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Original Article
Development and Validation of Self-Efficacy Scale for Self-Management of Breast Cancer (SESSM-B)
Ran Lee1, Soo Hyun Kim2, Keun Sook Lee3, Myung Kyung Seo4
Journal of Korean Academy of Nursing 2012;42(3):385-395.
DOI: https://doi.org/10.4040/jkan.2012.42.3.385
Published online: June 12, 2012

1Head Nurse, Endoscopy Center, National Cancer Center, Goyang, Korea

2Assistant Professor, Department of Nursing, Inha University, Incheon, Korea

3Head Nurse, Center for Breast Cancer, National Cancer Center, Goyang, Korea

4Nurse, Center for Breast Cancer, National Cancer Center, Goyang, Korea

1Head Nurse, Endoscopy Center, National Cancer Center, Goyang, Korea

2Assistant Professor, Department of Nursing, Inha University, Incheon, Korea

3Head Nurse, Center for Breast Cancer, National Cancer Center, Goyang, Korea

4Nurse, Center for Breast Cancer, National Cancer Center, Goyang, Korea

Address reprint requests to : Lee, Ran Endoscopy Center, National Cancer Center, 323 Jungbalsan-ro, Ilsandong-gu, Gyeonggi-do 410-769, Korea Tel: +82-31-920-1285 Fax: +82-31-920-1289 E-mail: iran@ncc.re.kr
• Received: June 21, 2011   • Revised: July 7, 2011   • Accepted: May 28, 2012

Copyright © 2012 Korean Society of Nursing Science

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    This purpose of this study was to develop and validate a Self-Efficacy Scale for Self-Management of Breast Cancer (SESSM-B).
  • Methods
    The SESSM-B was developed and validated as follows: Item generation, pilot study, and tests of validity and reliability. Twenty-one items were developed through evaluation by 10 experts and 13 items were finally confirmed through item analysis and factor analysis. Psychometric testing was performed with a convenience sample of 303 women with breast cancer. Data were analyzed using factor analysis, Pearson correlation coefficients, and Cronbach’s alpha.
  • Results
    Five factors evolved from the factor analysis, which explained 69.8% of the total variance. The first factor ‘coping with psycho-informational demand’ explained 17.2%, 2nd factor ‘maintenance of healthy lifestyle’ 14.5%. 3rd factor ‘management of side-effects' 13.3%, 4th factor ‘therapeutic compliance’ 12.8%, and 5th factor ‘sexual life’ 11.9%. SESSM-B also demonstrated a concurrent validity with health-related quality of life scale, EORTC QLQ-C30 & BR23. The internal consistency, Cronbach’s alpha, was .78, and reliability of the subscales ranged from .61 to .79.
  • Conclusion
    The results of this study suggest that the SESSM-B is an easy, reliable, and valid instrument to measure self-efficacy for self-management of breast cancer.
  • Keywords: Breast cancer; Self-efficacy; Validation studies
Table 1.
Socio-demographic and Clinical Characteristics of the Participants (N=303)
Characteristics Categories n (%) M±SD
Age (yr) <40 51 (16.8) 47.7±8.7
40-49 139 (45.9)
50-59 78 (25.7)
≥60 35 (11.6)
Marital status Married 250 (82.5)
Widowed/ Divorced 30 (9.9)
Unmarried 23 (7.6)
Educational level ≤Middle school 64 (21.1)
High school 143 (47.2)
College or University 96 (31.7)
Monthly income (10,000 won) <200 89 (29.3)
≥200 214 (70.7)
Religion Yes 229 (75.6)
No 74 (24.4)
Job Yes 85 (28.1)
No 218 (71.9)
Menopause (n=302) Yes 171 (56.6)
No 131 (43.4)
Duration since diagnosis (yr) (n=297) 1.0-2.0 167 (56.2) 3.4±3.6
2.1-4.0 55 (18.5)
≥4 75 (25.3)
Stage (n=300) 0 or I 102 (34.0)
II 102 (34.0)
III 51 (17.0)
IV 45 (15.0)
Metastasis Yes 48 (15.8)
No 255 (84.2)
Type of surgery (n=285) Mastectomy 80 (28.0)
Breast conserving surgery 189 (66.1)
Mastectomy+Reconstruction 16 (5.6)
Treatment trajectory During treatment 163 (53.8)
After treatment 140 (46.2)
Treatment modality*(n=163) Surgery 35 (21.5)
Radiation therapy 44 (27.0)
Chemotherapy 86 (52.8)
Herceptin therapy 6 (3.7)
Current anti-hormone therapy Yes 140 (46.2)
No 163 (53.8)

*This item was examined by patients undergoing cancer treatment and multiple choice was possible.

Table 2.
Item Analyses
Items M±SD Corrected item-total correlation Cronbach's α if item is deleted
I can accept the fact that I have been diagnosed with breast cancer and I should be treated. 4.45±0.60 .28 .84
I can continuously receive breast cancer treatment. 4.65±0.52 .33 .84
Once treatment is finished, I can visit the hospital regularly for examinations. 4.70±0.46 .39 .84
I can perform a breast self-examination every month. 4.12±0.90 .37 .84
I can maintain an optimum body weight. 4.10±0.80 .44 .83
I know how to prevent and manage lymphedema. 3.05±1.22 .41 .84
I can continue with day-to-day life and activities by sharing housework with my family. 4.13±0.81 .57 .83
I can seek help from a psychiatrist if I experience insomnia for more than a month. 4.08±0.79 .41 .83
I can use a public bath. 3.36±1.42 .26 .85
I can ask for information from medical doctors or nurses if needed. 4.25±0.70 .50 .83
I can share my difficulties with my friends or family. 4.20±0.71 .50 .83
When I become anxious I can ask for help from friends or family. 4.11±0.80 .51 .83
I can get help from a self-help group for breast cancer patients if needed. 3.58±1.07 .50 .83
I can exercise regularly. 4.08±0.82 .54 .83
I am able to continue sexual activity with my spouse. 3.28±1.21 .46 .83
I can practice birth control when necessary. 3.10±1.46 .41 .84
I can report the side-effects of anti-cancer therapy to medical doctors or nurses. 3.58±1.05 .51 .83
I am aware of anti-cancer therapy side effects that require hospitalization. 3.72±0.99 .44 .83
I can return to my job or continue what I have been doing. 3.52±1.04 .44 .83
I can eat regularly in appropriate amounts. 4.13±0.70 .51 .83
I can restrict alcohol consumption. 4.36±1.01 .29 .84
Table 3.
Results of Factor Analyses
No. Items Initial factor analysis
 Second factor analysis
Factors
 Factors
CPD MHL MSE TC SL CPD MSE MHL TC SL
11 Sharing difficulties .87 .12 -.01 .09 .08 .89 .02 .07 .12 .07
12 Anxiety control .82 .07 .16 .04 .10 .84 .17 .02 .08 .10
10 Seeking information .61 .26 .17 .06 .10 .64 .13 .28 .04 .11
20 Balanced diet .52 .25 .14 .18 .19
5 Weight control .14 .72 .01 .10 .12 .16 .05 .80 .03 .13
14 Regular exercise .42 .69 -.03 .08 .11 .45 .05 .62 .08 .14
6 Prevention of lymphedema -.04 .55 .46 .08 .08 -.01 .54 .40 .10 .10
13 Participation in self-help groups .33 .51 .17 -.14 .20
4 Breast self-examination -.02 .50 .27 .28 .058 -.02 .26 .63 .22 .03
7 Sharing housework .32 .49 .20 .21 .16
18 Recognition of side-effects .20 .16 .85 .02 -.04 .20 .88 .08 .03 -.03
17 Notifying about side-effects .12 .14 .81 .02 .27 .12 .82 .07 .02 .25
2 Compliance with treatment .11 .08 .09 .88 -.01 .10 .11 .06 .90 -.01
3 Regular visits and examinations .12 .18 -.03 .85 .13 .12 -.00 .20 .87 .13
16 Contraception .06 .12 .11 .02 .88 .07 .13 .10 .04 .85
15 Sexual activity .13 .23 .02 .00 .86 .17 .10 .12 .06 .83
19 Return to work .25 .11 .15 .30 .42
8 Consultation about insomnia .32 -.05 .34 .20 .36
Proportion of variances (%) 15.2 13.0 10.8 10.2 10.1 17.2 14.5 13.3 12.8 11.9
Total variances (%) 59.3 69.8

CPD=Coping with psycho-informational demand; MHL=Maintenance of healthy lifestyle; MSE=Management of side effects; TC=Therapeutic compliance; SL=Sexual life, Shaded items were excluded in second factor analysis.

Table 4.
Multitrait/Multi-item Matrix (Correlation Matrix Corrected for Overlap) for Item Convergent and Item Discriminant
No. Abbreviated items CPD MSE MHL TC SL
11 Sharing difficulties .71 .19 .31 .19 .28
12 Anxiety control .64 .26 .32 .18 .25
10 Seeking information .47 .29 .36 .16 .22
18 Recognition of side-effects .30 .61 .28 .10 .16
17 Notifying about side-effects .26 .56 .29 .10 .33
6 Prevention of lymphedema .17 .41 .34 .17 .22
5 Weight control .29 .282 .47 .17 .25
4 Breast self-examination .18 .31 .38 .26 .18
14 Regular exercise .46 .30 .42 .23 .27
2 Compliance with treatment .19 .19 .23 .66 .09
3 Regular visits and examinations .25 .15 .33 .66 .20
16 Contraception .23 .24 .25 .10 .50
15 Sexual activity .27 .28 .27 .14 .50

CPD=Coping with psycho-informational demand; MSE=Management of side effects; MHL=Maintenance of healthy lifestyle; TC=Therapeutic compliance; SL=Sexual life.

Table 5.
Correlations between the SESSM-B and the EORTC QLQ-C30 and BR23
Instruments Total
 CPD
 MSE
 MHL
 TC
 SL
r (p) r (p) r (p) r (p) r (p) r (p)
EORTC Physical functioning .21 .07 .12 .20 .15 .14
QLQ-C30 (<.001) (.249) (.046) (<.001) (.010) (.014)
Role functioning .14 .08 .04 .16 .08 .10
(.021) (.162) (.503) (.067) (.189) (.091)
Emotional functioning .20 .21 .23 .16 .06 .03
(<.001) (<.001) (<.001) (.005) (.292) (.651)
Cognitive functioning .09 -.09 .04 .10 .01 .06
(.108) (.127) (.485) (.076) (.980) (.297)
Social functioning .21 .18 .08 .11 .08 .13
(.002) (.002) (.154) (.055) (.165) (.022)
Global quality of life .30 .18 .32 .20 .06 .15
(<.001) (.002) (<.001) (.001) (.315) (.011)
EORTC Body image .09 .15 -.04 .04 .05 .10
QLQ-BR23 (.141) (.009) (.516) (.548) (.433) (.080)
Sexual functioning .20 .01 .07 .07 .04 .37
(<.001) (.929) (.213) (.203) (.550) (<.001)
Sexual enjoyment .28 .01 .23 .02 .16 .45
(.008) (.930) (.033) (.873) (.130) (<.001)
Future perspectives .11 .10 .06 .10 .01 .04
(.058) (.092) (.269) (.075) (.816) (.516)

EORTC QLQ-C30=European Organization of Research and Treatment for Cancer Quality of Life Questionnaire Core 30 items; EORTC QLQ-BR23=EORTC Breast Cancer Specific Module; SESSM-B=Self-Efficacy Scale for Self-Management of Breast Cancer; CPD=Coping with psycho-informational demand; MSE=Management of side effects; MHL=Maintenance of healthy lifestyle; TC=Therapeutic compliance; SL=Sexual life.

Table 6.
Change of Internal Consistency
Categories Cronbach's α
18 items 13 items
Total items .84 .78
CPD .76 .77
MSE .77 .70
MHL .72 .61
TC .66 .79
SL .62 .66

CPD=Coping with psycho-informational demand; MSE=Management of side effects; MHL=Maintenance of healthy lifestyle; TC=Therapeutic compliance; SL=Sexual life.

  • Aaronson N. K., Ahmedzai S., Bergman B., Bullinger M., Cull A., Duez N. J., et al. 1993;The European organization for research and treatment of cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute. 85:365–376. http://dx.doi.org/10.1093/jnci/85.5.365ArticlePubMed
  • Akin S., Can G., Durna Z., Aydiner, A. 2008;The quality of life and self-efficacy of Turkish breast cancer patients undergoing chemotherapy. European Journal of Oncology Nursing. 12:449–456. http://dx.doi.org/10.1016/j.ejon.2008.07.006ArticlePubMed
  • Bandura, A. 1977;Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review. 84:191–215. http://dx.doi.org/10.1037/0033-295X.84.2.191ArticlePubMed
  • Blacklock R., Rhodes R., Blanchard C., Gaul, C. 2010;Effects of exercise intensity and self-efficacy on state anxiety with breast cancer survivors. Oncology Nursing Forum. 37:206–212. http://dx.doi.org/10.1188/10.ONF.206-212ArticlePubMed
  • Boehmer S., Luszczynska A., Schwarzer, R. 2007;Coping and quality of life after tumor surgery: Personal and social resources promote different domains of quality of life. Anxiety, Stress and Coping. 20:61–75. http://dx.doi.org/10.1080/10615800701195439ArticlePubMed
  • Cho N.K. 2008;A study on breast cancer patients’ improvement of self- efficacy and health-outcome expectation through dance sport participation. Journal of Leisure and Recreation Studies. 32:211–219.
  • Damush T. M., Perkins A., Miller, K. 2006;The implementation of an oncologist referred, exercise self-management program for older breast cancer survivors. Psycho-Oncology. 15:884–890. http://dx.doi.org/10.1002/pon.1020ArticlePubMed
  • Fayer P. M., Machin, D. 2009.Quality of life: Assessment, analysis and interpretation. 2nd ed.Chichester, West Sussex: John Wiley & Sons.
  • Hoffman A. J., von Eye A., Gift A. G., Given B. A., Given C. W., Rothert, M. 2009;Testing a theoretical model of perceived self-efficacy for cancer-related fatigue self-management and optimal physical functional status. Nursing Research. 58:32–41. http://dx.doi.org/10.1097/NNR.0b013e3181903d7bArticlePubMedPMC
  • Hwang S. Y., Park B. W., Lee I.S. 2002;A psychoeducational group intervention for women with primary breast carcinoma. Korean Journal of Social Welfare. 51:93–118.
  • Akin S., Can G., Durna Z., Aydiner, A. 2008;The quality of life and self-efficacy of Turkish breast cancer patients undergoing chemotherapy. European Journal of Oncology Nursing. 12:449–456. http://dx.doi.org/10.1016/j.ejon.2008.07.006ArticlePubMed
  • Bandura, A. 1977;Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review. 84:191–215. http://dx.doi.org/10.1037/0033-295X.84.2.191ArticlePubMed
  • Blacklock R., Rhodes R., Blanchard C., Gaul, C. 2010;Effects of exercise intensity and self-efficacy on state anxiety with breast cancer survivors. Oncology Nursing Forum. 37:206–212. http://dx.doi.org/10.1188/10.ONF.206-212ArticlePubMed
  • Boehmer S., Luszczynska A., Schwarzer, R. 2007;Coping and quality of life after tumor surgery: Personal and social resources promote different domains of quality of life. Anxiety, Stress and Coping. 20:61–75. http://dx.doi.org/10.1080/10615800701195439ArticlePubMed
  • Cho N.K. 2008;A study on breast cancer patients’ improvement of self- efficacy and health-outcome expectation through dance sport participation. Journal of Leisure and Recreation Studies. 32:211–219.
  • Damush T. M., Perkins A., Miller, K. 2006;The implementation of an oncologist referred, exercise self-management program for older breast cancer survivors. Psycho-Oncology. 15:884–890. http://dx.doi.org/10.1002/pon.1020ArticlePubMed
  • Fayer P. M., Machin, D. 2009.Quality of life: Assessment, analysis and interpretation. 2nd ed.Chichester, West Sussex: John Wiley & Sons.
  • Hoffman A. J., von Eye A., Gift A. G., Given B. A., Given C. W., Rothert, M. 2009;Testing a theoretical model of perceived self-efficacy for cancer-related fatigue self-management and optimal physical functional status. Nursing Research. 58:32–41. http://dx.doi.org/10.1097/NNR.0b013e3181903d7bArticlePubMedPMC
  • Hwang S. Y., Park B. W., Lee I.S. 2002;A psychoeducational group intervention for women with primary breast carcinoma. Korean Journal of Social Welfare. 51:93–118.
  • Bandura, A. 1977;Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review. 84:191–215. http://dx.doi.org/10.1037/0033-295X.84.2.191ArticlePubMed
  • Blacklock R., Rhodes R., Blanchard C., Gaul, C. 2010;Effects of exercise intensity and self-efficacy on state anxiety with breast cancer survivors. Oncology Nursing Forum. 37:206–212. http://dx.doi.org/10.1188/10.ONF.206-212ArticlePubMed
  • Boehmer S., Luszczynska A., Schwarzer, R. 2007;Coping and quality of life after tumor surgery: Personal and social resources promote different domains of quality of life. Anxiety, Stress and Coping. 20:61–75. http://dx.doi.org/10.1080/10615800701195439ArticlePubMed
  • Cho N.K. 2008;A study on breast cancer patients’ improvement of self- efficacy and health-outcome expectation through dance sport participation. Journal of Leisure and Recreation Studies. 32:211–219.
  • Damush T. M., Perkins A., Miller, K. 2006;The implementation of an oncologist referred, exercise self-management program for older breast cancer survivors. Psycho-Oncology. 15:884–890. http://dx.doi.org/10.1002/pon.1020ArticlePubMed
  • Fayer P. M., Machin, D. 2009.Quality of life: Assessment, analysis and interpretation. 2nd ed.Chichester, West Sussex: John Wiley & Sons.
  • Hoffman A. J., von Eye A., Gift A. G., Given B. A., Given C. W., Rothert, M. 2009;Testing a theoretical model of perceived self-efficacy for cancer-related fatigue self-management and optimal physical functional status. Nursing Research. 58:32–41. http://dx.doi.org/10.1097/NNR.0b013e3181903d7bArticlePubMedPMC
  • Hwang S. Y., Park B. W., Lee I.S. 2002;A psychoeducational group intervention for women with primary breast carcinoma. Korean Journal of Social Welfare. 51:93–118.
  • Blacklock R., Rhodes R., Blanchard C., Gaul, C. 2010;Effects of exercise intensity and self-efficacy on state anxiety with breast cancer survivors. Oncology Nursing Forum. 37:206–212. http://dx.doi.org/10.1188/10.ONF.206-212ArticlePubMed
  • Boehmer S., Luszczynska A., Schwarzer, R. 2007;Coping and quality of life after tumor surgery: Personal and social resources promote different domains of quality of life. Anxiety, Stress and Coping. 20:61–75. http://dx.doi.org/10.1080/10615800701195439ArticlePubMed
  • Cho N.K. 2008;A study on breast cancer patients’ improvement of self- efficacy and health-outcome expectation through dance sport participation. Journal of Leisure and Recreation Studies. 32:211–219.
  • Damush T. M., Perkins A., Miller, K. 2006;The implementation of an oncologist referred, exercise self-management program for older breast cancer survivors. Psycho-Oncology. 15:884–890. http://dx.doi.org/10.1002/pon.1020ArticlePubMed
  • Fayer P. M., Machin, D. 2009.Quality of life: Assessment, analysis and interpretation. 2nd ed.Chichester, West Sussex: John Wiley & Sons.
  • Hoffman A. J., von Eye A., Gift A. G., Given B. A., Given C. W., Rothert, M. 2009;Testing a theoretical model of perceived self-efficacy for cancer-related fatigue self-management and optimal physical functional status. Nursing Research. 58:32–41. http://dx.doi.org/10.1097/NNR.0b013e3181903d7bArticlePubMedPMC
  • Hwang S. Y., Park B. W., Lee I.S. 2002;A psychoeducational group intervention for women with primary breast carcinoma. Korean Journal of Social Welfare. 51:93–118.
  • Boehmer S., Luszczynska A., Schwarzer, R. 2007;Coping and quality of life after tumor surgery: Personal and social resources promote different domains of quality of life. Anxiety, Stress and Coping. 20:61–75. http://dx.doi.org/10.1080/10615800701195439ArticlePubMed
  • Cho N.K. 2008;A study on breast cancer patients’ improvement of self- efficacy and health-outcome expectation through dance sport participation. Journal of Leisure and Recreation Studies. 32:211–219.
  • Damush T. M., Perkins A., Miller, K. 2006;The implementation of an oncologist referred, exercise self-management program for older breast cancer survivors. Psycho-Oncology. 15:884–890. http://dx.doi.org/10.1002/pon.1020ArticlePubMed
  • Fayer P. M., Machin, D. 2009.Quality of life: Assessment, analysis and interpretation. 2nd ed.Chichester, West Sussex: John Wiley & Sons.
  • Hoffman A. J., von Eye A., Gift A. G., Given B. A., Given C. W., Rothert, M. 2009;Testing a theoretical model of perceived self-efficacy for cancer-related fatigue self-management and optimal physical functional status. Nursing Research. 58:32–41. http://dx.doi.org/10.1097/NNR.0b013e3181903d7bArticlePubMedPMC
  • Hwang S. Y., Park B. W., Lee I.S. 2002;A psychoeducational group intervention for women with primary breast carcinoma. Korean Journal of Social Welfare. 51:93–118.
  • Boehmer S., Luszczynska A., Schwarzer, R. 2007;Coping and quality of life after tumor surgery: Personal and social resources promote different domains of quality of life. Anxiety, Stress and Coping. 20:61–75. http://dx.doi.org/10.1080/10615800701195439ArticlePubMed
  • Cho N.K. 2008;A study on breast cancer patients’ improvement of self- efficacy and health-outcome expectation through dance sport participation. Journal of Leisure and Recreation Studies. 32:211–219.
  • Damush T. M., Perkins A., Miller, K. 2006;The implementation of an oncologist referred, exercise self-management program for older breast cancer survivors. Psycho-Oncology. 15:884–890. http://dx.doi.org/10.1002/pon.1020ArticlePubMed
  • Fayer P. M., Machin, D. 2009.Quality of life: Assessment, analysis and interpretation. 2nd ed.Chichester, West Sussex: John Wiley & Sons.
  • Hoffman A. J., von Eye A., Gift A. G., Given B. A., Given C. W., Rothert, M. 2009;Testing a theoretical model of perceived self-efficacy for cancer-related fatigue self-management and optimal physical functional status. Nursing Research. 58:32–41. http://dx.doi.org/10.1097/NNR.0b013e3181903d7bArticlePubMedPMC
  • Boehmer S., Luszczynska A., Schwarzer, R. 2007;Coping and quality of life after tumor surgery: Personal and social resources promote different domains of quality of life. Anxiety, Stress and Coping. 20:61–75. http://dx.doi.org/10.1080/10615800701195439ArticlePubMed
  • Cho N.K. 2008;A study on breast cancer patients’ improvement of self- efficacy and health-outcome expectation through dance sport participation. Journal of Leisure and Recreation Studies. 32:211–219.
  • Damush T. M., Perkins A., Miller, K. 2006;The implementation of an oncologist referred, exercise self-management program for older breast cancer survivors. Psycho-Oncology. 15:884–890. http://dx.doi.org/10.1002/pon.1020ArticlePubMed
  • Fayer P. M., Machin, D. 2009.Quality of life: Assessment, analysis and interpretation. 2nd ed.Chichester, West Sussex: John Wiley & Sons.
  • Boehmer S., Luszczynska A., Schwarzer, R. 2007;Coping and quality of life after tumor surgery: Personal and social resources promote different domains of quality of life. Anxiety, Stress and Coping. 20:61–75. http://dx.doi.org/10.1080/10615800701195439ArticlePubMed
  • Cho N.K. 2008;A study on breast cancer patients’ improvement of self- efficacy and health-outcome expectation through dance sport participation. Journal of Leisure and Recreation Studies. 32:211–219.
  • Damush T. M., Perkins A., Miller, K. 2006;The implementation of an oncologist referred, exercise self-management program for older breast cancer survivors. Psycho-Oncology. 15:884–890. http://dx.doi.org/10.1002/pon.1020ArticlePubMed
  • Boehmer S., Luszczynska A., Schwarzer, R. 2007;Coping and quality of life after tumor surgery: Personal and social resources promote different domains of quality of life. Anxiety, Stress and Coping. 20:61–75. http://dx.doi.org/10.1080/10615800701195439ArticlePubMed
  • Cho N.K. 2008;A study on breast cancer patients’ improvement of self- efficacy and health-outcome expectation through dance sport participation. Journal of Leisure and Recreation Studies. 32:211–219.
  • Aaronson N. K., Ahmedzai S., Bergman B., Bullinger M., Cull A., Duez N. J., et al. 1993;The European organization for research and treatment of cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute. 85:365–376. http://dx.doi.org/10.1093/jnci/85.5.365ArticlePubMed
  • Akin S., Can G., Durna Z., Aydiner, A. 2008;The quality of life and self-efficacy of Turkish breast cancer patients undergoing chemotherapy. European Journal of Oncology Nursing. 12:449–456. http://dx.doi.org/10.1016/j.ejon.2008.07.006ArticlePubMed
  • Bandura, A. 1977;Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review. 84:191–215. http://dx.doi.org/10.1037/0033-295X.84.2.191ArticlePubMed
  • Blacklock R., Rhodes R., Blanchard C., Gaul, C. 2010;Effects of exercise intensity and self-efficacy on state anxiety with breast cancer survivors. Oncology Nursing Forum. 37:206–212. http://dx.doi.org/10.1188/10.ONF.206-212ArticlePubMed
  • Boehmer S., Luszczynska A., Schwarzer, R. 2007;Coping and quality of life after tumor surgery: Personal and social resources promote different domains of quality of life. Anxiety, Stress and Coping. 20:61–75. http://dx.doi.org/10.1080/10615800701195439ArticlePubMed
  • Cho N.K. 2008;A study on breast cancer patients’ improvement of self- efficacy and health-outcome expectation through dance sport participation. Journal of Leisure and Recreation Studies. 32:211–219.
  • Damush T. M., Perkins A., Miller, K. 2006;The implementation of an oncologist referred, exercise self-management program for older breast cancer survivors. Psycho-Oncology. 15:884–890. http://dx.doi.org/10.1002/pon.1020ArticlePubMed
  • Fayer P. M., Machin, D. 2009.Quality of life: Assessment, analysis and interpretation. 2nd ed.Chichester, West Sussex: John Wiley & Sons.
  • Hoffman A. J., von Eye A., Gift A. G., Given B. A., Given C. W., Rothert, M. 2009;Testing a theoretical model of perceived self-efficacy for cancer-related fatigue self-management and optimal physical functional status. Nursing Research. 58:32–41. http://dx.doi.org/10.1097/NNR.0b013e3181903d7bArticlePubMedPMC
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      Development and Validation of Self-Efficacy Scale for Self-Management of Breast Cancer (SESSM-B)
      J Korean Acad Nurs. 2012;42(3):385-395.   Published online June 12, 2012
      DOI: https://doi.org/10.4040/jkan.2012.42.3.385
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    Development and Validation of Self-Efficacy Scale for Self-Management of Breast Cancer (SESSM-B)
    Development and Validation of Self-Efficacy Scale for Self-Management of Breast Cancer (SESSM-B)
    Characteristics Categories n (%) M±SD
    Age (yr) <40 51 (16.8) 47.7±8.7
    40-49 139 (45.9)
    50-59 78 (25.7)
    ≥60 35 (11.6)
    Marital status Married 250 (82.5)
    Widowed/ Divorced 30 (9.9)
    Unmarried 23 (7.6)
    Educational level ≤Middle school 64 (21.1)
    High school 143 (47.2)
    College or University 96 (31.7)
    Monthly income (10,000 won) <200 89 (29.3)
    ≥200 214 (70.7)
    Religion Yes 229 (75.6)
    No 74 (24.4)
    Job Yes 85 (28.1)
    No 218 (71.9)
    Menopause (n=302) Yes 171 (56.6)
    No 131 (43.4)
    Duration since diagnosis (yr) (n=297) 1.0-2.0 167 (56.2) 3.4±3.6
    2.1-4.0 55 (18.5)
    ≥4 75 (25.3)
    Stage (n=300) 0 or I 102 (34.0)
    II 102 (34.0)
    III 51 (17.0)
    IV 45 (15.0)
    Metastasis Yes 48 (15.8)
    No 255 (84.2)
    Type of surgery (n=285) Mastectomy 80 (28.0)
    Breast conserving surgery 189 (66.1)
    Mastectomy+Reconstruction 16 (5.6)
    Treatment trajectory During treatment 163 (53.8)
    After treatment 140 (46.2)
    Treatment modality*(n=163) Surgery 35 (21.5)
    Radiation therapy 44 (27.0)
    Chemotherapy 86 (52.8)
    Herceptin therapy 6 (3.7)
    Current anti-hormone therapy Yes 140 (46.2)
    No 163 (53.8)
    Items M±SD Corrected item-total correlation Cronbach's α if item is deleted
    I can accept the fact that I have been diagnosed with breast cancer and I should be treated. 4.45±0.60 .28 .84
    I can continuously receive breast cancer treatment. 4.65±0.52 .33 .84
    Once treatment is finished, I can visit the hospital regularly for examinations. 4.70±0.46 .39 .84
    I can perform a breast self-examination every month. 4.12±0.90 .37 .84
    I can maintain an optimum body weight. 4.10±0.80 .44 .83
    I know how to prevent and manage lymphedema. 3.05±1.22 .41 .84
    I can continue with day-to-day life and activities by sharing housework with my family. 4.13±0.81 .57 .83
    I can seek help from a psychiatrist if I experience insomnia for more than a month. 4.08±0.79 .41 .83
    I can use a public bath. 3.36±1.42 .26 .85
    I can ask for information from medical doctors or nurses if needed. 4.25±0.70 .50 .83
    I can share my difficulties with my friends or family. 4.20±0.71 .50 .83
    When I become anxious I can ask for help from friends or family. 4.11±0.80 .51 .83
    I can get help from a self-help group for breast cancer patients if needed. 3.58±1.07 .50 .83
    I can exercise regularly. 4.08±0.82 .54 .83
    I am able to continue sexual activity with my spouse. 3.28±1.21 .46 .83
    I can practice birth control when necessary. 3.10±1.46 .41 .84
    I can report the side-effects of anti-cancer therapy to medical doctors or nurses. 3.58±1.05 .51 .83
    I am aware of anti-cancer therapy side effects that require hospitalization. 3.72±0.99 .44 .83
    I can return to my job or continue what I have been doing. 3.52±1.04 .44 .83
    I can eat regularly in appropriate amounts. 4.13±0.70 .51 .83
    I can restrict alcohol consumption. 4.36±1.01 .29 .84
    No. Items Initial factor analysis
    		 Second factor analysis
    Factors
    		 Factors
    CPD MHL MSE TC SL CPD MSE MHL TC SL
    11 Sharing difficulties .87 .12 -.01 .09 .08 .89 .02 .07 .12 .07
    12 Anxiety control .82 .07 .16 .04 .10 .84 .17 .02 .08 .10
    10 Seeking information .61 .26 .17 .06 .10 .64 .13 .28 .04 .11
    20 Balanced diet .52 .25 .14 .18 .19
    5 Weight control .14 .72 .01 .10 .12 .16 .05 .80 .03 .13
    14 Regular exercise .42 .69 -.03 .08 .11 .45 .05 .62 .08 .14
    6 Prevention of lymphedema -.04 .55 .46 .08 .08 -.01 .54 .40 .10 .10
    13 Participation in self-help groups .33 .51 .17 -.14 .20
    4 Breast self-examination -.02 .50 .27 .28 .058 -.02 .26 .63 .22 .03
    7 Sharing housework .32 .49 .20 .21 .16
    18 Recognition of side-effects .20 .16 .85 .02 -.04 .20 .88 .08 .03 -.03
    17 Notifying about side-effects .12 .14 .81 .02 .27 .12 .82 .07 .02 .25
    2 Compliance with treatment .11 .08 .09 .88 -.01 .10 .11 .06 .90 -.01
    3 Regular visits and examinations .12 .18 -.03 .85 .13 .12 -.00 .20 .87 .13
    16 Contraception .06 .12 .11 .02 .88 .07 .13 .10 .04 .85
    15 Sexual activity .13 .23 .02 .00 .86 .17 .10 .12 .06 .83
    19 Return to work .25 .11 .15 .30 .42
    8 Consultation about insomnia .32 -.05 .34 .20 .36
    Proportion of variances (%) 15.2 13.0 10.8 10.2 10.1 17.2 14.5 13.3 12.8 11.9
    Total variances (%) 59.3 69.8
    No. Abbreviated items CPD MSE MHL TC SL
    11 Sharing difficulties .71 .19 .31 .19 .28
    12 Anxiety control .64 .26 .32 .18 .25
    10 Seeking information .47 .29 .36 .16 .22
    18 Recognition of side-effects .30 .61 .28 .10 .16
    17 Notifying about side-effects .26 .56 .29 .10 .33
    6 Prevention of lymphedema .17 .41 .34 .17 .22
    5 Weight control .29 .282 .47 .17 .25
    4 Breast self-examination .18 .31 .38 .26 .18
    14 Regular exercise .46 .30 .42 .23 .27
    2 Compliance with treatment .19 .19 .23 .66 .09
    3 Regular visits and examinations .25 .15 .33 .66 .20
    16 Contraception .23 .24 .25 .10 .50
    15 Sexual activity .27 .28 .27 .14 .50
    Instruments Total
    		 CPD
    		 MSE
    		 MHL
    		 TC
    		 SL
    r (p) r (p) r (p) r (p) r (p) r (p)
    EORTC Physical functioning .21 .07 .12 .20 .15 .14
    QLQ-C30 (<.001) (.249) (.046) (<.001) (.010) (.014)
    Role functioning .14 .08 .04 .16 .08 .10
    (.021) (.162) (.503) (.067) (.189) (.091)
    Emotional functioning .20 .21 .23 .16 .06 .03
    (<.001) (<.001) (<.001) (.005) (.292) (.651)
    Cognitive functioning .09 -.09 .04 .10 .01 .06
    (.108) (.127) (.485) (.076) (.980) (.297)
    Social functioning .21 .18 .08 .11 .08 .13
    (.002) (.002) (.154) (.055) (.165) (.022)
    Global quality of life .30 .18 .32 .20 .06 .15
    (<.001) (.002) (<.001) (.001) (.315) (.011)
    EORTC Body image .09 .15 -.04 .04 .05 .10
    QLQ-BR23 (.141) (.009) (.516) (.548) (.433) (.080)
    Sexual functioning .20 .01 .07 .07 .04 .37
    (<.001) (.929) (.213) (.203) (.550) (<.001)
    Sexual enjoyment .28 .01 .23 .02 .16 .45
    (.008) (.930) (.033) (.873) (.130) (<.001)
    Future perspectives .11 .10 .06 .10 .01 .04
    (.058) (.092) (.269) (.075) (.816) (.516)
    Categories Cronbach's α
    18 items 13 items
    Total items .84 .78
    CPD .76 .77
    MSE .77 .70
    MHL .72 .61
    TC .66 .79
    SL .62 .66
    Table 1. Socio-demographic and Clinical Characteristics of the Participants (N=303)

    This item was examined by patients undergoing cancer treatment and multiple choice was possible.

    Table 2. Item Analyses

    Table 3. Results of Factor Analyses

    CPD=Coping with psycho-informational demand; MHL=Maintenance of healthy lifestyle; MSE=Management of side effects; TC=Therapeutic compliance; SL=Sexual life, Shaded items were excluded in second factor analysis.

    Table 4. Multitrait/Multi-item Matrix (Correlation Matrix Corrected for Overlap) for Item Convergent and Item Discriminant

    CPD=Coping with psycho-informational demand; MSE=Management of side effects; MHL=Maintenance of healthy lifestyle; TC=Therapeutic compliance; SL=Sexual life.

    Table 5. Correlations between the SESSM-B and the EORTC QLQ-C30 and BR23

    EORTC QLQ-C30=European Organization of Research and Treatment for Cancer Quality of Life Questionnaire Core 30 items; EORTC QLQ-BR23=EORTC Breast Cancer Specific Module; SESSM-B=Self-Efficacy Scale for Self-Management of Breast Cancer; CPD=Coping with psycho-informational demand; MSE=Management of side effects; MHL=Maintenance of healthy lifestyle; TC=Therapeutic compliance; SL=Sexual life.

    Table 6. Change of Internal Consistency

    CPD=Coping with psycho-informational demand; MSE=Management of side effects; MHL=Maintenance of healthy lifestyle; TC=Therapeutic compliance; SL=Sexual life.

    Table 1.

    Table 2.

    Table 3.

    Table 4.

    Table 5.

    Table 6.

    J Korean Acad Nurs : Journal of Korean Academy of Nursing
    © Korean Society of Nursing Science.
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