Table 1 Salient characteristics of self-care assessment tools
From: Tools for measuring individual self-care capability: a scoping review
# | Tool | Year | Origin | Brief Description | Stage | Target | Items | Time | Completed by | Scoring System |
|---|---|---|---|---|---|---|---|---|---|---|
1 | PULSES [37] | 1957 | USA | Predicts rehabilitation potential, evaluates patient progress & assists in program planning. Components: P = physical condition; U = upper limb functions; L = lower limb functions; S = sensory components (speech, vision, hearing); E = excretory functions; S = mental & emotional status | Rehabilitation | Specific – Chronic illness or disability | 6 | 1.5 min (est.) | Staff, self-reported | System: Ordinal (Normal-Mild-Moderate-Severe) which are given a point score of 1–4. Total Score: 6–24 points; Higher score indicates lower levels of self-care ability |
2 | Barthel Index (BI) [38] | 1958 | USA | Measures functional independence in personal care & mobility. Developed to monitor performance in long-term hospital patients before/after treatment & to indicate the amount of nursing care needed. Completed by a health professional from medical records or from direct observation. Largely replaced by the Modified Barthel Index | Rehabilitation | Specific – In-patients & post-discharge | 10 | 2–10 min | Staff | System: MCQ with ordinal points. Total Score: 0–100 points; Higher score indicates higher level of self-care ability |
3 | Rapid Disability Rating Scale [39] | 1967 | USA | Developed as a research tool to summarize the functional capacity & mental status of elderly long-stay patients. Assesses: ADLs, sensory abilities, mental capacities, dietary changes, continence, medications & confinement to bed | Rehabilitation | Specific- Chronic illness & disability | 16 | 3.2 min (est.) | Staff | System: Ordinal – 4-point Likert scale (1–4). Total Score: 18–72 points; Higher score indicates greater disability |
4 | Physical & Mental Impairment of Function Evaluation (PAMIE) [40] | 1972 | USA | Clinical rating scale of physical, psychological, & social disability in chronically ill, institutionalized elderly patients. Scores ten factors: 1. Self-care, 2. Belligerence, irritability, 3. Mental confusion, 4. Anxiety, depression, 5. Bedfast, moribund, 6. Behavioural deterioration, 7. Paranoia, suspicion, 8. Sensory & motor function, 9. Withdrawn, apathetic, 10. Ambulation | Rehabilitation | Specific—Chronic illness, elderly | 77 | 10–15 min | Staff | System: Mixed – Combination of Y/N questions, ordinal questions. Total Score: 85 points; Higher score indicates lower levels of self-care ability |
5 | Kenny Self-Care Evaluation (KSCE) [41] | 1973 | USA | A clinical rating scale that records functional performance to estimate a patient’s ability to live independently at home or in a protected environment. Intended for use in setting treatment goals & evaluating progress. Limited to physical activities, however the revised version covers 7 aspects of mobility & self-care: moving in bed, transfers, locomotion, dressing, personal hygiene, bowel & bladder &feeding | Management | General | 85 | 25 min | Staff | System: Ordinal – Observed tasks are rated on a 3-point scale (1. “Totally independent” 2. “Requiring assistance or supervision” 3. Or “Totally dependent.” Tasks summed up to give an Activity Score, which are summed up to give a total Categorical Score. Total Score: Categorical score of 0- 4; Higher score indicates higher levels of self-care ability |
6 | McMaster Health Index Questionnaire (MHIQ) [42] | 1976 | CAN | Assesses physical, emotional, & social function. Intended for use in health services evaluation & in clinical research involving outpatients & those living in the community. Includes disability/handicap, life events & the balance between physical, emotional & social coverage | Prevention | General | 59 | 20 min | Self-reported, staff | System: Ordinal – Each question is scored from 0 (extremely poor function) to 8 (extremely good function). Total Score: 0–44 points. Higher score indicates higher level of self-care ability |
7 | Social Functioning Schedule (SFS) Semi structured interview [25] | 1979 | UK | Assesses normal social functioning in patients using semi-structured interview design. Compares social functioning with personal expectations. Includes 12 dimensions: Employment, household chores, contribution to household, money self-care, marital relationship, care of children, patient-child relationships, patient-parent & household relationships, social contacts, hobbies & spare time activities. Covers a patient’s problems in social interaction, role performance & satisfaction. Later developed into the Social Functioning Questionnaire (SFQ) in 1989 [43] | Prevention | General population & patients with psychiatric disorders | 121 | 10–20 min | Staff | System: Visual Analogue Scale – Runs from ‘none’ to ‘severe difficulties. Total points: TBC. Higher score indicates absence of identifiable problems in the 12 tested sections |
8 | Exercise of Self-Care Agency scale (ESCA) [44] | 1979 | USA | Composed of 4 subscales that measure a person’s ability or power to exercise self-care: 1/ an active versus passive response to situations 2/ individual motivation, 3/ knowledge base of the individual 4/ the person’s sense of worth. Responses are summed to obtain a total agency score | Prevention | General | 43 | 4.3 min (est.) | Self-reported | System: Ordinal – 5-point Likert-type. Total points: 0–128 points; Higher score indicates higher level of self-care agency |
9 | Denyes Self- Care Practice Instrument (DSCPI-90) [45] | 1980 | USA | Measures self-care practice or the practice of self-care activities performed by the respondents in meeting their universal self-care requisites. It includes their valuing of health, healthy eating, decision-making capacity, ego strength & feelings. Initial version developed & tested in 1980 with adolescents, several modifications made to the instrument in 1988 & 1990 which make up the current version: DSCPI-90 presented here. Can be used with adolescent & adults | Health promotion & health management | General | 17–22 | 5–10 min | Self-reported | System: Mixed – Respondents are asked to rate questions from 0 (‘none of the time’) to 100 (‘all of the time’). Total Score: 1–100; Higher score indicates higher self-care practice |
10 | Denyes Self-Care Agency Instrument (DSCAI-90) [46] | 1980 | USA | Measures self-care agency or the ability of the respondent to meet their universal self-care requisites. It includes ego strength, valuing of health, health knowledge & decision-making capacity, energy, feelings, attention to health | Prevention | General | 34 | 15–20 min | Self-reported | System: Mixed – Respondents are asked to rate questions from 0 (‘nothing’) to 100 (‘everything’). Total points: Algorithm used to obtain a total score + 6 scale scores; Higher score indicates higher self-care abilities |
11 | Modified Barthel Index (MBI) [47] | 1981 | USA | Extension of the Barthel Index to cover 15 topics. Measure of physical disability widely used to assess activities of daily living in stroke patients or those with other disabling conditions. Translated into over 30 languages | Rehabilitation | Specific – Patients with disabling conditions | 25 | 10–15 min | Staff or an individual familiar with the patient | System: Ordinal– 4-point scale system. Total Scores: 0–100 points; Higher value indicates higher level of self-care ability |
12 | Functional Status Rating System (FSRS) [48] | 1981 | USA | Estimates the assistance required by rehabilitation patients in their daily lives. Covers independence in ADL, ability to communicate, & social adjustment. Includes the following functional states: Self-care, Mobility, Communication, & Psychosocial adjustment Cognitive function | Rehabilitation | General | 30 | 15–20 min | Staff | System: Ordinal – Each question is scored from 1–4 with 0.5 intervals (1: unable, 1.5 maximum assistance, 2: moderate assistance…). Total points: 30–120 points; Higher score indicates higher level of self-care ability |
13 | Perceived Self-Care Agency Questionnaire (PSCAQ) [49] | 1981 | USA | PSCAQ was not appropriate to measure the self-care agency in older people because many items were unclear & incomprehensible to them. Also deemed not appropriate for non-institutionalised patients [50]. Internal consistency assessed by Cronbach’s alpha (Cronbach’s alpha is a measure of internal consistency, that is, how closely related a set of items are as a group) rated negative as not all the factors showed values greater than 0.7 | Prevention | General | 53 | 5.3 min (est.) | Self-reported | System: Ordinal – Each question is scored from 1–5 (1: Never like me, 5: always like me). Total points: 53–265 points; Higher score indicates: Not specified as instrument could not be accessed |
14 | Rapid Disability Rating Scale (RDRS-2) [51] | 1982 | USA | A revised version of the 1967 Rapid Disability Rating Scale. Item definitions sharpened & directions expanded to indicate that ratings are based upon the patient’s performance regarding behaviour, & that prostheses normally used by the patient should be included in the assessment. Addition of 3 items & response items changed from three-point to four-point ratings to increase group discrimination & make the scale more sensitive to changes in treatment | Management | Specific – Disability | 18 | 2 min | Staff or an individual familiar with the patient | System: Ordinal – Each question is scored from 1–4 Total Score: 18–72 points; Higher score indicates greater disability |
15 | Performance Assessment of Self-Care Skills (PASS) [52] | 1984 | USA | A performance-based, criterion-referenced, observational tool designed to assist practitioners in documenting functional status & change & assess everyday tasks necessary for living in the community. Consists of 26 core tasks; 4 functional domains: functional mobility (n = 5) personal self-care (n = 3), instrumental activities of daily living with a cognitive emphasis (n = 14) & those with a physical emphasis (n = 4). Tasks are rated on 3 distinct concepts: Independence, Safety, & Adequacy of outcome. Each concept is scored on a predefined four-point ordinal scale (0–3). Two versions: PASS-Clinic & PASS-Home | Prevention | General | 26 | 10–20 min (est.) | Staff but also self- report (PASS-SR), proxy-report (PASS-PR), & clinical judgment (PASS-CJ) | System: Ordinal – PASS tasks are rated on three distinct concepts: Independence, Safety, & Adequacy of outcome. Each concept is scored on a predefined four-point ordinal scale (0–3). Total Score: Depends on number of tasks are tested (can be adapted to each patient). Highest grades indicate highest independence, safety & adequacy |
16 | Functional Independence Measure (FIM) [53] | 1987 | USA | Assesses physical & cognitive disability by assessing level of care required. Used to monitor patient progress & to assess outcomes of rehabilitation. Used for patients with motor impairment & has been widely adopted by rehabilitation facilities. Components: independence in self-care, sphincter control, mobility, locomotion, communication, cognition | Rehabilitation | General | 18 | 20–30 min | Staff via interview, observation, or telephone interview | System: Ordinal – 1–7 scale. Total Score: 18–126 points; Higher score indicates higher level of self-care ability |
17 | 1988 | USA | Used to permit individuals to express their perceived capacity to care for self. The structural validity of SCI, assessed through principal component analysis (PCA), was rated negative but the internal consistency was positive | Prevention | General | 40 | 4.0 min (est.) | Self-reported | System: Ordinal – Each Q is rated from 1 (very accurate) to 6 (very inaccurate). Total points: 40–240 | |
18 | Appraisal of Self-Care Agency Scale–version A (ASA-A) [31] | 1991 | NL | Two formats of the ASA scale were developed: (1) ASA-A for self-appraisal, & (2) ASA-B for assessment by caregivers. The instrument was translated into many languages, which some changes in number of items. Has been largely replaced by ASA-R | Prevention | General | 24 | 2.4 min (est.) | Self-reported | System: Ordinal – Each question is scored from 1 (total agree) to 5 (totally agree); Total points: 24–120 points; Higher score indicates greater self-care agency |
19 | Short-Form Health Survey SF-36) [56] | 1992 | USA | Indicator of health status for use in population surveys & evaluative studies of health policy. Measures: 1. Physical functioning; 2. Role limitations due to physical health problems; 3. Bodily pain; 4. Social functioning; 5. General mental health (incl. psychological distress & well-being); 6. Role limitations due to emotional problems; 7. Vitality, energy or fatigue; 8. General health perceptions | Prevention | General | 36 | 5–10 min | Self-reported | System: Mixed – Ordinal, Yes/No, MCQ. Total points: 0–100 points; Higher score indicates poorer health status |
20 | EuroQol EQ-5D Quality of Life Scale [34] | 1993 | INTL | Expresses health status in a single index score; intended for use in evaluative studies such as drug trials & policy research. Facilitates cross-national comparisons. Covers five dimensions of health: mobility, self-care, usual activities, pain/discomfort, anxiety/depression | Prevention | General | 5 | 0.5 min (est.) | Self-reported or observer, proxy, telephone interview | System: Ordinal – Each question scored from 1 (none) to 3 (severe) problems. A self-rating of overall health is obtained from an analogue scale (0: worst imaginable health state to 100: best imaginable health state). Total Score: 5–15 points; Higher score indicates lower levels of self-care ability |
21 | Health Promoting Lifestyle Profile II (HPLP II) [57] | 1966 | USA | Measures behaviours in the theorised dimensions of health-promoting lifestyle: 1. Spiritual growth, 2. Interpersonal relations, 3. Nutrition, 4. Physical activity, 5. Health responsibility & 6. Stress management | Prevention | General | 52 | 5.2 min (est.) | Self-reported | System: Ordinal – Each question is scored on an N-S–O-R scale (Never, Sometimes, Often, Routinely) & given a score of 1–4. Total Score: 1–4; Higher score indicates higher frequency of health-promoting lifestyle behaviours |
22 | Strategies Used by People to Promote Health (SUPPH) [58] | 1996 | USA | 29-item self-report is a measure of self-care self-efficacy. 4 factors: coping, stress reduction, making decisions, Enjoying life. Many studies have used it with adult cancer patients but could be used for broader population | Management | General | 29 | 2.6 min (est.) | Self-reported | System: Ordinal – Each question is scored from 1 (very little to do to) 5 (quite a lot to do). Total score: 29–145 points; Higher score indicates higher level of self-care practice |
23 | Self-Care Ability Scale for the Elderly (SASE) [59] | 1996 | SW & FIN | Assess goal care, environment care & repertoire care over 7 factors: ADLs, mastery, well-being, volition, determination, loneliness, dressing. Reflects a person’s intention to do certain things of importance for the care of capacity | Rehabilitation | Specific – Elderly | 17 | 5.3 min (est.) | Self-reported | System: Ordinal – Each question is scored from 1 (completely disagree) to 5 (completely agree). Total points: 53–256 points; Higher score indicates higher level of self-care ability |
24 | Quality of Well-Being Scale (QWB) [60] | 1996 | USA | Summarizes current symptoms & disability in a single number that represents a judgment of the social undesirability of the problem. Intended for use as an outcome indicator & estimation of present & future need for care. Classifies level of functioning in the following dimensions: Mobility & confinement (e.g., in hospital or institution); Physical activity, ambulation, social activity, (includes work, housekeeping), & self-care | Prevention | General | 71 | 10–20 min | Structured interview or self-reported | System: Mixed. Combination of yes/no questions & Likert-type scales. Total points: Scoring is completed using a proprietary algorithm & expressed it in terms of quality-adjusted life years (QALYs) |
25 | 1998 | NOR | Assesses self-care capability in the elderly on an ongoing basis either at home or in institutions. Original scale published in 1986 & revised in 1998. The current scale consists of 56 items covering 13 dimensions & organised in terms of 3 constructs in Orem’s theory (universal self-care, developmental self-care & health-deviation self-care. LSCS covers knowing capabilities, decision-making capabilities, operational capabilities & doing capabilities that enable older persons to stay at home | Prevention | General | 56 | 5.6 min (est.) | Self-reported | System: Ordinal – each question is scored from 1–4 (1: Totally dependent on help, 4: Can manage without help) Total score: 56–224; Higher score indicates higher level of self-care ability | |
26 | Patient Activation Measure (PAM) [61] | 2004 | USA | Measures levels of insight into a range of health-related behaviours & outcomes. Results classified into 4 levels based on score – Level 1: Passive/feel overwhelmed by managing their own health/may not understand their role in the care process; Level 2: May lack the knowledge & confidence to manage their health; Level 3: Appears to be taking action but may still lack the confidence/skill to support their behaviours; Level 4: Adopted many of the behaviours needed to support health but may not be able to maintain them in face of life stressors | Management | Specific – Chronic illness | 22 | 2.2 min (est.) | Self-reported | System: Ordinal. 4-point scale of disagree, disagree, agree or strongly agree. Raw score produced by obtaining an average of all response & converted to activation score which is used to categorise patient into activation level segment (level 1–4. Total score: 100 points; Higher score indicates lower levels of self-care ability |
27 | PAM-13 [19] | 2005 | USA | A shortened 13-item version of the original 22-item PAM which was shown to have similar psychometric properties. Has largely superseded the original PAM & has been translated to several different languages & widely validated | Management | General | 13 | 1.3 min (est.) | Self-Reported | System: Ordinal scale “Disagree strongly, Disagree, Agree, Agree Strongly, N/A”. Total score: 100; Higher score indicates better self-care |
28 | Self-Care of Home-Dwelling Elderly (SCHDE) [30] | 2007 | FIN | A five-subscale measure that assesses: types of self-care; self-care orientation, life satisfaction, self-esteem, & functional capacity | Management | Specific – Elderly | 82 | 8.2 min (est.) | Unknown | System: Ordinal: Most questions scored from 1–5 (1: Totally disagree; 5: Totally agree), functional ability scored from 1–3 (1: I can manage without difficulties) to 3 (I cannot manage independently without difficulties); Total points: 82–410 points |
29 | Therapeutic Self-Care (TSC) [62] | 2014 | CAN | Generic measure of self-care ability in hospital in-patients. Designed to assess perceived ability to engage in self-care at home upon discharge. Assesses: 1. Taking medications as prescribed, 2. Recognizing & managing symptoms, 3. Carrying out activities of daily living, 4. Managing changes in condition | Rehabilitation | Specific – In-patients | 12 | 1.2 min (est.) | Staff | System: Ordinal. Each question is rated from 0 (not at all) – 6 (very much so). Total points: 0–78; Higher score indicates higher level of self-care ability |
30 | Self-Management Screening (SeMaS) [32] | 2015 | NL | Facilitates personalised counselling & support for self-management in patients with chronic diseases in primary care. 27 items measuring the psychological constructs self-efficacy (n = 2), coping (n = 6) depression (n = 3), anxiety (n = 4) & locus of control (n = 2). The construct of social support includes 5 items & the perceived burden of disease is 1 item. Three other items that guide the type of support concerned computer skills, functioning in groups & willingness to perform self-monitoring | Management | Specific – Chronic diseases | 27 | 2.7 min (est.) | Staff | System: items are scored from 0 to 4 & summed. The perceived burden of disease is scored on a visual analogue scale from 0 to 10. For coping, depression & anxiety, all responses from ‘often’ to ‘always’ are scored as 2. Item 7 is inversely scored |
31 | Appraisal of Self-Care Agency Scale – Revised (ASA-R) [29] | 2017 | SPN | A revised version of the original 24-item ASA scale & the 12-item Short Form Health Survey (SF-12) that assesses self-care capacity | Prevention | Specific – Elderly | 15 | 15 min | Self-reported | System: Ordinal – Questions rated in a 5-point Likert scale. Total points: 15–75 points; Higher score indicates better self-care agency |
32 | Mindful Self-Care Scale (MSCS) [63] | 2018 | USA | Intended to help identify areas of strength & weakness in mindful self-care behaviour as well as assess interventions that serve to improve self-care. Assesses: physical care, supportive relationships, mindful awareness, self-compassion & purpose, mindful relaxation & supportive structure | Prevention | General | 42 | 4.2 min (est.) | Self-reported | System: Likert scale of 1–5. Consists of 33 scale items, 6 clinical, & 3 general assessing global practices of self-care. Total points: 42–210 points; Higher score indicates higher frequency of health-promoting lifestyle behaviours |
33 | Self-Care of Chronic Illness Inventory (SCCII) [36] | 2018 | INTL | Measures self-care maintenance, management, & confidence in chronic illness patients, defined as those with a permanent or recurring condition lasting more than 3 years that significantly affects well-being & requires daily & consistent health care management. Based on the Middle Range Theory of Self-Care of Chronic Illness, with 3 separate scales measuring Self-Care Maintenance, Self-Care Monitoring, & Self-Care Management | Management | Specific – Chronic illness | 30 | 3.0 min (est.) | Self-reported | System: Likert 1–5 scale (1: Never to 5: Always) Total points: 0–100 points (standardised score); Higher score indicates better self-care Depends on version |
34 | Consumer Health Activation Index (CHAI) [64] | 2018 | USA | Examines knowledge, self-efficacy, motivation & beliefs, activity & locus of control. Can be used to assess health activation among adults, including those with limited health literacy | Management & prevention | General | 10 | 1.0 min (est.) | Self-reported / Staff | System: 1–6-Likert scale (1: strongly disagree to 6 > strongly agree) Total points: 0–100 (obtained through linear regression from the initial 10–60). Higher score indicates higher activation |
35 | Making it CLEAR (MiC) questionnaire [26] | 2021 | UK | Multidimensional measure of resilience for use with older adults at the point of discharge from hospital. 34 items assess individual determinants of resilience (IdoR, 21 items) & environmental determinants of resilience (EdoR, 13 items). IDoR contains 6 factors (self-efficacy, values, interpersonal skills, life orientation, self-care ability & process skills). EDoR contains 5 factors (person–environment fit, friends, material assets, habits & family). Items address participants’ perceptions of their self-care, leisure, work, responsibilities, social environment, resources, habits, values, self-efficacy, motor skills, communication skills & process skills | Management | Specific – Elderly | 34 | 3.4 min (est.) | Self-reported | System: Ordinal – Likert 0–3 scale (strongly agree, agree, disagree, & strongly disagree). Total points: IDoR 0–63 / EDoR 0–39. Higher scores indicate higher individual determinants of resilience |
36 | Self-Care Activities Screening Scale (SASS-14) [35] | 2021 | SPN & COL | Developed during COVID-19 lockdown but could be helpful to address future evaluations & interventions to promote healthy behaviours. Health consciousness as a key component of self-care. 14-item scale with 4 main dimensions: Health consciousness (5 items), Nutrition & Physical Activity (3 items), Sleep quality (2 items), Interpersonal & Intrapersonal coping strategies (4 items) | Prevention | General – lockdown | 14 | 1.4 min (est.) | Self-reported | System: Ordinal – Likert 1–6 scale (never, very rarely, rarely, occasionally, very frequently, always). Total points: 0–63; Higher score indicates higher frequency of self-care activities performed by individuals |
37 | Self-Care Self-Efficacy (SCSE) Scale [65] | 2021 | USA | A 10-item scale that measures confidence in the ability to self-care. Developed as a self-report single domain scale to measure self-efficacy in self-care maintenance (action to maintain physiologic stability), selfcare monitoring (actions to track behaviour, detect & interpret changes in signs & symptoms), & self-care management (actions to recognize a change in health & address the process to reverse an illness exacerbation) | Prevention & management | General | 10 | 1.0 min (est.) | Self-reported | System: Ordinal – 5-point Likert scale (1 = not confident, 5 = extremely confident). Total points: 10–50; Higher score indicates higher level of self-efficacy to self-care |
38 | Self-Care Inventory (SCI)– Patient Version [33] | 2022 | ITA | The SCI has 20 5-point Likert items & 3 separate scales: (1) self-care maintenance (8 items) which addresses those activities aimed at maintaining the best possible health status through health promoting practices; (2) self-care monitoring (6 items) which reflects body listening with awareness of symptoms & bodily changes; (3) self-care management (6 items) which comprises those actions aimed at controlling or managing said symptoms & changes | Prevention | General | 20 | 2.0 min (est.) | Self-reported | System: Ordinal: 5-point Likert scale (1 = never, 5 = always). Total points: 20–100; Higher score indicates higher level of self-care |