There is evidence that the psychological attribute of perceived self-efficacy plays a role in mediating health outcomes for persons with chronic arthritis who take the Arthritis Self-Management Course. An instrument to measure perceived self-efficacy was developed through consultation with patients and physicians and through study of 4 groups of patients. Tests of construct and concurrent validity and of reliability showed that the instrument met appropriate standards. Health outcomes and self-efficacy scores improved during the Arthritis Self-Management Course, and the improvements were correlated.We describe the development and testing of an instrument to measure patients' perceived self-efficacy (SE) to cope with the consequences of chronic arthritis. The need for such an instrument arose in the course of studying the effects of the Arthritis SelfManagement Course (ASMC). When evaluated in randomized studies, subjects who took the ASMC were found to have less pain and to be more active than controls (1). These results persisted, albeit attenuated, for 20 months after the course, without reinforcement. However, when the data were examined for anticipated associations between changes in behavior (ex- ercise, relaxation, and walking) and changes in health status (pain, disability, and depression), the expected associations were weak or were absent (2).These unexpected findings precipitated an interview with the participants and evaluation of their experiences in the course. Fifty-four participants were asked why they found the course helpful or not helpful. For half the people interviewed, pain and/or disability had decreased; for the other half, pain and/or disability had not changed or had increased. The former group attributed their benefits to an increased sense of influence over the consequences of arthritis; the latter group believed that they could do little to improve their situation (3).The findings from these interviews indicated that a sense of one's personal ability to affect the consequences of disease was strong in some subjects and relatively weak in others, and interacted with the course to create the health outcomes. This sense of ability to effect change (akin to confidence) is similar to the psychological concept of perceived SE (43). In a preliminary study using early instruments to measure perceived SE to cope with the consequences of arthritis, we found statistically significant correlations between perceived SE and health status (ref. 6 and unpublished observations). We therefore sought to develop a reliable and valid instrument for measuring perceived SE.Perceived SE, as postulated by Bandura (4), is one's belief that one can perform a specific behavior or task in the future. It refers to personal judgments of performance capabilities in a given domain of activity.Although it is related to other psychological concepts, such as locus of control, learned helplessness, and self-esteem, it differs in that it is behavior-specific.

This article introduces the construct of self-concealment, the active concealment from others of personal information that one perceives as negative or distressing. A Self-Concealment Scale (SCS) was developed and was included in a questionnaire battery completed by 306 subjects. The SCS had excellent psychometric properties. Self-concealment was conceptually and empirically distinguished from self-disclosure. Self-concealment significantly correlated with self-report measures of anxiety, depression, and bodily symptoms and accounted for a significant incremental per centage of the variance in physical and psychological symptoms even after controlling for occurrence of trauma, trauma distress, disclosure of the trauma, social support, social network, and self-disclosure. The implications of these findings are discussed and directions for further research are briefly outlined.Self-concealment is a familiar human experience. Most people have un comfortable feelings, thoughts, and information about themselves that they avoid telling others. These secrets can range from mildly embarrassing to highly distressing. Sometimes these secrets have been told to only one or two persons and sometimes to no one at all. Clinical practice and research, as well as casual observation, indicate that some individuals tend to self-conceal more than others do and that the most painful or traumatic experiences are often concealed; examples are sexual abuse as a child (Russell

The demographic variables of age, race, sex, education, and occupation have proven useful in the prediction of premorbid IQs based on the 1955 Wechsler Adult Intelligence Scale (WAIS; Wilson, Rosenbaum, Brown, Rourke, Whitman, & Grisell, 1978). Recent revision of the WAIS has necessitated the reformulation of the regression or estimation formulas used in this prediction. The present study mimicked previous methodology but in addition used the available demographic data of region of residence, urban versus rural residence, and handedness. The resulting regression equations are reported to aid in an accurate estimate of premorbid IQ for the 1981 revised WAIS (WAIS-R).

an extensive empirical literature has focused on the self-concealment (SC) construct. in this article, we review 137 studies that used the Self-Concealment Scale (SCS) with varied populations (e.g., adolescent; intercultural; international; lesbian, gay, and bisexual; and intimate partner). We propose a working model for the psychology of SC and the mechanisms of action for its effects on well-being. a dual-motive conflict between urges to conceal and reveal is seen to play a central role in these health effects. meta-analytic techniques identify significant associations for SC with 18 constructs falling into six general categories: antecedents, disclosure and concealment, emotion regulation, social well-being, psychological and physical health, and psychotherapy. We interpret these findings with reference to current research and theory on secret keeping and health as well as emotionand self-regulatory processes. this first integrative review supports the construct validity of the SCS and demonstrates the value of the SC construct for the study of psychological phenomena in which secret keeping is a recognized issue.

Evaluation of the Arthritis Self-ManagementCourse revealed significant positive changes in the practice of behaviors that were taught and in health outcomes. However, utilizing a variety of statistical techniques, we were able to demonstrate only weak associations between changes in behavior and changes in health status. This suggests the need to examine the mechanisms by which health education affects heaMh status.As do other persons who have chronic and disabling illnesses, the person who has arthritis plays a potentially significant role in the management of his or her health care. This role includes using techniques for maintaining mobility and strength, engaging in practices that reduce pain, and balancing the beneficial and adverse effects of medication. If the patient's role is to emerge fully, it is necessary that he or she gain new understanding about chronic illness and skills for coping with the effects. The purpose of the Arthritis Self-Management Course (ASMC) was to assist patients in attaining such understanding and skills.The underlying assumptions of those who developed the ASMC hold that enhanced knowledge and adoption of specific self-management behaviors will lead to improved functional outcomes. The ASMC, as originally tested in a randomized trial of 190 people with arthritis, was successful: Knowledge about arthritis was increased, taught behaviors were adopted, and pain was diminished by approximately 20%. No significant improvement in the average degree of disability was observed, but there was no deterioration. The effects persisted without reinforcement, albeit with some decay, for as long as 20 months, which was the longest time interval studied (1). We describe here the results of an inquiry into mechanisms of the effects of the ASMC. The first part of the report presents ASMC outcomes for 707 people, including the original 190 participants in the initial study. The second part describes the associations between participants' adoption of taught behaviors and improved health outcomes. The data reveal only weak correlations between the two.The weak associations of behavior change with health outcomes, which run counter to the usual perception of a direct progression from health education intervention to specified behavior change to improved health outcome, raise potentially important questions concerning the sources of benefit from health education. PATIENTS AND METHODSPublic service announcements in newspapers, on radio, and on television in the San Francisco Bay area were used to recruit 854 persons with arthritis. A physician's consent form confirming the patient's diagnosis was part of the application process.Upon completion of the application, all subjects were classified by the site at which they chose to take