The Self-Efficacy for Functional Abilities Scale for Older Adults in Long-Term Care: Two-Level Exploratory and Confirmatory Factor Analysis

By Liu, Wen; Galik, Elizabeth et al. | Journal of Nursing Measurement, April 1, 2015 | Go to article overview

The Self-Efficacy for Functional Abilities Scale for Older Adults in Long-Term Care: Two-Level Exploratory and Confirmatory Factor Analysis


Liu, Wen, Galik, Elizabeth, Resnick, Barbara, Journal of Nursing Measurement


Background and Purpose: This study examines the underlying factor structure of the Self-Efficacy for Functional Abilities (SEFA) scale among older adults in long-term care settings. Methods: A secondary analysis of SEFA data for 568 residents in 16 long-term care facilities was applied. The sample was randomly split into 2 subsamples. A 2-level exploratory and confirmatory factor analysis adjusting for clustering effect of facilities was used to identify and determine the factor structures respectively. Results: There were 1- and 2-factor models that were identified. Both models demonstrated acceptably mixed model fit. The 2-factor model had poor discriminant validity with high correlation between factors (r = .92, p < .001). The single-factor model was considered valid with moderate correlation with function (r = .301, p < .001). Conclusions: The SEFA scale demonstrated a unidimensional construct among older adults in long-term care settings. Future testing is needed among other older adult populations.

Keywords: factor analysis; long-term care; Self-Efficacy for Functional Abilities (SEFA) scale; older adults

The ability to perform activities of daily living (ADLs) is the most basic function for older adults in long-term care settings, and decreased functional abilities has significant impact on health (Hjaltadóttir, Hallberg, Ekwall, & Nyberg, 2011). Older adults demonstrate functional decline in performing various ADLs over time after admission to long-term care facilities (Carpenter, Hastie, Morris, Fries, & Ankri, 2006; Gillen, Spore, Mor, & Freiberger, 1996; Hjaltadóttir, Hallberg, Ekwall, & Nyberg, 2012) and that functional decline is frequently beyond what is anticipated with aging-related deteriorations and various comorbidities (Wang, Kane, Eberly, Virnig, & Chang, 2009). Long-term care residents may experience risk of greater functional decline because of various personal and institutional factors. These factors included caregivers' perception that residents are unable to actively perform functional activities with or without assistance (Galik, Resnick, & Pretzer-Aboff, 2009), custodial care practice that focuses on task completion, which reinforces excessive dependence (Bowers, Esmond, & Jacobson, 2000), and institutional policies that restrict activities for safety reasons (Galik et al., 2009). It is imperative to evaluate residents' current confidence and motivation in doing ADLs so as to reduce excessive dependence and enhance autonomy in performing functional activities at appropriate time (Resnick, 1998b, 2000). Increased independence and participation in these activities not only improves and maintains function but also enhances physical and emotional health and quality of life (Galik et al., 2008; Resnick, Galik, Gruber-Baldini, & Zimmerman, 2009; Resnick, Gruber-Baldini, et al., 2009).

The Self-Efficacy for Functional Abilities (SEFA) scale assesses individuals' confidence in doing daily functional activities. Previous studies that have used the SEFA scale employed the total score by summing up the responses of 11 items, instead of using the score of any single item or a subgroup of items, with the underlying assumption that the 11 items cluster together (Pretzer-Aboff, Galik, & Resnick, 2011; Resnick, Galik, et al., 2009; Resnick, Galik, Gruber-Baldini, & Zimmerman, 2011; Resnick, Gruber-Baldini, et al., 2009). Prior research also pointed out the need of continued testing of the scale to ensure that the items have a direct relationship with the latent variable of self-efficacy for functional abilities, indicating the need of factor analysis (Resnick, 2003). The purpose of this study is to examine the underlying factor structure of the 11 SEFA items among older adults in long-term care using factor analysis modeling approaches. We conducted two-level exploratory factor analysis (EFA) to identify initial empirical factor structures in one randomly selected half of the sample and then two-level confirmatory factor analysis (CFA) to evaluate the identified factor structures in the other half of sample. …

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