title: The European Heart Failure Self-care Behaviour Scale: new insights into factorial structure, reliability, precision and scoring procedure.
abstract: OBJECTIVE
  To evaluate a new factorial structure of the European Heart Failure Self-care Behaviour Scale 9-item version (EHFScBS-9), and to test its reliability, floor and ceiling effect, and precision. To propose a new 0-100 score with a higher score meaning better self-care.
  
  
  METHODS
  A sample of 1192 Heart Failure (HF) patients (mean age 72 years, 58% male) was enrolled. Psychometric properties of the EHFScBS-9 were tested with confirmative factor analysis, factor score determinacy, determining the floor and ceiling effect, and evaluating the precision with the standard error of measurement (SEM) and the smallest real difference (SRD).
  
  
  RESULTS
  We identified three well-fitting factors: consulting behaviour, autonomy-based adherence, and provider-based adherence (comparative fit index=0.96). Reliability ranged from 0.77 to 0.95. The EHFScBS-9 showed no floor and ceiling effect except for the provider-based adherence which had an expected ceiling effect. The SEM and the SRD indicated good precision of the EHFScBS-9.
  
  
  CONCLUSIONS
  The new factorial structure of the EHFScBS-9 showed supportive psychometric properties.
  
  
  CONCLUSIONS
  The EHFScBS-9 can be used to compute a total and specific scores for each identified factor. This may allow more detailed assessment and tailored interventions to improve self-care. The new score makes interpretation of the EHFScBS-9 easier.
authors.affiliation: Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy. Electronic address: ercole.vellone@uniroma2.it.
authors.forename: Ercole
authors.initials: E
authors.lastname: Vellone
authors.affiliation: Department of Social and Welfare Studies, Faculty of Health Sciences, University of Linköping, Norrköping, Sweden.
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
authors.affiliation: Department of Medical and Health Sciences, Faculty of Health Sciences, University of Linköping, Norrköping, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Strömberg
authors.affiliation: Department of Psychology, Sapienza University, Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Fida
authors.affiliation: Faculty of Health and Life Sciences, Linneaeus University, Kalmar, Sweden; Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Kristofer
authors.initials: K
authors.lastname: Årestedt
authors.affiliation: Center of Excellence for Nursing Scholarship, Rome, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Rocco
authors.affiliation: Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: Cocchieri
authors.affiliation: Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy.
authors.forename: Rosaria
authors.initials: R
authors.lastname: Alvaro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005163:Factor Analysis, Statistical; D005260:Female; D015438:Health Behavior; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011594:Psychometrics / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012648:Self Care; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: Heart Failure; Instrument validity and reliability; Psychometrics; Self-care