Abstract
BackgroundSelf-efficacy concerns individuals’ beliefs in their capability to exercise control in specific situations and complete tasks successfully. In people with multiple sclerosis (PwMS), self-efficacy has been associated with physical activity levels and quality of life. As a validated German language self-efficacy scale for PwMS is missing the aims of this study were to translate the Unidimensional Self-Efficacy Scale for Multiple Sclerosis (USE-MS) into German, establish face and content validity and cultural adaptation of the German version for PwMS in Austria. A further aim was to validate the German USE-MS (USE-MS-G) in PwMS.MethodsPermission to translate and validate the USE-MS was received from the scale developers. Following guidelines for translation and validation of questionnaires and applying Bandura’s concept of self-efficacy, the USE-MS was forward-backward translated with content and face validity established. Cultural adaptation for Austria was performed using cognitive patient interviews. Reliability was assessed using Cronbach’s alpha, Person separation index and Lin’s concordance correlation coefficient. Rasch analysis was employed to assess construct validity. Comparison was made to scales for resilience, general self-efficacy, anxiety and depression, multiple sclerosis fatigue and health-related quality of life. Data were also pooled with an historic English dataset to compare the English and German language versions.ResultsThe translation and cultural adaptation were successfully performed in the adaptation process of the USE-MS-G. Pretesting was conducted in 30 PwMS, the validation of the final USE-MS-G involved 309 PwMS with minimal to severe disability. The USE-MS-G was found to be valid against the Rasch model when fitting scale data using a bifactor solution of two super-items. It was shown to be unidimensional, free from differential item functioning and well targeted to the study population. Excellent convergent and known-groups validity, internal consistency, person separation reliability and test-retest reliability were shown for the USE-MS-G. Pooling of the English and German datasets confirmed invariance of item difficulties between languages.ConclusionThe USE-MS-G is a robust, valid and reliable scale to assess self-efficacy in PwMS and can generate interval level data on an equivalent metric to the UK version.Trial registrationISRCTN Registry; ISRCTN14843579; prospectively registered on 02. 01. 2019.
Highlights
Self-efficacy concerns individuals’ beliefs in their capability to exercise control in specific situations and complete tasks successfully
Phase 1 The prefinal USE-Multiple Sclerosis (MS)-G resulted from a forwardbackward translation procedure
Some differences were detected between the English and Austrian cultures relating to this scale
Summary
Self-efficacy concerns individuals’ beliefs in their capability to exercise control in specific situations and complete tasks successfully. Multiple Sclerosis (MS) is a chronic demyelinating disease of the central nervous system, with accumulating disability and loss in quality of life [1]. It appears relevant for people with MS (PwMS) to preserve their autonomy, despite functional limitations and an unpredictable disease course. Self-efficacy is not related to people’s level of functioning or their skills but rather their judgement of what can be achieved [2] This implies that PwMS who are confident in their ability to master challenges and reach their goals may cope with the disease more effectively. Higher levels of self-efficacy may enhance people’s motivation to be physically active as there is a strong relationship with health promoting behaviour and perceived quality of life in PwMS [3]
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