroma2.it

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CAREGIVER SELF-EFFICACY IN CONTRIBUTION TO SELF-CARE SCALE

All answers are confidential.

In general, in reference to the person you care for, how confident you are that you can:

(Circle one number for each statement)

	Not Confident		Somewhat Confident		Very Confident
1. Keep the illness of the person you care for stable and free of symptoms?	1	2	3	4	5
2. Follow the treatment plan that have been given to the person you care for?	1	2	3	4	5
3. Persist in following the treatment plan even when difficult?	1	2	3	4	5
4. Routinely monitoring the condition of the person you care for?	1	2	3	4	5
5. Persist in routinely monitoring the condition of the person you care for even when difficult?	1	2	3	4	5
6. Recognize changes in the health of the person you care for if they occur?	1	2	3	4	5
7. Evaluate the importance of symptoms?	1	2	3	4	5
8. Do something to relieve symptoms of the person you care for?	1	2	3	4	5
9. Persist in finding a remedy for symptoms of the person you care for even when difficult?	1	2	3	4	5
10. Evaluate how well a remedy works?	1	2	3	4	5

THANK YOU FOR COMPLETING THIS SURVEY!