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Development and initial testing of a Health Confidence Score (HCS)
  1. Tim Benson1,2,
  2. Henry W W Potts2,
  3. Pippa Bark2,
  4. Clive Bowman3
  1. 1R-Outcomes Ltd, Thatcham, UK
  2. 2Institute of Health Informatics, UCL, London, UK
  3. 3School of Health Sciences, City, University of London, London, UK
  1. Correspondence to Tim Benson; tim.benson{at}


Introduction Patients need to feel confident about looking after their own health. This is needed to improve patient outcomes and clinical support. With few suitable tools available to measure self-care health confidence, we developed and validated a short, generic survey instrument for use in evaluation and quality improvement.

Methods The Health Confidence Score (HCS) was developed through literature review, patient and expert focus groups and discussions. This paper reports an initial survey (n = 1031, study 1) which identified some issues and a further face-to-face survey (n = 378, study 2) to test the construct and concurrent validity of the final version. Scores were correlated against the My Health Confidence (MHC) rating scale, howRu (health status measure) and relevant demographics.

Results The HCS is short (50 words) with good readability (reading age 8). It has four items covering health knowledge, capability to self-manage, access to help and shared decision-making; each has four response options (strongly agree, agree, neutral disagree). Items are reported independently and as a summary score.

The mean summary score was 76.7 (SD 20.4) on 0–100 scale. Cronbach’s alpha = 0.82. Exploratory factor analysis suggested that the four items relate to a single dimension. Correlation of the HCS summary score with MHC was high (Spearman r = 0.76). It was also associated with health status (Spearman r = 0.49), negatively with number of medications taken (r=–0.29) and age (r=–0.22) and not with ethnicity, having children or education level.

Conclusions The HCS is short, easy to use, with good psychometric properties and construct validity. Each item is meaningful independently and the summary score gives an overall picture of health confidence.

  • attitudes
  • patient-centred care
  • surveys
  • healthcare quality improvement
  • quality measurement

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  • Contributors TB designed the Health Confidence Score with CB and wrote the first draft of the paper. HWWP designed the surveys with TB. TB, HWWP and PB performed the analyses. All authors contributed to the final text, read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests TB is a director and shareholder in R-Outcomes Ltd, which provides quality improvement and evaluation services using the Health Confidence Score. HWWP has received consultancy fees from Crystallise, System Analytic and The HELP Trust and received funding from myownteam and, unrelated to the work reported here. CB is a non-executive director of AKARI Care Homes, FINCCH and Invatech Health. The authors declare that they have no other conflicting interests. Please contact R-Outcomes Ltd if you wish to use the Health Confidence Score.

  • Patient consent for publication Not required.

  • Ethics approval Research ethics approval was not sought because both studies used data collected anonymously from members of the public who consented freely to complete the task.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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