Open Access Open Access  Restricted Access Subscription Access

The relationship between self-efficacy and health-related quality of life in Multiple Sclerosis patients

Silvia Testa, Giorgia Molinengo, Alessandra Oggero, Antonio Bertolotto, Rosalba Rosato


Background and Objectives Multiple sclerosis (MS) has a broad spectrum of physical, social, psychological effects and significant impact on quality of life (QoL). Several studies has showed the importance of self-efficacy as a predictor of QoL in patients with MS.

This study aims at evaluating the robustness of the relationship between self-efficacy and QoL. Specifically it aims to test whether such relation will vanish under the following conditions: using a general measure of self-efficacy and controlling for level of impairment defined as a broad construct dealing with physical, social and working changes due to the illness condition.

Methods One hundred-fifty five participants responded to a questionnaire, including QoL and general self-efficacy measures, socio demographic and clinical variables. Two nested structural equation models that differ for the presence or absence of the path connecting self-efficacy and QoL was estimated.

Results and Conclusions The hypothesis of the vanishing of the relationship between self-efficacy and QoL had to be rejected. These results support the genuineness of this relation and emphasize the importance of interventions promoting self-efficacy to improve QoL in chronic diseases such as MS. From a methodological perspective this study is an example of the usefulness of formative indicators in QoL studies.


Formative and reflective indicators, HRQoL scores, multiple sclerosis, person-centered healthcare, quality of life, self-efficacy, structural equation model

Full Text:



Sadovnick, A. D., Ebers, G. C. (1993) Epidemiology of multiple sclerosis: a critical overview. Canadian Journal of Neurological Sciences, 20(1), 17-29.

Rothwell, P. M., McDowell, Z., Wong, C. K., Dorman, P. J. (1997) Doctors and patients don't agree: cross sectional study of patients' and doctors' perceptions and assessments of disability in multiple sclerosis. British Medical Journal, 314(7094), 1580-1583.

McCabe, M. P., Mc Kern, S. (2002) Quality of life and multiple sclerosis: comparison between people with multiple sclerosis and people from the general population. Journal of Clinical Psychology in Medical Settings, 9(4), 287-295.

Nicholl, C. R, Lincoln, N. B., Francis, V. M., Stephan, T. F. (2001) Assessing quality of life in people with multiple sclerosis. Disability and Rehabilitation, 23(14), 597-603.

Pittock, S. J., Mayr, W. T., McClelland, R. L., Jorgensen, N. W., Weigand, S. D., Noseworthy, J. H., Rodriguez, M. (2004) Quality of life is favorable for most patients with multiple sclerosis: a population-based cohort study. Archives of neurology, 61(5), 679-686.

Dennison, L., Moss-Morris, R., Chalder, T. (2009) A review of psychological correlates of adjustment in patients with multiple sclerosis. Clinical psychology review, 29(2), 141-153.

Stuifbergen, A. K. (1995) Health-promoting behaviors and quality of life among individuals with multiple sclerosis. Research and theory for nursing practice, 9(1), 31-50.

Stuifbergen, A. K., Blozis, S. A., Harrison, T. C., Becker, H. A. (2006) Exercise, functional limitations, and quality of life: A longitudinal study of persons with multiple sclerosis. Archives of physical medicine and rehabilitation, 87(7), 935-943.

Bandura, A. (1986) Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, New Jersey: Prentice-Hall.

Barnwell, A. M., Kavanagh, D. J. (1997) Prediction of psychological adjustment to multiple sclerosis. Social Science & Medicine, 45(3), 411-418.

Riazi, A., Thompson, A. J., Hobart, J. C. (2004) Self-efficacy predicts self-reported health status in multiple sclerosis. Multiple sclerosis, 10(1), 61-66.

Wassem, R. (1992) Self-efficacy as a predictor of adjustment to multiple sclerosis. Journal of neuroscience nursing, 24(4), 224-229.

Mitchell, A. J., Benito-Leon, J., Gonzalez, J. M., Rivera-Navarro, J. (2005) Quality of life and its assessment in multiple sclerosis: integrating physical and psychological components of wellbeing. Lancet neurology, 4(9), 556-566.

Stuifbergen, A. K., Seraphine, A., Roberts, G. (2000) An explanatory model of health promotion and quality of life in chronic disabling conditions. Nursing Research, 49(3), 122-129.

Amir, M., Roziner, I., Knoll, A., Neufeld, M. Y. (1999) Self-Efficacy and Social Support as Mediators in the Relation Between Disease Severity and Quality of Life in Patients with Epilepsy. Epilepsia, 40(2), 216-224.

Motl, R. W., McAuley, E., Snook, E. M., Gliottoni, R. C. (2009) Physical activity and quality of life in multiple sclerosis: Intermediary roles of disability, fatigue, mood, pain, self-efficacy and social support. Psychology, health & medicine, 14(1), 111-124.

Schwarzer, R., Jerusalem, M. (1995) Generalized Self-Efficacy scale. In Measures in health psychology: A user’s portfolio (eds M. Johnston, S. Wright, J. Weinman), pp. 35-37. Windsor: Nfer-Nelson.

Boehmer, S., Luszczynska, A., Schwarzer, R. (2007) Coping and quality of life after tumor surgery: personal and social resources promote different domains of quality of life. Anxiety, Stress, & Coping, 20(1), 61-75.

Reuter, T., Ziegelmann, J. P., Wiedemann, A. U., Geiser, C., Lippke, S., Schüz, B., Schwarzer, R. (2010) Changes in intentions, planning, and self-efficacy predict changes in behaviors: An application of latent true change modeling. Journal of health psychology, 15(6), 935-947.

Kurtzke, J. F. (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology, 33(11), 1444-1452.

Apolone, G., Mosconi, P. (1998) The Italian SF-36 Health Survey: translation, validation and norming. Journal of clinical epidemiology, 51(11), 1025-1036.

Ware, J. E., Kosinski, M., Dewey, J. E., Gandek, B. (2000) SF-36 health survey: manual and interpretation guide. Lincoln, Rhode Island: Quality Metric Inc.

Ware, J. E., Sherbourne, C. D. (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical care, 30(6), 473-483.

Scholz, U., Dona, B. G., Sud, S., Schwarzer, R. (2002) Is general self-efficacy a universal construct? Psychometric findings from 25 countries. European journal of psychological assessment, 18(3), 242-251.

Sibilia, L., Schwarzer, R., Jerusalem, M. (26 Dec 1997). Italian Adaptation of the General Self-Efficacy Scale. Available at: (Accessed 07 July 2009).

Jarvis, C. B., Mackenzie, S. B., Podsakoff, P. M. (2003) A critical review of construct inidicators and measurement model misspecification in marketing and consumer research. Journal of consumer research, 30(2), 199-218.

Bollen, K. A., Davis, W. R. (2009) Causal Indicator Models: Identification, Estimation, and Testing. Structural equation modeling, 16(3), 498–522.

Jöreskog, K. C., Sörbom, D. (1993) LISREL 8: User’s reference guide. Chicago: Scientific Software.

Browne, M. W., Cudeck, R. (1993) Alternatives ways of assessing model fit. In Testing Structural Equation Models (eds K. A. Bollen, J. S. Long), pp. 132–162. London: Sage.

Hu, L., Bentler, P. M. (1999) Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural equation modeling, 6(1), 1-55.

Schwarzer, R., Hallum, S. (2008) Perceived teacher self efficacy as a predictor of job stress and burnout: Mediation analyses. Applied Psychology: An Interntional Review, 57(s1), 152-171.

Motl, R. W., Snook, E. M. (2008) Physical Activity, Self-Efficacy, and Quality of Life in Multiple Sclerosis. Annals of behavioral medicine, 35(1), 111-115.

Ng, A., Kennedy, P., Hutchinson, B., Ingram, A., Vondrell, S., Goodman, T., Miller, D. (2012) Self-efficacy and health status improve after a wellness program in persons with multiple sclerosis. Disability and rehabilitation, 35(12), 1039-1044.

Marks, R., Allegrante, J. P., Lorig, K. (2005) A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: implications for health education practice (part I). Health promotion practice, 6(1), 37-43.

Anderson, J. C., Gerbin, D. W. (1982) Some methods for respecifying measurement models to obtain unidimensional construct measurement. Journal of marketing research, 19(4), 453-460.

Rapley, P., Fruin, D. J. (1999) Self-efficacy in chronic illness: the juxtaposition of general and regimen-specific efficacy. International journal of nursing practice, 5(4), 209-215.



  • There are currently no refbacks.