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Emma Vincent, BSc; Louise Sewell, PhD; Katy Wagg, BSc; Sarah Deacon, MD; Johanna Williams, MSc; Sally Singh, PhD
Author and Funding Information

From the Pulmonary Rehabilitation Research Group, Department of Respiratory Medicine and Thoracic Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust.

Correspondence to: Emma Vincent, BSc, Pulmonary Rehabilitation Research Group, Department of Respiratory Medicine and Thoracic Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Groby Rd, Leicester, LE3 9QP, England; e-mail: emma.vincent@uhl-tr.nhs.uk


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts: Dr Singh has received numerous not-for-profit grant monies and an unrestricted educational grant from AstraZeneca. Mss Vincent, Wagg, and Williams and Drs Deacon and Sewell report that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(4):1124. doi:10.1378/chest.11-3178
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To the Editor:

We thank Drs DePew and Benzo for their interest in the Pulmonary Rehabilitation Adapted Index of Self-Efficacy (PRAISE) tool and their comments regarding general and task-specific self-efficacy. The PRAISE tool1 was devised as an adaptation of the well-validated General Self-Efficacy Scale,2 with the intention that it might be integrated comprehensively into our pulmonary rehabilitation (PR) program. We specifically chose a tool that would measure general self-efficacy as well as the task-specific items related purely to rehabilitation.

As practitioners, we would hope to enhance task-specific self-efficacy and promote positive behavior change, particularly as a result of rehabilitation. Indeed, previous studies have devised such tools to demonstrate that specific, rather than generalized, expectations can mediate behavior change in patients with COPD.3 However, the knowledge and skills that a rehabilitation program imparts may also promote a change in self-efficacy, which may expand into other areas of our patients’ lives, assisting their ability to cope overall. In this context, the measurement of general self-efficacy seems prudent. It is interesting that Drs DePew and Benzo raise the issue of general self-efficacy with physical activity. Although an improvement in physical activity is a core element of PR, we strongly believe that the overall effect of the program achieves much more than this: behavioral change, self monitoring, problem solving, action planning, goal setting, education, and social interaction. These effects are more likely to be observed by asking general questions, and so perhaps a task-specific tool may not be sufficient for such a holistic intervention.

The association between general and specific self-efficacy is complex. We are currently examining the internal consistency of both the general and task-specific questions of the PRAISE tool. It may transpire that it will be valuable to consider task-specific and general scores as separate domains.

Health-specific self-efficacy is a patient’s optimistic “can-do” belief regarding their capability to problem solve, their ability to consider possible precautions that may affect them, and their strength to embrace a healthier lifestyle. In the United Kingdom, patients often describe this anecdotally as their level of confidence. Measuring this construct is challenging; however, we hope the PRAISE tool will reinvigorate the debate about the importance of self-efficacy in PR.

Vincent E, Sewell L, Wagg K, Deacon S, Williams J, Singh S. Measuring a change in self-efficacy following pulmonary rehabilitation: an evaluation of the PRAISE tool. Chest. 2011;1406:1534-1539 [CrossRef] [PubMed]
 
Schwarzer R, Jerusalem M.Weinman J, Wright S, Johnson M. Generalized Self-Efficacy Scale. Measures in Health Psychology: A Users Portfolio. Causal and Control Beliefs. 1995; Windsor, England NFER-NELSON:35-37
 
Kaplan RM, Atkins CJ, Reinsch S. Specific efficacy expectations mediate exercise compliance in patients with COPD. Health Psychol. 1984;33:223-242 [CrossRef] [PubMed]
 

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References

Vincent E, Sewell L, Wagg K, Deacon S, Williams J, Singh S. Measuring a change in self-efficacy following pulmonary rehabilitation: an evaluation of the PRAISE tool. Chest. 2011;1406:1534-1539 [CrossRef] [PubMed]
 
Schwarzer R, Jerusalem M.Weinman J, Wright S, Johnson M. Generalized Self-Efficacy Scale. Measures in Health Psychology: A Users Portfolio. Causal and Control Beliefs. 1995; Windsor, England NFER-NELSON:35-37
 
Kaplan RM, Atkins CJ, Reinsch S. Specific efficacy expectations mediate exercise compliance in patients with COPD. Health Psychol. 1984;33:223-242 [CrossRef] [PubMed]
 
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