The Control Attitudes Scale-Revised

Abstract

Perceived control is an individual’s belief that he or she has the resources required to cope with negative events in a way that positively influences their adversive nature (Moser & Dracup, 1995; Thompson, Sobolew-Shubin, Galbraith, Schwankovsky, & Cruzen, 1993). Higher levels of perceived control are associated with lower levels of psychological distress. A number of investigators have demonstrated that anxiety and depression levels are substantially higher and quality of life lower in individuals with low levels of perceived control (Ballash, Pemble, Usui, Buckley, & Woodruff-Borden, 2006; Donovan, Hartenbach, & Method, 2005; Evangelista, Moser, Dracup, Doering, & Kobashigawa, 2004; Thuen & Rise, 2006). Although thought to be a personality characteristic, perceived control is not immutable and can be increased by intervention, the most common of which is education and counseling (Moser & Dracup, 2000; Olajos-Clow, Costello, & Lougheed, 2005). Thus, perceived control is an appropriate topic for nursing and other healthcare researchers, particularly in patient groups with a chronic illness who require a high degree of self-management. As the number of individuals with chronic illnesses increase dramatically worldwide (Strong, Mathers, Leeder, & Beaglehole, 2005), it is particularly important for nurses to understand how to improve their adaptation. The phenomenon of perceived control is important to clinicians caring for patients with chronic illnesses for a number of reasons. First, perceived control is a construct fundamental to nursing and behavioral science and clinical practice. Many interventions, such as education and the provision of information, have at their foundation the goal of increasing perceptions of control in order to improve patients’ emotional adjustment and clinical outcomes (Johnston, Gilbert, Partridge, & Collins, 1992; Moser & Dracup, 2000; Skinner, 1996; Thompson et al., 1993). Second, perceived control moderates the negative impact of emotional distress on clinical outcomes such as post-myocardial infarction complications including recurrent ischemia, reinfarction and malignant dysrhythmias (Moser et al., 2007). Third, despite the importance of perceived control, this mechanism has not been elucidated clearly in many interventions, possibly due to lack of an instrument capable of capturing the construct. The construct of perceived control is particularly relevant to patients with cardiovascular disease. Besides being the number one killer of Americans, coronary heart disease (CHD) is highly prevalent; more than 13 million people have CHD in the United States alone (Rosamond et al., 2007). Of these, more than 7 million are survivors of an acute myocardial infarction (AMI) and it is estimated that 1.2 million will suffer a new or recurrent AMI each year (Rosamond et al., 2007). Other cardiac conditions are equally prevalent. For example, more than 5 million Americans have heart failure (Rosamond et al., 2007). Quality of life, adaptation to the chronicity of cardiac disease and psychosocial recovery from acute cardiac events depends more on psychological than on physical factors (Heo, Moser, Riegel, Hall, & Christman, 2005; Moser & Dracup, 1995). A fundamental construct predicting how successfully patients adapt to cardiovascular conditions is perceived control (Johnson & Morse, 1990). Practical application of the construct in research and clinical practice awaits development of an easily administered, instrument that has evidence of reliability and validity. Accordingly, the purpose of this study was to obtain psychometric support for the Control Attitudes Scale-Revised (CAS-R). The research hypotheses were that the instrument would show evidence of (a) quality of item distributions and their contribution to the scale; (b) internal consistency reliability; and (c) construct validity.