Reliability and validity of a self‐efficacy instrument for hepatitis C antiviral treatment regimens
Open accessAbstract
Summary. Self‐efficacy or confidence in one’s ability to successfully engage in goal‐directed behaviour has been shown to influence medication adherence across many chronic illnesses. In the present study, we investigated the psychometric properties of a self‐efficacy instrument used during treatment for chronic hepatitis C viral infection (HCV). Baseline (n = 394) and treatment week 24 (n = 254) data from the prospective, longitudinal Viral Resistance to Antiviral Therapy of Chronic Hepatitis C study were examined. Baseline participants were randomly split into two equal‐sized subsamples (S 1 and S 2). Initial exploratory and confirmatory factor analyses (EFA/CFA) were performed on S 1, while S 2 was used to validate the factor structure of the S 1 results using CFA. An additional CFA was performed on the treatment week 24 participants. Convergent and discriminant validity were assessed by comparing the revised instrument with other psychosocial measures: depression, social support, quality of life and medication‐taking behaviour. Our findings supported a reduced 17‐item global measure of HCV treatment self‐efficacy (HCV‐TSE) with four underlying factors: patient communication self‐efficacy, general physical coping self‐efficacy, general psychological coping self‐efficacy and adherence self‐efficacy. The global score (0.92–0.94) and four factors (0.85–0.96) demonstrated good internal consistency. Correlations of convergent and discriminant validity yielded low to moderate associations with other measures of psychosocial functioning. The revised HCV‐TSE instrument provides a reliable and valid global estimate of confidence in one’s ability to engage in and adhere to HCV antiviral treatment. The four‐factor structure suggests different types of efficacy beliefs may function during HCV treatment and should be explored further in relation to clinical outcomes.
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- Findingown data
Factor loadings in the week 24 CFA were similar to those in S1 and S2.
“In addition, the factor loadings were similar to those obtained in S1 and S2 (Table 1).”
Quote in the paperSubstantial claim - Findingown data
Four factors accounted for at least 5% of the variance.
“Four factors explained at least 5% of the variance.”
Quote in the paperSubstantial claim - Findingown data
At week 24, adherence self-efficacy correlated positively, from low to moderate, with medication taking behaviors (0.31-0.45).
“At treatment week 24, adherence self-efficacy demonstrated low to moderate positive correlations with medication taking behaviors (0.31–0.45).”
Quote in the paperSubstantial claim - Findingown data
One more item, item 13, was dropped because it did not load meaningfully on a single factor.
“One additional item (item 13) was removed for failure to meaningfully load onto a single factor.”
Quote in the paperNot a substantial claim - Findingown data
General physical coping self-efficacy showed associations from very weak (0.13) to moderate (0.44), all in the expected directions.
“General physical coping self-efficacy had very little (0.13) to moderate (0.44) relationships in the expected directions (e.g., positive with physical functioning, vitality; negative with depression).”
Quote in the paperSubstantial claim
- Findingown data
At week 24, the remaining three factors showed associations with psychosocial measures broadly comparable to those at baseline.
“Additionally, at treatment week 24, the other 3 factors yielded relationships with psychosocial measures that were relatively similar to treatment baseline.”
Quote in the paperSubstantial claim - Findingown data
Patient communication self-efficacy had a low positive association with social support (0.24).
“As noted in Table 3, patient communication self-efficacy demonstrated a low, positive association with social support (0.24).”
Quote in the paperNot a substantial claim - Findingreasoning
At baseline, adherence self-efficacy showed just one weak association, with bodily pain.
“Adherence self-efficacy yielded only one small relationship with bodily pain at baseline; however, this was expected as items on this factor corresponded to medication taking behavior which had yet to occur at baseline.”
Quote in the paperNot a substantial claim - Findingown data
The global HCV-TSE score had low positive associations with medication taking behavior at week 24.
“The global score also demonstrated low, positive associations with medication taking behavior at treatment week 24.”
Quote in the paperNot a substantial claim - Findingown data
Internal consistency, treated as a form of convergent validity, showed strong correlations for the global score and the factor scores.
“While no other measures of self-efficacy were available to fully assess convergent validity, internal consistency, a type of convergent validity, yielded high to very high correlations for the global and factor scores (Table 2) (57).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [57]
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- Findingown data
At baseline, the global HCV-TSE score had low to moderate correlations (0.31 to 0.50) with other psychosocial measures.
“As expected, low to moderate correlations (0.31 to 0.50) were found between the global HCV-TSE score and other psychosocial measures at baseline (Table 3).”
Quote in the paperSubstantial claim - Study design and conductreasoning
A limitation was the inability to select comparison measures a priori, including another self-efficacy measure.
“A second limitation was the inability to a priori select measures to compare with the HCV-TSE instrument, including another measure of self-efficacy.”
Quote in the paperNot a substantial claim - Interpretationown data
The four-factor structure suggests that different types of efficacy beliefs may operate during HCV treatment.
“The four factor structure suggests different types of efficacy beliefs may function during HCV treatment and should be explored further in relation to clinical outcomes.”
Quote in the paperSubstantial claim - Interpretationown data
The HCV-TSE yielded evidence of an adherence self-efficacy factor (factor 4), the belief that one can perform intended behaviors such as taking medications as prescribed and attending clinical visits.
“Finally, the HCV-TSE yielded evidence of an Adherence self-efficacy (factor 4) scale, which is essentially the belief that one can engage in the intended behavior (i.e., take medications as prescribed, attend clinical visits).”
Quote in the paperSubstantial claim - Study design and conductnone given
No other self-efficacy measures were available to fully assess convergent validity.
“While no other measures of self-efficacy were available to fully assess convergent validity, internal consistency, a type of convergent validity, yielded high to very high correlations for the global and factor scores (Table 2) (57).”
Quote in the paperSubstantial claim - Interpretationcitation
The six-month gap between baseline and week 24 would likely bias test-retest results because time and treatment experience are expected to change patients' efficacy beliefs.
“This six month time interval would likely have biased test-retest results, as the effects of time and experience with antiviral treatment is expected to affect patients’ efficacious beliefs about HCV treatment (14).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [14] source
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- Study design and conductcitation
Using self-report adherence questions to validate the HCV-TSE adherence self-efficacy scale was a limitation.
“A fourth limitation related to the use of self-reported medication adherence items to assess validity of the HCV-TSE’s adherence self-efficacy scale.”
Quote in the paperNot a substantial claim - Study design and conductown data
The study could not evaluate whether the HCV-TSE instrument remained stable over time.
“A third limitation was the inability to assess the HCV-TSE instrument’s stability over time.”
Quote in the paperNot a substantial claim - Study design and conductown data
Those without week 24 data were comparable to those with it on baseline variables including age, race, sex, and work status.
“Individuals missing 24 week information were similar to those with week 24 information on baseline characteristics such as age, race, sex, employment status, etc.”
Quote in the paperNot a substantial claim - Premisecitation
Confidence in one's ability to pursue goals affects how well people adhere to medication across many long-term illnesses.
“Self-efficacy or confidence in one’s ability to successfully engage in goal-directed behavior has been shown to influence medication adherence across many chronic illnesses.”
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- Study design and conductreasoning
A limitation was the smaller overall sample size caused by splitting the baseline sample.
“A final limitation is the reduction in the overall sample size due to the splitting of the baseline sample.”
Quote in the paperNot a substantial claim - Interpretationcitation
The HCV-TSE instrument has two underlying factors related to confidence in coping with physical and psychological stressors (factors 2 and 3).
“Our findings indicated that the HCV-TSE instrument has two underlying factors related to one’s confidence to cope with physical and psychological stressors (factors 2 and 3) (55).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [55] source
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- Study design and conductcitation
Each subsample was of minimally adequate size.
“However, it is important to note that each of the subsamples were of minimally adequate size (49).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [49]
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- Premisecitation
The VIRAHEP-C self-efficacy measure was a 24-item self-report adapted from validated self-efficacy measures used in the Adult AIDS Clinical Trials Group.
“The VIRAHEP-C self-efficacy measure was a 24-item self-report measure adapted from previously validated self-efficacy measures created for the Adult AIDS Clinical Trials Group (see Appendix A for the original VIRAHEP-C measure) (19;39) (personal communication, S. Smith, Nov. 11, 2010).”
Quote in the paperSubstantial claim0 of 2 sources checked - Interpretationcitation
Patients who lack confidence in communicating with providers are indirectly at risk of nonadherence because they may misunderstand instructions or not report side effects.
“Patients lacking confidence in their ability to effectively communicate with their providers (e.g., factor 1) are indirectly at risk for nonadherence to treatment regimens, as they may misunderstand treatment instructions or fail to report adverse side effects (58).”
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- Premisecitation
Those with greater coping self-efficacy are more apt to stay with demanding treatments via cognitive and behavioral mechanisms.
“This is critical, as patients with higher coping self-efficacy beliefs are more likely to persevere in treatments that are difficult through behavioral and cognitive processes (13–15;31–33;59).”
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- May combine two claims. 25
- The quote only partly states this claim. 1
- Classified as probably not a substantial claim. 7
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Findingown dataAt week 24, the strength of these relationships increased slightly, but their directions stayed the same.
“At treatment week 24 (Table 4), the magnitude of these relationships were slightly increased, but the directions remained the same.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataItem 21 (lowest loading 0.78) and then item 12 (next lowest loading 0.78) were removed, leaving a final model of 17 items across four factors.
“The item with the lowest factor loading (0.78) was removed (item 21), the model was refitted and further reduction was needed. The item with the next lowest factor loading (0.78) was removed (item12). Our final model contained 17 items distributed across 4 factors (see Appendix B).”
Quote in the paperSubstantial claimMay combine two claims. The quote only partly states this claim.
Findingown dataCronbach's alpha values for the global 17-item HCV-TSE and its four factors were all high (≥0.85), indicating good internal consistency; S2 values were slightly lower than S1.
“The values for S2 were slightly lower than those for S1; yet, all alphas were high (≥0.85) demonstrating good internal consistency.”
- Also stated in: § Abstract · boosted
“The global score (0.92 to 0.94) and four factors (0.85 to 0.96) demonstrated good internal consistency.”
Quote in the paperSubstantial claim- Also stated in: § Abstract · boosted
May combine two claims.
Findingown dataAt baseline, the global HCV-TSE score correlated negatively with depression (−0.50) and irritability (−0.38), and positively with social support (0.42) and QOL subscales (0.35 to 0.48).
“The directions of these relationships were also in the expected direction, with the global HCV-TSE score demonstrating negative associations with depression (−0.50) and irritability (−0.38) and positive associations with social support (0.42) and the QOL subscales (0.35 to 0.48).”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataPhysical coping and psychological coping were moderately correlated (r=0.57), while all other factor pairs had low correlations (r=0.27-0.40).
“Inter-factor correlations demonstrated physical coping and psychological coping were moderately associated (r=0.57), while all other pairwise comparisons demonstrated low associations (r=0.27–0.40).”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataIn the week 24 follow-up CFA (n=254), overall fit was unsatisfactory (χ2=417.8, df=113, p<0.0001) but met NNFI (0.92) and CFI (0.94).
“As was seen previously, the overall fit was not satisfactory (χ2=417.8, df =113, p<0.0001), but this model met the criteria for goodness of fit with both the NNFI (0.92) and the CFI (0.94).”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataIn the S1 CFA, the initial 19-item model fit was unsatisfactory by chi-square (χ2=573.6, df=146, p<0.0001), NNFI (0.87), and CFI (0.89).
“Based on the chi-square test (χ2=573.6, degrees of freedom (df) =146, p<0.0001), the NNFI (0.87) and the CFI (0.89), the fit was not satisfactory.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataThe four-factor model satisfied the criteria and could be interpreted.
“The 4 factor model met the above criteria and was interpretable.”
Quote in the paperSubstantial claim- The authors state this as an assumption: The VIRAHEP-C self-efficacy items have face validity for assessing different types of self-efficacy beliefs relevant to antiviral treatment.
May combine two claims.
Findingown dataThe final 17-item model was unsatisfactory by chi-square (χ2=388.4, df=113, p<0.0001) but met NNFI (0.90) and CFI (0.92) criteria.
“The model fit was not satisfactory based on the chi square test of fit (χ2=388.4, df =113, p<0.0001), but met the criteria for NNFI (0.90) and CFI (0.92).”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataIn S2, overall fit was unsatisfactory (χ2=371.7, df=113, p<0.0001); the model met CFI (0.91) but fell just short of NNFI (0.89).
“The overall fit of the model was not satisfactory (χ2=371.7, df =113, p<0.0001). The model met the criteria for CFI (0.91), but was just shy of reaching the criteria for NNFI (0.89).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataFor general psychological coping self-efficacy, correlations were moderate with depression (−0.41) and mental health functioning (0.48).
“General psychological coping self-efficacy had moderate correlations with depression (−0.41) and mental health functioning (0.48).”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataOther models had items loading on multiple factors, too many items without strong single-factor loadings, or interpretability problems.
“The other models had double loading of items onto multiple factors, too many items that were not strongly loading onto one specific factor or interpretability issues.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataFactor loadings were very similar across the two subsamples, and the factor correlations in both CFAs closely matched the EFA.
“When comparing the factor loadings of the EFA and two CFAs (Table 1), we see that the loadings are very similar for the two subsamples. In addition, the factor correlations for both CFAs were nearly identical to those found in the EFA.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataAfter reviewing factor loadings, the item count was cut from 24 to 20 because four items did not load meaningfully on a single factor.
“After a review of the factor loadings in the 4 factor model, we reduced the number of items from 24 to 20. Four items (Items 1–4 of the original measure; Appendix A) were removed because they did not meaningfully load onto a single factor.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationThe medication-taking behavior questions gave relatively reliable and valid estimates but tended to overstate how often patients took ribavirin and injected pegylated interferon relative to electronic monitoring.
“During the VIRAHEP-C study, these questions demonstrated relatively reliable and valid estimates, although they tended to overestimate medication adherence to ribavirin and injected pegylated interferon when compared with electronic monitoring devices (46).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [46] source
Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable).
Interpretationnone givenThis work lays groundwork for understanding how self-efficacy functions in HCV treatment.
“Despite these limitations, we believe this study provides a foundation for understanding the role of self-efficacy during HCV treatment.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataThe HCV-TSE instrument produced four reliable and valid factors reflecting different belief types that may matter for adherence and treatment persistence during antiviral treatment.
“Additionally, the HCV-TSE instrument yielded four reliable and valid factors that reflect different types of beliefs that may be important to adherence and treatment persistence during antiviral treatment.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
PremisecitationGreater self-efficacy may protect against depression, which is a common side effect of interferon-based therapy.
“Moreover, higher levels of self-efficacy can buffer against the effects of depression, which is a major adverse side effect of interferon-based therapies (13;14;34).”
Quote in the paperSubstantial claim0 of 3 sources checkedMay combine two claims.
Interpretationown dataThe revised HCV-TSE instrument gives a reliable and valid global estimate of confidence in engaging in and adhering to HCV antiviral treatment.
“The revised HCV-TSE instrument provides a reliable and valid global estimate of confidence in one’s ability to engage in and adhere to HCV antiviral treatment.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductreasoningThe baseline group was randomly split into two equal halves; S1 served for the initial EFA/CFA, and S2 served to validate the factor structure.
“Since we were aware that performing EFA and CFA on the same sample could lead to less generalizable results and more significance by chance, we randomly split the baseline sample (N=394) into two equal sized subsamples. Subsample 1 (S1) was used to perform the initial EFA/CFA; subsample 2 (S2) was used to validate the factor structure of S1 using CFA.”
Quote in the paperSubstantial claim- Rests on an assumption: Performing EFA and CFA on the same sample can produce less generalizable results and more significance by chance.
May combine two claims.
Interpretationown dataThe HCV-TSE global score had strong reliability and construct validity relative to other psychosocial measures.
“Findings from our analyses of the HCV-TSE lend support for a global, overall estimate of self-efficacy during HCV treatment. The global score demonstrated very good reliability and construct validity when compared with other psychosocial measures.”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductreasoningThe split did not create two truly independent groups, but the two random subsamples allowed validation of the HCV-TSE instrument from the initial EFA/CFA.
“Although this splitting did not result in two truly independent populations, obtaining two random subpopulations permitted us to validate the HCV-TSE instrument obtained from the initial EFA/CFA.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationResearch on self-efficacy beliefs in hepatitis C is scarce, and no studies were found that looked at these beliefs while patients were on antiviral treatment.
“Despite the importance of self-efficacy to medication adherence in other medical regimens, there is limited research in the HCV literature that examine self-efficacy beliefs, and no studies were identified that examined these beliefs during antiviral treatment (35;36).”
Quote in the paperSubstantial claim0 of 2 sources checkedClassified as probably not a substantial claim. May combine two claims.
PremisecitationSelf-efficacy beliefs are important targets for clinical intervention because they can be enhanced, leading to better self-management of chronic illness, including hepatitis C.
“Self-efficacy beliefs are important targets for clinical intervention, given that they can be enhanced, resulting in improved patient self-management of chronic illness, including chronic hepatitis C (35;36).”
Quote in the paperSubstantial claim0 of 2 sources checkedMay combine two claims.
PremisecitationPrior work found these self-report adherence questions somewhat overstated antiviral medication use relative to electronic monitoring, yet the discrepancy was small enough to treat the self-report as reliable and valid.
“These items were previously found to somewhat overestimate adherence to antiviral medication when compared to electronic monitoring, although this difference was acceptable enough to deem the self-report reliable and valid (61).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [61]
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationTask or action self-efficacy is central to starting cognitive and behavioral processes to begin a behavior and, less so, to maintaining it.
“This type of self-efficacy is referred in the literature as task or action self-efficacy and is pivotal to initiating basic cognitive and behavioral processes to initially engage in a behavior, and to a lesser degree, maintain the behavior (33;48).”
Quote in the paperNot a substantial claim0 of 2 sources checkedClassified as probably not a substantial claim.
PremisecitationDifferent types of self-efficacy may exist at the same time.
“Marlatt et al., was the first to posit that different types of self-efficacy may exist simultaneously (33;47).”
Quote in the paperSubstantial claim0 of 2 sources checkedProbably not a substantial claim: may not pass S2 (checkable).
Premisenone givenSelf-efficacy measurement must be precise to the behavior studied and the patient population.
“However, self-efficacy requires measurement precision specific to the (1) behavior being studied (e.g., medication taking, communication, etc.), and the (2) patient population (e.g., diabetes, cancer, HIV, HCV, etc.).”
Quote in the paperNot a substantial claim
The authors state this as an assumption.
The VIRAHEP-C self-efficacy items have face validity for assessing different types of self-efficacy beliefs relevant to antiviral treatment.
“First, given the face validity of the items, the measure appeared to potentially assess different types of self-efficacy beliefs which may be important to antiviral treatment (14;15;47;48).”
The paper relies on this without support.
Performing EFA and CFA on the same sample can produce less generalizable results and more significance by chance.
“Since we were aware that performing EFA and CFA on the same sample could lead to less generalizable results and more significance by chance, we randomly split the baseline sample (N=394) into two equal sized subsamples.”
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Flagged first, then by citations
Research works printed but not linked: 7
- World Health Organization, 2010, Viral Hepatitis: Report by the Secretariat
- Jacobsen IM, 2010, Telaprevir in combination with peginterferon and ribavirin in genotype 1 HCV treatment‐naive patients: final results of phase 3 ADVANCE study, Hepatology, 52
- Sherman KE, 2010, Telaprevir in combination with peginterferon alfa‐2a and ribavirin for 24 or 48 weeks in treatment‐naive genotype 1 HCV patients who achieved an extended rapid viral response: final results of phase 3 ILLUMINATE study, Hepatology, 52
- Poordad F, 2010, Boceprevir combined with peginterferon alfa‐2b/ribavirin for treatment‐naive patients with hepatitis C virus genotype 1: SPRINT‐2 final results, Hepatology, 52
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Cited by
Sorted by citations
Evon, D. M., Golin, C. E., Ruffin, R., Ayres, S., & Fried, M. W. (2018) · Pilot and Feasibility Studies · doi:10.1186/s40814-018-0285-5 · Cited by 8 · see citing works
“, relaxation, awareness of tension, assertiveness, coping confidence) using the Measure of Current Status (MOCS) [22], HCV treatment self-efficacy [23], and nonspecific therapeutic aspects of group therapy [24–26].”
MethodSelf-citation
- Authors
- Bonner, J. E., Esserman, D., & Evon, D. M.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Esserman, D.
- Venue
- Journal of Viral Hepatitis
- Publisher
- Wiley
- Published
- 2011-11-24
- Volume
- 19
- Issue
- 5
- Pages
- 316-326
- ISSN
- 1352-0504 (ISSN-L)
- 1365-2893
- PMC
- PMC3334309
- OpenAlex
- W1962387439
- Cited by
- 8
- References
- 53
- Citations by year
- 2024: 1 · 2019: 1 · 2018: 2 · 2016: 1 · 2015: 2 · 2013: 1
- FWCI
- 0.20
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Viral Hepatitis (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (KL2TR001109)
- National Institute of Diabetes and Digestive and Kidney Diseases (K23DK089004)
- National Center for Research Resources (UL1RR025747)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Hepatology › Hepatitis C virus research
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Social Sciences › Education › Health Education and Validation
- Keywords
- hepatitis C, self-efficacy, antiviral treatment adherence, psychometric validation, factor structure, coping self-efficacy, medication adherence, chronic viral hepatitis
- MeSH terms
- Antiviral Agents, Hepatitis C, Humans, Longitudinal Studies, Neuropsychological Tests, Prospective Studies, Reproducibility of Results, Drug Monitoring, Self Efficacy
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read under definition version 3 (extract-v3) on 2026-09-28.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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