1. Schnell-Hoehn, Karen RN, BN,MN

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Thank you for providing the opportunity to elaborate on the predisposing variable of "self-efficacy" in comparison to "self-confidence" as it pertains to this research article.


According to Bandura,1(p22) "Perceived self-efficacy is concerned with judgments of how well one can execute courses of action required to deal with prospective situations." Within the context of self-care, self-efficacy refers to the belief that one has in his/her self-care abilities. Self-confidence refers to the belief in one's personal worth and the likelihood of succeeding. The construct of self-confidence is a combination of self-esteem and self-efficacy.


The Self-care of Heart Failure Index (SCHFI) used for this research indicates the self-confidence subscale pertaining to confidence in one's self-care ability (not self-worth), making it a clear measure of self-efficacy.2,3 Using lay terminology, questions in this subscale addressed how confident a person is that he/she could do something to ease symptoms. With this understanding, the self-care research highlighted in this article addresses the predisposing variable of self-efficacy.


I agree that taxonomy should be clear and precise when possible. Equally important is using the subscales, terminology, and measures within a research tool in a way the authors of the tool intended it to be used. This has occurred for the research presented in the article and is consistent with the published psychometric testing of the SCHFI tool.2,3 For further rationale regarding SCHFI or the taxonomy of the subscales, please contact the authors of this tool.




Karen Schnell-Hoehn, RN, BN, MN


Clinical Nurse Specialist


Cardiac Science Program


St. Boniface General Hospital


Winipeg, Manitoba, Canada




1. Bandura A. Self-efficacy mechanism in human agency. Am Psychol. 1982;37:122-147. [Context Link]


2. Riegel B, Carlson B, Moser DK, Sebern M, Hicks FD, Roland V. Psychometric testing of the Self-care of Heart Failure Index. J Card Fail. 2004;19:350-360. [Context Link]


3. Riegel B, Carlson B, Glaser D. Development and testing of a clinical tool measuring self-management of heart failure. Heart Lung. 2000;29:4-14. [Context Link]