Annals of Behavioral Medicine

, Volume 41, Issue 1, pp 48–58 | Cite as

Development and Validation of the Health Competence Beliefs Inventory in Young Adults With and Without a History of Childhood Cancer

  • Branlyn Werba DeRosa
  • Anne E. Kazak
  • Kinjal Doshi
  • Lisa A. Schwartz
  • Jill Ginsberg
  • Jun J. Mao
  • Joseph Straton
  • Wendy Hobbie
  • Mary T. Rourke
  • Claire Carlson
  • Richard F. Ittenbach
Original Article



Adolescent and young adult survivors of childhood cancer are a vulnerable population. Health beliefs may be related to necessary follow-up care.


This study seeks to develop a measure of health beliefs for adolescents and young adults with and without a history of cancer.


Inductive and deductive methods and focus groups were used to develop the Health Competence Beliefs Inventory. Cancer survivors (n = 138) and comparison participants (n = 130) completed the Health Competence Beliefs Inventory and other measures. Healthcare providers reported current medical problems.


A series of iterative exploratory factor analyses generated a 21-item four-factor solution: (1) Health Perceptions; (2) Satisfaction with Healthcare; (3) Cognitive Competence; and (4) Autonomy. Survivors reported significantly different Health Competence Beliefs Inventory scale scores than comparisons (p < .05). The Health Competence Beliefs Inventory was associated with beliefs, affect, quality of life, posttraumatic stress symptoms, and medical problems.


The Health Competence Beliefs Inventory is a promising measure of adolescent and young adult perceptions of health and well-being.


Cancer Survivorship Young adults Psychological outcomes Health Beliefs 



This research was supported by the National Cancer Institute (CA106928). The authors thank the study participants. We also thank Sue Ogle, CRNP, Stephanie K. Bui, MD, Janice K. Hillman, MD, FACP, Evelyn Wiener, MD, Michele Demski, BSN, RN, and Maureen Reilly, BSN, RN for assisting with recruitment and access to patients; and Andrew Gaffney, Emily Knudsen-Strong, Muhammad Monsour, Ifigenia Mougianis, Sonali Sanyal, Mary Caitlin St. Clair, James Wolf, and Mindy Yang for serving as research assistants and Kevin Oeffinger, MD for his review of the proposed items. The authors also thank the members of Writers Seminar of The CHOP/PENN Mentored Psychosocial Research Curriculum, supported by a K05 award to Dr. Kazak (CA128805). Requests for a copy of the Health Competence Beliefs Inventory may be sent to Dr. Kazak (

Conflict of Interest Statement

The authors have no conflict of interest to disclose.


  1. 1.
    Park MJ, Mulye TP, Adams SH, Brindis C, Irwin CE, Jr. The health status of young adults in the U.S. J Adolesc Health. 2006; 39: 305–317.CrossRefPubMedGoogle Scholar
  2. 2.
    National Cancer Institute, LIVESTRONG Young Adult Alliance. Closing the gap: Research and care imperative for adolescents and young adults with cancer, report of the adolescent and young adult oncology progress review group. NIH Publication No. 06-6067; 2006.Google Scholar
  3. 3.
    Oeffinger KC, Mertens MD, Sklar CA, et al. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med. 2006; 355: 1572–1582.CrossRefPubMedGoogle Scholar
  4. 4.
    Stam H, Hartman EE, Deurloo JA, Groothoff J, Grootenhuis MA. Young adult patients with a history of pediatric disease: Impact on course of life and transition into adulthood. J Adolesc Health. 2006; 39: 4–13.CrossRefPubMedGoogle Scholar
  5. 5.
    Zeltzer LK, Recklitis CJ, Buchbinder D, et al. Psychological status in childhood cancer survivors: A report for the childhood cancer survivor study. J Clin Oncol. 2009; 27: 2396–2404.CrossRefPubMedGoogle Scholar
  6. 6.
    Schwartz L, Drotar D. Defining the nature and impact of goals in children and adolescents with a chronic health condition: A review of research and a theoretical framework. J Clin Psychol Med Settings. 2006; 13: 393–405.CrossRefGoogle Scholar
  7. 7.
    Rourke MT, Hobbie WL, Schwartz LA, Kazak AE. Posttraumatic stress disorder (PTSD) in young adult survivors of childhood cancer. Pediatr Blood Cancer. 2007; 49: 177–182.CrossRefPubMedGoogle Scholar
  8. 8.
    Lee YL, Santacroce SJ, Sadler L. Predictors of healthy behaviour in long-term survivors of childhood cancer. J Clin Nurs. 2007; 16: 285–295.CrossRefPubMedGoogle Scholar
  9. 9.
    American Academy of Pediatrics and the Children’s Oncology Group. Long-term follow-up care for pediatric cancer survivors. Pediatrics. 2009; 123: 906–915.CrossRefGoogle Scholar
  10. 10.
    Kadan-Lottick NS, Robison LL, Gurney JG, et al. Childhood cancer survivors’ knowledge about their past diagnosis and treatment: Childhood cancer survivor study. J Am Med Assoc. 2002; 287: 1832–1839.CrossRefGoogle Scholar
  11. 11.
    Reiss JG, Gibson RW, Walker LR. Health care transition: Youth, family, and provider. Pediatrics. 2005; 115: 112–120.CrossRefPubMedGoogle Scholar
  12. 12.
    Ginsberg JP, Hobbie WL, Carlson CA, Meadows AT. Delivering Long-Term Follow-Up Care to Pediatric Cancer Survivors: Transitional Care Issues. Pediatr Blood Cancer. 2006; 46: 169–173.CrossRefPubMedGoogle Scholar
  13. 13.
    Haller DA, Sanci LA, Sawyer SM, Patton G. Do young people’s illness beliefs affect health care? A systematic view. J Adolesc Health. 2008; 42: 436–449.CrossRefPubMedGoogle Scholar
  14. 14.
    Oeffinger KC. Longitudinal risk-based health care for adult survivors of childhood cancer. Curr Probl Cancer. 2003; 27(3): 143–167.CrossRefPubMedGoogle Scholar
  15. 15.
    Smith MS, Wallston KA, Smith CA. The development and validation of the perceived health competence scale. Health Educ Res. 1995; 10: 51–64.CrossRefPubMedGoogle Scholar
  16. 16.
    Zebrack B. Developing a new instrument to assess the impact of cancer in young adult survivors of childhood cancer. J Cancer Surviv. 2009; 3: 174–180.CrossRefPubMedGoogle Scholar
  17. 17.
    Kazak AE, DeRosa BW, Schwartz LA, et al. Psychological outcomes and health beliefs in adolescent and young adult (AYA) survivors of childhood cancer and controls. J Clin Oncol. 2010; 28: 2002–2007.CrossRefPubMedGoogle Scholar
  18. 18.
    Author. The Health Competence Beliefs Inventory: A technical report of scale development. Author Institution; 2009.Google Scholar
  19. 19.
    Schwarzer R, Jerusalem M. Generalized Self-Efficacy scale. In: Weinman J, Wright S, Johnston M, eds. Measures in health psychology: A user’s portfolio. Causal and control beliefs; 1995: 35–37.Google Scholar
  20. 20.
    Scholz U, Dona B, Sud S, Schwarzer, R. Is general self-efficacy a universal construct? Psychometric findings from 25 countries. Eur J Psychol Assess. 2002; 18: 242–251.CrossRefGoogle Scholar
  21. 21.
    Schwartz L, Mao J, DeRosa B, et al. Self-reported health problems of young adults in clinical settings: Survivors of childhood cancer and healthy controls. J Am Board Fam Med. 2010; 23: 306–314.CrossRefPubMedGoogle Scholar
  22. 22.
    Diener E, Emmons RA. The independence of positive and negative affect. J Pers Soc Psychol. 1985; 47: 1105–1117.Google Scholar
  23. 23.
    Gill KM, Carson JW, Porter LS, et al. Daily stress and mood and their association with pain, health-care use, and school activity in adolescents with sickle cell disease. J Pediatr Psychol. 2003; 28: 363–373.CrossRefGoogle Scholar
  24. 24.
    Weathers FW, Ford J. Psychometric review of the PTSD Checklist. In: Stamm, BH, ed. Measurement of stress, trauma, and adaptation; 1996: 250–251.Google Scholar
  25. 25.
    Andrykowski MA, Cordova MJ, Studts JL, Miller TW. Posttraumatic stress disorder after treatment for breast cancer: Prevalence of diagnosis and use of the PTSD Checklist-Civilian Version (PCL-C) as a screening instrument. J Consult Clin Psychol. 1998; 66: 586–90.CrossRefPubMedGoogle Scholar
  26. 26.
    Smith MY, Redd WH, DuHamel KN, Viekberg SMJ, Ricketts R. Validation of the post-traumatic stress disorder checklist-civilian in survivors of bone marrow transplantation. J Trauma Stress. 1999; 12: 485–499.CrossRefPubMedGoogle Scholar
  27. 27.
    Ware JE Jr, Kosinski M, Keller SD. A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Med Care. 1996; 34: 220–33.CrossRefPubMedGoogle Scholar
  28. 28.
    Jenkinson C, Chandola T, Coulter A, Bruster A. An assessment of the construct validity of the SF-12 summary scores across ethnic groups. J Public Health Med. 2001; 23: 187–194.CrossRefPubMedGoogle Scholar
  29. 29.
    Hayton JC, Allen DG, Scarpello, V. Factor Retention Decisions in Explorator Factor Analysis: A Tutorial on Parallel Analysis. Organizational Research Methods. 2004; 7: 191–205.CrossRefGoogle Scholar
  30. 30.
    Zwick WR, Velicer WF. Comparison of five rules for determining the number of components to retain. Psychol Bull. 1986; 99: 4327–4442.CrossRefGoogle Scholar
  31. 31.
    DeVellis, R. Scale development: Theory and applications. 2nd ed. Thousand Oaks, CA: Sage Publications, Inc.; 2003.Google Scholar
  32. 32.
    Kline, P. The new psychometrics: Science, psychology and measurement. London: Routledge; 1998.Google Scholar
  33. 33.
    Worthington RL, Whittaker T A. Scale development research: A content analysis and recommendations for best practices. Couns Psychol. 2006; 34(6): 806–838.CrossRefGoogle Scholar
  34. 34.
    Alazri MH, Neal RD. The association between satisfaction with services provided in primary care and outcomes in Type 2 diabetes mellitus. Diabet Med. 2003; 20: 486–90.CrossRefPubMedGoogle Scholar
  35. 35.
    Fan VS, Burman M, McDonell MB, Fihn SD. Continuity of care and other determinants of patient satisfaction with primary care. J Gen Intern Med. 2005; 20: 226.CrossRefPubMedGoogle Scholar
  36. 36.
    Oeffinger KC, Mertens AC, Hudson MM, et al. Health care of young adult survivors of childhood cancer: A report from the childhood cancer survivor study. Ann Fam Med. 2004; 2: 61–70.CrossRefPubMedGoogle Scholar
  37. 37.
    Ressler IB, Cash J, McNeill D, Joy S, Rosoff PM. Continued parental attendance at a clinic for adult survivors of childhood cancer. J Pediatr Hematol Oncol. 2003; 25: 868–873.CrossRefPubMedGoogle Scholar
  38. 38.
    Banner LM, Mackie EJ, Hill JW. Family relationships in survivors of childhood cancer: Resource or restraint? Patient Educ Couns. 1996; 28: 191–199.CrossRefPubMedGoogle Scholar
  39. 39.
    O’Leary TE, Diller L, Reklitis CJ. The effects of response bias on self-reported quality of life among childhood cancer survivors. Qual Life Res. 2007; 16: 1211–1220.CrossRefPubMedGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2010

Authors and Affiliations

  • Branlyn Werba DeRosa
    • 1
  • Anne E. Kazak
    • 1
    • 2
  • Kinjal Doshi
    • 2
  • Lisa A. Schwartz
    • 1
  • Jill Ginsberg
    • 1
    • 2
  • Jun J. Mao
    • 2
  • Joseph Straton
    • 2
  • Wendy Hobbie
    • 1
  • Mary T. Rourke
    • 1
  • Claire Carlson
    • 1
  • Richard F. Ittenbach
    • 1
  1. 1.The Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.The University of PennsylvaniaPhiladelphiaUSA

Personalised recommendations