CC-Self Efficacy Scale (English)

Translated 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

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!