SELF-EFFICIENCY MEASUREMENT INSTRUMENTS FOR INDIVIDUALS WITH CORONARY DISEASE: validation of the Cardiac Self-Efficacy Scale for the Brazilian population and a systematic review
Self-efficacy. Coronary artery disease. Acute coronary syndrome. Validation study. Psychometry. Surveys and questionnaires.
STUDY 1: Objective: Perform the translation, cross-cultural adaptation and psychometric analysis of the Cardiac Self-Efficacy Scale (CSES) for the Brazilian population. Methods: This is an exploratory methodological study, approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte - Faculty of Health Sciences of Trairi (UFRN/FACISA) under opinion 4,765,082. The translation and cross-cultural adaptation took place through the stages of translation into Brazilian Portuguese, synthesis of translations, reverse translation, synthesis of translations, review by a multidisciplinary committee of specialists and application in a pre-test group, formed by participants who represented the target population . Psychometric properties were investigated through tests for reliability, construct, structural, discriminant, concurrent and convergent validity. Results: Considering the cognitive breakdown showed a good comprehension index (CVI > 0.90), Cronbach's alpha was 0.83; the Kaiser-Meyer-Olkin test (KMO=0.72) and the Barlett test of sphericity (X2=426.82; p=<0.001) indicate adequate data adjustment, allowing the performance of exploratory factor analysis; the results of the confirmatory factor analysis of the Brazilian version of the CSES (X2=33.85; Degrees of Freedom (df)=62, X2/df = 0.54; p-value = 0.99; Comparative Fit Index (CFI)= 1.00; Tucker-Lewis Index (TLI)= 1.09; Root mean square error of approximation (RMSEA)=0.00) indicate that the model was saturated and the fit was perfect; the convergent validity showed weak and moderate correlations with the domains of the quality of life scale (SF-36): Functional capacity (65, IQ 35-80; ρ=0.358; p=0.003), Physical aspects (100, IQ 25- 100; ρ=0.378; p=0.002), Pain (62, IQ 41-74; ρ=0.303; p=0.014), General health status (47, IQ 37-62; ρ=0.412; p=0.001), Vitality (85, IQ 75-105; ρ=0.415; p=0.001), Social aspects (75, IQ 50-100; ρ=0.358; p=0.003), Emotional aspects (100, IQ 33-100; ρ=0.320 ; p=0.009) and Mental health (36, IQ 28-48; ρ=0.493; p=<0.001). For discriminant validity, weak correlation with level of anxiety and depression (HAM-D) (10, IQ 5-18; ρ=-0.277; p=0.026) and moderate for number of symptoms (3, IQ 1-4; ρ= -0.449; p=<0.001) and symptomatic level (2, IQ 1-3; ρ=-0.590; p=<0.001). The concurrent validity was considered weak in the correlation with general perceived self-efficacy (31.38±7.01; ρ=0.260; p=0.036). Conclusion: The Brazilian version of the CSES was adequately translated and cross-culturally adapted and psychometrically valid, due to the construct validity, content and internal consistency presenting values that validate the instrument.
STUDY 2: Objectives: This systematic review aims to evaluate the measurement properties, methodological quality and link the content extracted from the items of the cardiac self-efficacy instruments for individuals with CAD with the International Classification of Functioning, Disability and Health (ICF). Methods: The study was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Consensus Norms for Selection of Health Measuring Instruments (COSMIN). The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO), under registration number CRD42021262613. The following databases were used: MEDLINE (Ovid), Web of Science, EMBASE and PsycINFO. Studies that evaluated the measurement properties of self-efficacy instruments for individuals with CAD were included. No date or language restrictions were applied to the search. Two independent authors were responsible for assessing the eligibility of the studies. The methodological quality of the studies was assessed using the COSMIN RoB Checklist, and the Recommendations Rating, Evaluation, Development was used to assess the quality of each study. In addition, the Modified Grading of Recommendations, Assessment, Development and Evaluation (GRADE) recommended by COSMIN was used to determine the quality of the evidence. Two other authors linked the content of the extracted items with the components of the ICF. Results: A total of 21 studies were included, representing and being grouped into 12 instruments to measure self-efficacy for individuals with CAD. None of the studies presented level of evidence A, since both presented deficiency of information in the evaluation of psychometric properties. The best evaluated instruments with quality of evidence level B were the Barnason Efficacy Expectation Scale (BEES), which presented a low level of content validity, and a high level for structural validity, construct validity and internal consistency; Cardiac Self-Efficacy Scale (CSES), which presented a moderate level for construct validity, and a high level for construct validity, structural validity and internal consistency; Cardiovascular Management Self-efficacy Scale, presented a low level for content validity and internal consistency, and a high level for structural and construct validity; Exercise self-efficacy Scale (ESE), presented a low level for content validity, moderate for structural and construct validities, and high for internal consistency; Self-efficacy for Appropriate Medication Use (SEAMS), with a low level for content and construct validities, and a high level for structural validity and internal consistency. The CSES instrument was the one with the highest number of connections with the ICF components. Conclusion: Instruments classified as level B have potential for use, but require further psychometric studies to strengthen information about measurement properties. With regard to the CIF, we recommend the use of the CSES, as it has a greater number of links.