The European Heart Failure Self-care Behaviour Scale: New insights into factorial structure, reliability, precision and scoring procedure

Ercole Vellone (Lead Author), Tiny Jaarsma, Anna Strömberg, Roberta Fida, Kristofer Årestedt, Gennaro Rocco, Antonello Cocchieri, Rosaria Alvaro

Research output: Contribution to journalArticlepeer-review

68 Citations (Scopus)


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.
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).
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.
The new factorial structure of the EHFScBS-9 showed supportive psychometric properties.

Practice implications

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.
Original languageEnglish
Pages (from-to)97-102
Number of pages6
JournalPatient Education and Counseling
Issue number1
Publication statusPublished - Jan 2014


  • Heart Failure
  • Self-care
  • Psychometrics
  • Instrument validity
  • reliability

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