Introduction
Rheumatoid arthritis (RA) significantly impacts patients’ quality of life, making self-management crucial for better outcomes. Consequently, the Rheumatoid Arthritis Self-Efficacy Scale (RASE), developed by Sarah Hewlett and colleagues in 2001, emerges as a vital tool for assessing task-specific self-efficacy in RA patients. With over 90 citations on Google Scholar, this 28-item questionnaire measures patients’ confidence in initiating self-management behaviors across eight domains, such as pain management and emotional regulation. Furthermore, its robust psychometric properties ensure reliability and validity for clinical and research applications.
This article provides a comprehensive guide to the RASE, detailing its structure, applications, and value for researchers and clinicians aiming to improve RA patient outcomes.
Key Features of the Rheumatoid Arthritis Self-Efficacy Scale
Purpose and Use of the Rheumatoid Arthritis Self-Efficacy Scale
The RASE is designed to measure task-specific self-efficacy, focusing on patients’ beliefs in their ability to perform self-management tasks related to RA. Unlike general self-efficacy tools, its targeted approach ensures relevance for RA patients, addressing key areas like relaxation, exercise, and fatigue management. As a result, it supports clinicians in tailoring interventions and researchers in studying self-management trends.
Target Population
The RASE is suitable for adults aged 18 and older with rheumatoid arthritis, including:
- Young adults (18–24 years)
- Middle-aged adults (25–44 years)
- Older adults (45–64 years)
- Seniors (65+ years)
Its applicability across these groups makes it versatile for rheumatology clinics and research studies, though it lacks validation for non-RA populations.
Structure
The RASE comprises 28 items across eight dimensions of self-management critical to RA:
- Relaxation: Confidence in managing stress and tension.
- Relationships: Ability to maintain social connections.
- Function: Competence in daily activities.
- Leisure Activities: Belief in engaging in recreational pursuits.
- Exercise: Confidence in maintaining physical activity.
- Sleep: Ability to achieve restful sleep.
- Medication: Adherence to prescribed treatments.
- Fatigue: Strategies to manage energy levels.
Each item uses a 5-point Likert scale (1 = Strongly disagree, 5 = Strongly agree), producing a total score from 28 to 140, with higher scores indicating greater self-efficacy.
Scoring Method of the Rheumatoid Arthritis Self-Efficacy Scale
The RASE uses a 5-point Likert scale, with scores summed to a total ranging from 28 to 140. Higher scores reflect greater self-efficacy in RA self-management. Notably, there are no strict cut-off scores; however, clinicians can use score trends to identify areas needing intervention. For example, low scores in the “Fatigue” dimension might prompt targeted energy management strategies. Researchers often analyze subscale scores to explore specific self-efficacy patterns.
Administration Format and Time
The RASE can be administered via:
- Paper-based forms
- Digital (online) platforms
- In-person interviews
- Phone or video calls
This flexibility enhances its accessibility in diverse contexts. It takes approximately 10 minutes to complete making it ideal for clinical settings. No training is required as it is self-administered.
Applications of the Rheumatoid Arthritis Self-Efficacy Scale
The RASE offers diverse applications for researchers and clinicians:
- Monitoring: Tracks changes in self-efficacy over time or during interventions.
- Treatment Planning: Guides personalized interventions based on subscale scores, such as exercise programs for low physical activity confidence.
- Research: Supports studies on RA self-management and intervention outcomes.
- Evaluating Interventions: Assesses the impact of self-management or education programs, providing insights into their effectiveness.
For instance, a clinician might use a low “Medication” subscale score to address adherence issues, while researchers can analyze trends to inform RA care protocols.
Languages and Availability
To support global use, the RASE is available in:
- English
- Danish
Additional translations may require validation to ensure cultural relevance. Items are included in appendices of published papers and may be used for non-commercial research with citation. For copies or formal permission (especially for commercial use or republication), contact the lead author (Prof. Sarah Hewlett) at Sarah.Hewlett@uwe.ac.uk.
Reliability and Validity
The RASE demonstrates high reliability and validity, with a Cronbach’s alpha of 0.89–0.91, indicating strong internal consistency. Although it was developed specifically for RA patients in the UK, the items appear to be appropriate for other forms of arthritis, and other countries as well. Validation studies, including the original study, a revalidation and a Danish validation, confirm its sensitivity to change and applicability in RA populations. Consequently, it is a trusted tool for monitoring self-efficacy in clinical and research settings.
Limitations and Considerations
Despite its strengths, the RASE has a few limitations:
- Self-Report: Responses may be influenced by social desirability bias or personal interpretation.
- Cultural Bias: Limited validation in diverse populations may affect applicability.
- Language Barriers: Available only in English and Danish, requiring further translations.
- Limited Validation Studies: Additional studies are needed for broader applicability, particularly in non-RA arthritis populations.
Other Versions and Related Questionnaires
Other versions of the RASE include:
- 9-item Shortened RASE: A condensed version for quicker administration.
The RASE complements other self-efficacy tools:
- Arthritis Self-Efficacy Scale (ASES): Focuses on general arthritis self-efficacy.
Chronic Disease Self-Efficacy Scale (CDSES): Addresses self-efficacy in chronic conditions broadly.
These tools can be paired with the RASE for comprehensive assessments of RA and related conditions.
Additional Resources
For more information on the RASE, explore these resources:
- The Original Validation Study.
- A revalidation study.
- The Danish validation study.
- Item response theory analysis of two questionnaire measures of arthritis-related self-efficacy beliefs: Link.
- For inquiries, contact Sarah Hewlett at Sarah.Hewlett@uwe.ac.uk.
- For more information consult: Measures of self-efficacy.
Frequently Asked Questions (FAQ)
- Who can use the RASE?
Clinicians, researchers, and healthcare providers use the RASE for RA patients aged 18 and older. - How long does it take to complete the RASE?
Patients typically take about 10 minutes, making it suitable for busy clinical settings. - How is the RASE administered?
Healthcare teams can administer it via paper, digital, interview, or phone/video call formats, offering flexibility. - Is there any cost to using the RASE?
The RASE is free for non-commercial research with citation. For commercial use, contact Sarah Hewlett at Hewlett@uwe.ac.uk.
A word from ResRef about the Rheumatoid Arthritis Self-Efficacy Scale
The Rheumatoid Arthritis Self-Efficacy Scale (RASE) is a validated instrument designed to assess self-efficacy beliefs in individuals with rheumatoid arthritis (RA). Self-efficacy, a key construct in chronic disease management, refers to a patient’s confidence in their ability to cope with symptoms, adhere to treatment, and maintain daily functioning despite disease challenges. The RASE evaluates multiple domains, including pain management, symptom control, and emotional regulation, providing insights into patients’ perceived capabilities. Developed through rigorous psychometric testing, the scale demonstrates good reliability and validity, making it a useful tool for clinicians and researchers aiming to improve RA self-management interventions.
References
- Hewlett S, Cockshott Z, Kirwan J, Barrett J, Stamp J, Haslock I. Development and validation of a self-efficacy scale for use in British patients with rheumatoid arthritis (RASE). Rheumatology (Oxford). 2001 Nov;40(11):1221-30. doi: 10.1093/rheumatology/40.11.1221. PMID: 11709605. Study link.
- Hewlett S, Cockshott Z, Almeida C, Richards P, Lowe R, Greenwood R, Kirwan J; RASE Study Group. Sensitivity to change of the Rheumatoid Arthritis Self-Efficacy scale (RASE) and predictors of change in self-efficacy. Musculoskeletal Care. 2008 Mar;6(1):49-67. doi: 10.1002/msc.125. PMID: 18228530. Study link.
- Primdahl J, Wagner L, Hørslev-Petersen K. Self-efficacy in rheumatoid arthritis: translation and test of validity, reliability and sensitivity of the Danish version of the Rheumatoid Arthritis Self-Efficacy Questionnaire (RASE). Musculoskeletal Care. 2010 Sep;8(3):123-35. doi: 10.1002/msc.172. PMID: 20229609. Study link.
- Brady TJ. Measures of self-efficacy: Arthritis Self-Efficacy Scale (ASES), Arthritis Self-Efficacy Scale-8 Item (ASES-8), Children’s Arthritis Self-Efficacy Scale (CASE), Chronic Disease Self-Efficacy Scale (CDSES), Parent’s Arthritis Self-Efficacy Scale (PASE), and Rheumatoid Arthritis Self-Efficacy Scale (RASE). Arthritis Care Res (Hoboken). 2011 Nov;63 Suppl 11:S473-85. doi: 10.1002/acr.20567. PMID: 22588769. Study link.
- Mielenz TJ, Edwards MC, Callahan LF. Item Response Theory Analysis of Two Questionnaire Measures of Arthritis-Related Self-Efficacy Beliefs from Community-Based US Samples. Arthritis. 2010;2010:416796. doi: 10.1155/2010/416796. Epub 2010 Jun 6. PMID: 22046509; PMCID: PMC3195381. Study link.
