Cardiac Self-Efficacy Scale

How confident are you that you…? Not at all Somewhat Moderately Very Completely
confident confident confident confident confident
1. Can control your chest pain by
0 1 2 3 4
changing your activity levels?
2. Can control your breathlessness by
0 1 2 3 4
changing your activity levels?
3. Can control your chest pain by taking
0 1 2 3 4
your medications?
4. Can control your breathlessness by
0 1 2 3 4
taking your medications
5. Know when you should call or visit
0 1 2 3 4
your doctor about your heart disease?
6. Know how to make your doctor
understand your concerns about your 0 1 2 3 4
heart?
7. Know how to take your cardiac
0 1 2 3 4
medications?
8. Know how much physical activity is
0 1 2 3 4
good for you?
9. Can maintain your usual social
0 1 2 3 4
activities?
10. Can maintain your usual activities at
0 1 2 3 4
home with your family?
11. Can maintain your usual activities at
0 1 2 3 4
work?
12. Can maintain your sexual
0 1 2 3 4
relationship with your spouse?
13. Can get regular aerobic exercise
(work up a sweat and increase your 0 1 2 3 4
heart rate?