EHFScB scale - Versions

The EHFScB scale is available in a number of translations. You are welcome to use the EHFScB scale in the language you want. No license is needed and it is free to use. If there is no version in the language you wish, there is a manual of the translation procedure further down on this page.

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Validation papers

Feijo MK, Avila CW, de Souza EN, Jaarsma T, Rabelo ER. Cross-cultural adaptation and validation of the European Heart Failure Self-Care Behavior Scale for Brazilian Portuguese. Rev Lat Am Enfermagem. 2012;20:988-96.

Papers that used the scale in research 

Linn AC, Azollin K, Souza EN. Association between self-care and hospital readmissions of patients with heart failure. Rev Bras Enferm. 2016 Jun;69(3):500-6. English, Portuguese. doi: 10.1590/0034-7167.2016690312i. Erratum in: Rev Bras Enferm. 2016 Sep-Oct;69(5):1003. PMID: 27355299. 

Papers that used the scale in research 

Lupón J, González B, Mas D, et al. Patients’ Self-Care Improvement with Nurse Education Intervention in Spain Assessed by the European Heart Failure Self-Care Behaviour Scale. European Journal of Cardiovascular Nursing. 2008;7(1):16-20. doi:10.1016/j.ejcnurse.2007.05.004

Validation papers

Yu DS, Lee DT, Thompson DR, Jaarsma T, Woo J, Leung EM. Psychometric properties of the Chinese version of the European Heart Failure Self-care Behaviour Scale. Int J Nurs Stud. 2011;48:458-67.

Papers that used the scale in research

Hu X, Hu X, Su Y, Qu M, Dolansky MA. The changes and factors associated with post-discharge self-care behaviors among Chinese patients with heart failure. Patient Prefer Adherence. 2015 Nov 9;9:1593-601. doi: 10.2147/PPA.S88431. PMID: 26635468; PMCID: PMC4646583.

Uchmanowicz I, Wleklik M, Gobbens RJ. Frailty syndrome and self-care ability in elderly patients with heart failure. Clin Interv Aging. 2015 May 18;10:871-7. doi: 10.2147/CIA.S83414. PMID: 26028966; PMCID: PMC4441356.

Validation papers

Ostergaard B, Mahrer-Imhof R, Lauridsen J, Wagner L. Validity and reliability of the Danish version of the 9-item European Heart Failure Self-care Behavior Scale. Scand J Caring Sci. 2017;31:405-12.

Papers that used the scale in research 

Kessing D, Denollet J, Widdershoven J, Kupper N. Self-Care and All-Cause Mortality in Patients With Chronic Heart Failure. JACC Heart Fail. 2016 Mar;4(3):176-83. doi: 10.1016/j.jchf.2015.12.006. Epub 2016 Feb 10. PMID: 26874385.

Wagenaar KP, Broekhuizen BDL, Jaarsma T, Kok I, Mosterd A, Willems FF, Linssen GCM, Agema WRP, Anneveldt S, Lucas CMHB, Mannaerts HFJ, Wajon EMCJ, Dickstein K, Cramer MJ, Landman MAJ, Hoes AW, Rutten FH. Effectiveness of the European Society of Cardiology/Heart Failure Association website 'heartfailurematters.org' and an e-health adjusted care pathway in patients with stable heart failure: results of the 'e-Vita HF' randomized controlled trial. Eur J Heart Fail. 2019 Feb;21(2):238-246. doi: 10.1002/ejhf.1354. Epub 2018 Nov 28. PMID: 30485612; PMCID: PMC6607483.

Lycholip E, Thon Aamodt I, Lie I, Šimbelytė T, Puronaitė R, Hillege H, de Vries A, Kraai I, Stromberg A, Jaarsma T, Čelutkienė J. The dynamics of self-care in the course of heart failure management: data from the IN TOUCH study. Patient Prefer Adherence. 2018 Jun 26;12:1113-1122. doi: 10.2147/PPA.S162219. PMID: 29983549; PMCID: PMC6027682.

Liljeroos M, Kato NP, van der Wal MH, Brons M, Luttik ML, van Veldhuisen DJ, Strömberg A, Jaarsma T. Trajectory of self-care behaviour in patients with heart failure: the impact on clinical outcomes and influencing factors. Eur J Cardiovasc Nurs. 2020 Jun;19(5):421-432. doi: 10.1177/1474515120902317. Epub 2020 Jan 29. PMID: 31992064; PMCID: PMC7272123.

Validation papers

Shuldham C, Theaker C, Jaarsma T, Cowie M. Evaluation of the European heart failure self-care behaviour scale in a United Kingdom population. J Adv Nurs 2007;60:87-95.

Lee CS, Lyons KS, Gelow JM, Mudd JO, Hiatt SO, Nguyen T, Jaarsma T. Validity and reliability of the European Heart Failure Self-care Behavior Scale among adults from the United States with symptomatic heart failure. Eur J Cardiovasc Nurs. 2013 Apr;12(2):214-8. doi: 10.1177/1474515112469316. Epub 2012 Dec

Papers that used the scale in research 

Lee KS, Moser DK, Dracup K. Relationship between self-care and comprehensive understanding of heart failure and its signs and symptoms. Eur J Cardiovasc Nurs. 2018 Aug;17(6):496-504. doi: 10.1177/1474515117745056. Epub 2017 Dec 1. PMID: 29192794.

Stut W, Deighan C, Cleland JG, Jaarsma T. Adherence to self-care in patients with heart failure in the HeartCycle study. Patient Prefer Adherence. 2015 Aug 19;9:1195-206. doi: 10.2147/PPA.S88482. PMID: 26316725; PMCID: PMC4548736.

Papers that used the scale in research 

Róin T, Á Lakjuni K, Kyhl K, Thomsen J, Veyhe AS, Róin Á, Jan R, Marin S. Knowledge about heart failure and self-care persists following outpatient programme- a prospective cohort study from the Faroe Islands. Int J Circumpolar Health. 2019 Dec;78(1):1653139. doi: 10.1080/22423982.2019.1653139. PMID: 31429677; PMCID: PMC6713150.

Validation papers

Boisvert S, Francoeur J, Gallani MC. Cross-Cultural Adaptation and Reliability of the French-Canadian Version of the European Heart Failure Self-Care Behaviour Scale-9. J Nurs Meas. 2019;27:458-77.

Validation papers

Koberich S, Glattacker M, Jaarsma T, Lohrmann C, Dassen T. Validity and reliability of the German version of the 9-item European Heart Failure Self-care Behaviour Scale. Eur J Cardiovasc Nurs. 2013;12:150-8.

Papers that used the scale in research 

Müller-Tasch T, Löwe B, Lossnitzer N, Frankenstein L, Täger T, Haass M, Katus H, Schultz JH, Herzog W. Anxiety and self-care behaviour in patients with chronic systolic heart failure: A multivariate model. Eur J Cardiovasc Nurs. 2018 Feb;17(2):170-177. doi: 10.1177/1474515117722255. Epub 2017 Jul 18. PMID: 28718661.

Peters-Klimm F, Freund T, Kunz CU, Laux G, Frankenstein L, Müller-Tasch T, Szecsenyi J. Determinants of heart failure self-care behaviour in community-based patients: a cross-sectional study. Eur J Cardiovasc Nurs. 2013 Apr;12(2):167-76. doi: 10.1177/1474515112439964. Epub 2012 Apr 18. PMID: 22514139.

Validation papers

Lambrinou E, Kalogirou F, Lamnisos D, Papathanassoglou E, Protopapas A, Sourtzi P, et al. The Greek version of the 9-item European Heart Failure Self-care Behaviour Scale: a multidimensional or a uni-dimensional scale? Heart Lung. 2014;43:494-9.

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Validation papers

Ben Gal T, Kato NP, Yaari V, Avraham B, Klompstra L, Strömberg A, et al. Psychometric Testing of the Hebrew Version of the European Heart Failure Self-Care Behaviour Scale. Heart Lung Circ. 2020;29:e121-e30.

Paper that used the scale in research

Ingadottir B, Thylén I, Jaarsma T. Knowledge expectations, self-care, and health complaints of heart failure patients scheduled for cardiac resynchronization therapy implantation. Patient Prefer Adherence. 2015 Jul 2;9:913-21. doi: 10.2147/PPA.S83069. PMID: 26170641; PMCID: PMC4494625.

Ketilsdottir A, Ingadottir B, Jaarsma T. Self-reported health and quality of life outcomes of heart failure patients in the aftermath of a national economic crisis: a cross-sectional study. ESC Heart Fail. 2019 Feb;6(1):111-121. doi: 10.1002/ehf2.12369. Epub 2018 Oct 18. PMID: 30338668; PMCID: PMC6351898.

Validation papers

Pulignano G, Del Sindaco D, Minardi G, Tarantini L, Cioffi G, Bernardi L, et al. Translation and validation of the Italian version of the European Heart Failure Self-care Behaviour Scale. J Cardiovasc Med (Hagerstown). 2010;11:493-8.

Papers that used the scale in research 

Lee CS, Bidwell JT, Paturzo M, Alvaro R, Cocchieri A, Jaarsma T, Strömberg A, Riegel B, Vellone E. Patterns of self-care and clinical events in a cohort of adults with heart failure: 1 year follow-up. Heart Lung. 2018 Jan-Feb;47(1):40-46. doi: 10.1016/j.hrtlng.2017.09.004. Epub 2017 Oct 18. PMID: 29054487; PMCID: PMC6497061.

Vellone E, Fida R, Ghezzi V, D'Agostino F, Biagioli V, Paturzo M, Strömberg A, Alvaro R, Jaarsma T. Patterns of Self-care in Adults With Heart Failure and Their Associations With Sociodemographic and Clinical Characteristics, Quality of Life, and Hospitalizations: A Cluster Analysis. J Cardiovasc Nurs. 2017 Mar/Apr;32(2):180-189. doi: 10.1097/JCN.0000000000000325. PMID: 26938506.

Validation papers

Kato N, Ito N, Kinugawa K, Kazuma K. Validity and reliability of the Japanese version of the European Heart Failure Self-Care Behavior Scale. Eur J Cardiovasc Nurs. 2008;7:284-9.

Papers that used the scale in research 

Kato N, Kinugawa K, Ito N, Yao A, Watanabe M, Imai Y, Takeda N, Hatano M, Kazuma K. Adherence to self-care behavior and factors related to this behavior among patients with heart failure in Japan. Heart Lung. 2009;38:398-409.

Kato NP, Kinugawa K, Sano M, Kogure A, Sakuragi F, Kobukata K, Ohtsu H, Wakita S, Jaarsma T, Kazuma K. How effective is an in-hospital heart failure self-care program in a Japanese setting? Lessons from a randomized controlled pilot study. Patient Prefer Adherence. 2016 Feb 18;10:171-81. doi: 10.2147/PPA.S100203. PMID: 26937177; PMCID: PMC4762442.

Abe R, Sakata Y, Nochioka K, Miura M, Oikawa T, Kasahara S, Sato M, Aoyanagi H, Shiroto T, Sugimura K, Takahashi J, Miyata S, Shimokawa H; CHART-2 Investigators. Gender differences in prognostic relevance of self-care behaviors on mortality and hospitalization in patients with heart failure - A report from the CHART-2 Study. J Cardiol. 2019 May;73(5):370-378. doi: 10.1016/j.jjcc.2018.11.006. Epub 2018 Dec 31. PMID: 30606681.

Validation papers

Son YJ, Won MH. Psychometric Validation of the Korean Version of the 9-Item European Heart Failure Self-Care Behaviour Scale. Eval Health Prof. 2020;43:33-40.

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Validation papers

Lin CY, Pakpour AH, Brostrom A, Fridlund B, Arestedt K, Stromberg A, et al. Psychometric Properties of the 9-item European Heart Failure Self-care Behavior Scale Using Confirmatory Factor Analysis and Rasch Analysis Among Iranian Patients. J Cardiovasc Nurs. 2018;33:281-8.

Validation papers

Uchmanowicz I, Loboz-Rudnicka M, Jaarsma T, Loboz-Grudzien K. Cross-cultural adaptation and reliability testing of Polish adaptation of the European Heart Failure Self-care Behavior Scale (EHFScBS). Patient Prefer Adherence. 2014;8:1521-6.

Uchmanowicz I, Wleklik M. Polish adaptation and reliability testing of the nine-item European Heart Failure Self-care Behaviour Scale (9-EHFScBS). Kardiol Pol. 2016;74:691-6.

Papers that used the scale in research 

Uchmanowicz I, Jankowska-Polańska B, Mazur G, Sivarajan Froelicher E. Cognitive deficits and self-care behaviors in elderly adults with heart failure. Clin Interv Aging. 2017 Oct 3;12:1565-1572. doi: 10.2147/CIA.S140309. PMID: 29042757; PMCID: PMC5633303.

Mlynarska A, Golba KS, Mlynarski R. Capability for self-care of patients with heart failure. Clin Interv Aging. 2018 Oct 8;13:1919-1927. doi: 10.2147/CIA.S178393. PMID: 30349210; PMCID: PMC6183697.

Prochota B, Szwamel K, Uchmanowicz I. Socio-clinical variables affecting the level of self-care in elderly patients with heart failure. Eur J Cardiovasc Nurs. 2019 Oct;18(7):628-636. doi: 10.1177/1474515119855600. Epub 2019 Jun 13. PMID: 31195805.

Papers that used the scale in research 

Kartamysheva ED, Lopatin YM. [Comparative analysis of self-care assessment scales in patients with chronic heart failure, advantages and disadvantages]. Kardiologiia. 2020 Sep 17;60(8):84-89. Russian. doi: 10.18087/cardio.2020.8.n1114. PMID: 33155963.

Grebennikova AA, Stoliarov AY, Lopatin YM. [The use of platform for remote monitoring on the base of mobile app for improving self-care in patients with chronic heart failure]. Kardiologiia. 2017 Apr;57(S4):11-18. Russian. doi: 10.18087/cardio.2413. PMID: 29466178.

Papers that used the scale in research 

Santesmases-Masana R, González-de Paz L, Real J, Borràs-Santos A, Sisó-Almirall A, Navarro-Rubio MD. Alfabetización en salud en pacientes con insuficiencia cardiaca atendidos en atención primaria [Health literacy in patients with heart failure treated in primary care]. Aten Primaria. 2017 Jan;49(1):28-34. Spanish. doi: 10.1016/j.aprim.2016.03.003. Epub 2016 May 25. PMID: 27236716; PMCID: PMC6875916.

Gonzalez B, Lupon L, Parajon T, Urrutia A, Herreros J, Valle V. Use of the European Heart Failure Self-care Behaviour Scale (EHFScBS) in a heart failure unit in Spain. Rev Esp Cardiol 2006;59:166-70.

León-González R, García-Esquinas E, Paredes-Galán E, Ferrero-Martínez AI, González-Guerrero JL, Hornillos-Calvo M, Menéndez-Colino R, Torres-Torres I, Galán MC, Torrente-Carballido M, Olcoz-Chiva M, Rodríguez-Pascual C, Rodríguez-Artalejo F. Health Literacy and Health Outcomes in Very Old Patients With Heart Failure. Rev Esp Cardiol (Engl Ed). 2018 Mar;71(3):178-184. English, Spanish. doi: 10.1016/j.rec.2017.06.010. Epub 2017 Jul 8. PMID: 28697926.

Salvadó-Hernández C, Cosculluela-Torres P, Blanes-Monllor C, Parellada-Esquius N, Méndez-Galeano C, Maroto-Villanova N, García-Cerdán RM, Núñez-Manrique MP, Barrio-Ruiz C, Salvador-González B; en representación del grupo de investigación del proyecto COIB 5367-11. Insuficiencia cardiaca en atención primaria: actitudes, conocimientos y autocuidado [Heart failure in primary care: Attitudes, knowledge and self-care]. Aten Primaria. 2018 Apr;50(4):213-221. Spanish. doi: 10.1016/j.aprim.2017.03.008. Epub 2017 Jun 23. PMID: 28652033; PMCID: PMC6837070.

Lupón J, González B, Mas D, et al. Patients’ Self-Care Improvement with Nurse Education Intervention in Spain Assessed by the European Heart Failure Self-Care Behaviour Scale. European Journal of Cardiovascular Nursing. 2008;7(1):16-20. doi:10.1016/j.ejcnurse.2007.05.004.

Papers that used the scale in research 

Ingadottir B, Thylén I, Jaarsma T. Knowledge expectations, self-care, and health complaints of heart failure patients scheduled for cardiac resynchronization therapy implantation. Patient Prefer Adherence. 2015 Jul 2;9:913-21. doi: 10.2147/PPA.S83069. PMID: 26170641; PMCID: PMC4494625.

Johansson P, Jaarsma T, Andersson G, Lundgren J. The impact of internet-based cognitive behavioral therapy and depressive symptoms on self-care behavior in patients with heart failure. A secondary analysis of a randomised controlled trial. Int J Nurs Stud. 2019 Oct 31:103454. doi: 10.1016/j.ijnurstu.2019.103454. Epub ahead of print. PMID: 31727306.

Hjelm CM, Broström A, Riegel B, Årestedt K, Strömberg A. The association between cognitive function and self-care in patients with chronic heart failure. Heart Lung. 2015 Mar-Apr;44(2):113-9. doi: 10.1016/j.hrtlng.2014.12.003. Epub 2015 Feb 11. PMID: 25682390.

Holst M, Willenheimer R, Mårtensson J, Lindholm M, Strömberg A. Telephone follow-up of self-care behaviour after a single session education of patients with heart failure in primary health care. Eur J Cardiovasc Nurs. 2007 Jun;6(2):153-9. doi: 10.1016/j.ejcnurse.2006.06.006. Epub 2006 Aug 22. PMID: 16928469.

Melin M, Hägglund E, Ullman B, Persson H, Hagerman I. Effects of a Tablet Computer on Self-care, Quality of Life, and Knowledge: A Randomized Clinical Trial. J Cardiovasc Nurs. 2018 Jul/Aug;33(4):336-343. doi: 10.1097/JCN.0000000000000462. PMID: 29369123.

Hedemalm A, Schaufelberger M, Ekman I. Reported adherence and social support among immigrants compared to native Swedes. J Immigr Minor Health. 2010 Feb;12(1):124-31. doi: 10.1007/s10903-009-9235-x. Epub 2009 Mar 3. PMID: 19255854.

Validation papers

Baydemir C, Ozdamar K, Unalir A. Validity of the Turkish version of the European Heart Failure Self-Care Behavior Scale. Anadolu Kardiyol Derg. 2013;13:573-9.

Ozer S, Karaman E, Karaoz B, Fadiloglu C, Aykar FS. Validity and Reliability of the Turkish Version of the European Heart Failure Self-Care Behaviour Scale (Ehfscb-9). International Journal of Caring Sciences. 2019;12:1561-9.

Yildiz E, Erci B. The Turkish Version of Reliability and Validity of Nine Item-European Heart Failure Self-Care Behaviour Scale. Kafkas J Med Sci. 2018;8:55-60.

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Translation and backtranslation Show/Hide content

5 steps:

1. Use the English version as a basis.

2. Recruit 2 translators for the forward translation: English to ‘new language’.

It is generally recommended that the forward translators should have the ‘new language’ as their mother tongue. It is recommended that one translator has expertise on the construct to be measured (e.g. nurse, health care professional ), and the second one being a language expert, but naive on the topic.

The translators should work independently from each other and be instructed to stay close to the English version.

So in step 2 you make two ‘new Language version (1 per translator);

3. In this step you combine the 2 ‘new language’ versions into one. Discuss possible differences and use the words that are closest to meaning in the English version

4. Recruit 2 other translators for the backward translation: ‘New language’ (from step 3) to English.

The back translators should have the original language as their mother tongue (= English). They should be blind for the original version of the questionnaire. It is recommended that the back translators are both language experts and naïve to the constructs to be measured.

The translators should work independently from each other.

So in step 4 you make two English versions (1 per translator);

5. Combine the 2 English versions from step 4 into one. Discuss possible differences and make a final ‘back-translated English’ version. Send that version to Tiny Jaarsma for a final check.


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