Care-Receiver Efficacy Scale (CRES)

Abstract

The Care-Receiver Efficacy Scale (CRES) is a specialized psychometric instrument designed to measure the perceived sense of self-efficacy among individuals who are recipients of long-term care, particularly older adults managing chronic health challenges. Developed by Cox et al. (2006), the CRES moves beyond traditional measures of patient compliance to assess the care-receiver’s active role in managing their health situation and maintaining well-being. The scale is structured around five key domains of efficacy related to the care process, providing a comprehensive assessment of the individual’s competence and confidence in navigating dependency and relational dynamics with caregivers.

The instrument includes a full 48-item version and corresponding 5-item short forms for each subscale, making it adaptable for various research and clinical settings focused on late-life challenges and the enhancement of the care process.

Keywords

Care-Receiver Efficacy Scale, CRES, Self-efficacy, Self-Care Performance, Relational Coping, Perceptions of Dependence, Performance-Related Quality of Life, Gerontology, Chronic Illness.

Authors

Cox, E., Green, K. E., Seo, H., Inaba, M., & Ayala Quillen, A. (2006).

Purpose

The primary purpose of the Care-Receiver Efficacy Scale (CRES) is to quantify the strength of an individual’s belief in their ability to successfully execute behaviors necessary for managing their health and social interactions while receiving care. It specifically aims to capture the care-receiver’s sense of agency—or efficacy—in the face of physical limitations and increased dependence due to chronic conditions.

This measurement is crucial for identifying areas where interventions can strengthen the care-receiver’s active participation in their care planning and improve their overall psychological adjustment. By assessing efficacy across multiple domains, CRES provides insights into how well older adults cope with the complex realities of late-life care.

Construct

The CRES is grounded in Albert Bandura’s social cognitive theory, specifically focusing on self-efficacy—the belief in one’s capacity to execute behaviors necessary to produce specific performance attainments. The construct measured here is not general self-efficacy but domain-specific efficacy tailored to the experience of receiving care, conceptualized across five distinct factors:

• Self-Care Performance: Efficacy related to active involvement in health decisions, information seeking, and managing one’s own care regimen.
• Relational Coping with Caregivers: Efficacy in maintaining a positive, reciprocal relationship with professional or informal caregivers, including emotional support and scheduling accommodation.
• Perceptions of Dependence: Efficacy concerning the emotional and psychological management of feelings associated with requiring assistance, such as anger, fear, or loss of freedom.
• Performance-Related Quality of Life (QOL): Efficacy in maintaining meaningful social, recreational, and community activities despite physical limitations.
• Accepting Help: Efficacy in adjusting emotionally and practically to the need for assistance.

Validity

The initial development and validation study conducted by Cox et al. (2006) established the scale’s construct validity. The development process involved expert review and extensive testing within the target population.

The five-factor structure, confirmed through exploratory and confirmatory factor analysis, demonstrated that the CRES effectively measures distinct but related dimensions of care-receiver efficacy. Furthermore, validity was supported by demonstrating that CRES scores correlated theoretically consistent ways with established measures of well-being, depression, and functional status among older adults, confirming its utility in gerontology research.

Reliability

The CRES demonstrates strong internal consistency reliability across its subscales, supporting its use as a reliable measure of care-receiver efficacy. The Cronbach’s alpha coefficients reported in the original validation study (Cox et al., 2006) for the five subscales are:

• Self-Care Strategies: 0.91 (Excellent)
• Relational Coping w/Caregivers: 0.82 (Very Good)
• Performance-Related Quality of Life: 0.86 (Very Good)
• Accepting Help: 0.71 (Adequate)
• Perceptions of Dependence: 0.69 (Adequate)

These values indicate that the items within each factor are highly correlated and measure their intended construct consistently. The short-form versions of the scale were also validated, showing acceptable reliability for screening and large-scale studies (Ma et al., 2012).

Factor Analysis

The Care-Receiver Efficacy Scale was developed based on a hypothesized five-factor structure, which was confirmed through empirical factor analysis. This analysis successfully differentiated the five theoretical domains of efficacy.

Subsequent research, specifically focusing on the 25-item short form (Ma, Green, & Cox, 2012), verified that the factor structure remained stable and reliable even when using only the five highest-loading items from each of the original subscales. This robust factor structure supports the use of CRES in measuring these distinct facets of efficacy in the care-receiving population.

Instrument

Test Type: Self-report psychological scale (Quantitative Survey)

Format: The full scale contains 48 items, answered using a 5-point Likert scale where 1 represents “Not sure at all” and 5 represents “Completely sure.” A validated 25-item short form (5 items per subscale) is also available.

Language Available: English (Original validation)

Population Group: Individuals receiving long-term care or managing chronic conditions.

Age Group: Late-life/Older adults.

Population Details: The scale was specifically developed for individuals facing late-life challenges, often associated with decreased mobility, chronic illness, and reliance on formal or informal caregivers.

Test Methodology: Respondents rate their level of certainty or confidence regarding their ability to perform specific actions or manage specific feelings related to their care situation. Scores are typically summed or averaged within each of the five subscales.

Keywords

Self-efficacy, Care-Receiver, Gerontology, Chronic Illness, Coping Strategies, Dependency, Long-term Care, Healthcare Partnering, Quality of Life, Psychometrics.

Authors

Author ORCID Identifier: Not provided in source data.

Affiliation Email addresses: Not provided in source data.

Correspondence Address: Not provided in source data.

Permissions & Fee and Test Year

Test Year: 2006

Permissions/Fee: Standard academic use is implied through publication, but specific commercial permissions or licensing fees should be sought directly from the primary author, E. Cox, or the journal publisher, The Gerontologist.

The original PDF of the instrument and related information can be downloaded here: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.524.366&rep=rep1&type=pdf

Reference’s

• Cox, E., Green, K. E., Seo, H., Inaba, M., & Ayala Quillen, A. (2006). Coping with late life challenges: Development and validation of the Care-Receiver Efficacy Scale. The Gerontologist, 46, 640–649.
• Cox, E.I., Green, K.E., Hobart, K., Jang, L., Seo, H. (2007). Strengthening the late-life care process: Effects of two forms of a care-receiver efficacy intervention, Gerontologist, 47, 388-397.
• Ma, L., Green, K.E., Cox, E. (2012). Factor Structure Investigation of the Care-Receiver Efficacy Scale–Short-Form. Research on Aging, 34(1), 100-107.
• Cox et al, (2006). Care-Receiver Efficacy Scale. In: Simmons C. A., Lehmann P. (eds). Tools for strengths-based assessment and evaluation, New York, NY: Springer, pp. 298-300. (2013).

Items of the Care-Receiver Efficacy Scale (CRES)

Self-Care Performance

1. I am very involved in any planning that is initiated on my behalf. *
2. I frequently make care decisions that my professional caregivers agree to follow. *
3. I have learned about the knowledge and skills that various health professionals have and can offer to my situation. *
4. I find out as much as possible about the medical conditions that I have. *
5. I often give my doctor information about my situation that helps her or him make decisions about my care. *
6. I have learned about the specialized knowledge and skills that professionals have.
7. I read about the side effects of drugs that are prescribed for me.
8. I believe that I have good skills with respect to guiding my care situation.
9. I am able to ask professional caregivers about anything I don’t understand.
10. I actively work to learn more about my health problems.
11. I have learned new ways of doing things so that I don’t have to depend on others.
12. I believe that the things I do to improve my health can be effective.
13. I think of myself as a partner in my own health care.
14. I am willing to try new services.
15. I participate actively in decisions about my care.

Relational Coping with Caregivers

16. I make every effort to know about my caregiver’s needs and problems. *
17. I often provide emotional support for my caregiver. *
18. I often tell my caregiver that I love or care about him or her. *
19. My caregiver and I are good friends. *
20. I try to fit my needs into my caregiver’s schedule. *
21. My caregiver pays attention when I talk to him or her.
22. I find ways to entertain myself so my caregiver won’t worry about me.
23. I often wait to ask for help from my caregiver until it will be convenient for my caregiver to provide assistance.
24. I try to find things I can do for my caregiver.
25. My caregiver asks me for help with the things I can do.

Perception of Dependence

26. I don’t like being dependent on anyone; it’s hard. *
27. I feel very angry about ha‎ving to be dependent on others. *
28. I hate to ask for help. *
29. My greatest fear is being a burden on others. *
30. I feel like my freedom has been taken away. *

Performance-Related QOL

31. I have developed a number of new interests in the past few years. *
32. I can still do a number of things that I enjoyed all of my life. *
33. I am still able to find ways to participate in meaningful activities. *
34. I have a number of friends that enjoy the same activities as I do. *
35. I am able to contribute to my community. *
36. I still enjoy learning new things.
37. There are still a number of things I would like to accomplish before I die.
38. I value every day of life that I have.
39. I have made new friends since my health status has changed.
40. I have found new kinds of entertainment that replace things I am unable to do because of physical limitations.

Accepting Help

41. I have found ways to accept the need for assistance and still enjoy life. *
42. I just accept the fact that I need help and don’t dwell on it. *
43. I believe that I can handle my feelings about increased dependency well. *
44. I have decided to just accept the fact that I need assistance. *
45. Taking help when I need it is easy. *
46. The things I did before are important in helping me accept help now.
47. I am very grateful for assistance.
48. You have to focus on the positive and retain your sense of humor when disabilities occur.

* Indicates items used in the 5-item short form scales.