The Self-Management Behavior Questionnaire
(SMBQ),30 was used to measure older persons’ selfmanagement
behaviors. The SMBQ is a 37-item
instrument consisting of five dimensions of selfmanagement
behaviors, including: communication
with health care providers (eight items); partnership
in care (seven items); self-care activities (11 items);
self-advocacy behaviors (10 items); and, medication
adherence behavior (one item). Examples of an item
from two different dimensions, within the instrument,
include: “During the past six months, how often have
you kept track of blood glucose (sugar) levels?”
(self-care activities); and, “In the past six months,
how often have you used additional treatments other
than what your doctor prescribed?” (medication
adherence behavior). Possible responses to each item
ranged from 1 = “never” to 5 = “all of the time.” A
total score, which could range from 37 to 185, was
obtained by summing the response values across all
items. The total score indicated the level of selfmanagement
behaviors, whereby a score of: 37 to
85.9 = low; 86 to 135.9 = moderate; and, 136-185
= high. Cronbach’s alpha for the SMBQ, in this study,
was 0.95.
The 12-item Perceived Self-Management
Self-Efficacy Questionnaire (PSMESEQ),30 was used
to measure each subject’s level of perceived selfefficacy
for self-management. Examples of items
were: “How confident are you in your ability to know
what questions to ask a doctor?” and “How confident
are you in your ability to adjust your food intake to
improve your health?” Each item had possible
responses ranging from 1 = “not at all confident” to
5 = “very confident.” A total score, which could range
from 12 to 60, was obtained by summing the response
values across all items. The total score indicated the
subject’s amount of perceived self-efficacy for selfmanagement,
whereby a score of: 12 to 27.9 = low;
28 to 43.9 = moderate; and, 44 to 60 = high. The
instrument’s internal consistency coefficient, in this
study, was 0.96.
The 10-item Modified Barthel Activities of
Daily Living Index (BAI),38 was used to measure each
subject’s ability to perform personal care in basic ADL.
Two items addressed activities related to bathing and
grooming (i.e., “Were you able to wash your face/do
your hair/ brush your teeth /shave in the preceding
24-48 hours?”) and had responses of either 0 =
“require some assistance” or 1 = “do independently.”
Six items (i.e. “To what degree can you eat food that
is cooked and served by others, but not cut up?” and
“To what degree can you control your bowels and
bladder without accidents?”) dealt with the activities
of eating, dressing, toileting, urine and bowel
continence, and stair climbing. Possible responses
were: 0 = “completely dependent;” 1 = “require some
assistance;” or, 2 = “do independently.” Two items
focused on activities of transferring (in and out of bed
or chair) and mobility (i.e. “To what degree are you
able to move in and out of bed or a chair without
assistance, other than using a cane or walker?”).
Possible responses were: 0 = “completely dependent;”
1 = “require some assistance;” or, 3 = “do
independently.” A total score, which could range from
0 to 20, was obtained by summing the response values
across all items. The total score indicated the amount
of dependence, whereby: 0 to 4 = total; 5 to 8 = severe;
9 to 11 = moderately severe; or, 12 to 20 = mildly
severe. The test-retest reliability for the BAI, in this
study, was r = 1.000; p ≤ .001.
The 5-item Chula Activities of Daily Living
Index (Chula ADL)39 was used to measure each elder’s
instrumental ADL. The instrument addressed five
complex activities: walking outdoors (one item);
cooking (one item); using public transportation (one
item); doing heavy housework (one item); and,
exchanging money (one item). Examples of items and
their possible responses were: “Walking outdoors” (0 =
“don’t do;” 1 = “need assistance from another;” 2 =
“need to be accompanied by another”; or, 3 = “do
independently.”); “Cooking” (0 = “don’t do;” 1 =“need assistance from another”; or, 2 =
“do independently”); “Using public transportation”
(0 = “don’t do;” 1 = “need assistance from another;”
or, 2 = “do independently”); “Doing heavy
housework” (0 = “don’t do” or 1 = do independently”)
and, “Money exchange” (0 = “don’t do” or 1 =
do independently”). A total score, which could range
from 0 to 9, was obtained by summing response values
across all items. A low score suggested a low level of
functional ability, while a high score suggested the
presence of functional independence. The test-retest
reliability for the Chula ADL, in this study, was r =
1.000; p ≤ .001.
The 13-item Chula Mental Test (CMT)40 was
used to assess cognitive function regarding: perception
(four items: i.e. “Show pen and ask what it is?”);
memory (three items: i.e. “How old are you?” and
“What time is it?”); attention (three items: i.e. “Clap
your hands