The developed measures demonstrated excellent initial reliability and validity, with nearly all of the hypothesized relationships being confirmed. Parent and child scales measuring child self-efficacy for functioning normally when in pain
were correlated in the expected directions with parent reports of fewer problems functioning, fewer symptoms, increased self-esteem, and unrelated to child pain, age and gender. The child version was also correlated in the expected directions with child reports of increased self-esteem and fewer somatic symptoms. While the parent self-efficacy scale was not related to child reports of self-esteem, and somatic and emotional symptoms, this finding does not contradict any previously published research, as these hypotheses have not been previously tested. In fact, previous research has demonstrated that youth internalizing symptoms are likely to be overlooked by adults, particularly during adolescence (Yeh and Weisz, 2001
; Martin et al., 2004
). Consequently, it may be that our finding should be expected since the patients are making assessments of symptoms and self-efficacy based on internal perceptions of symptoms and thoughts, and the parents are doing so from their observations of external behavior. For example, it may be that parents are less sure their children can function with pain if they are not going to school (an observed disability); whereas the patients' assessments of self-efficacy may be tied more closely to their (unobservable) feelings, thoughts, symptoms, experiences and/or memories. This is a potentially important distinction since parents can influence the decisions related to functioning, such as school attendance, and family factors have been demonstrated to influence pain perception, functioning and outcomes (Chambers, 2003
; Crushell et al., 2003
). While parent perception is important to understand, our findings highlight the importance of including child reports for the most relevant assessment of child self-efficacy for functioning normally when in pain
Successful treatment models for childhood pain have been specifically based on concepts from social cognitive theory and the health belief model. For example, the best studies in children with chronic headaches offer compelling evidence that relaxation skills training and cognitive behavioral therapy can be highly effective in reducing the severity and frequency of pediatric chronic pain (Eccleston et al., 2002
). These scales represent a first step in developing useful measurement tools to test our theoretical constructs and interventions. Our findings offer preliminary support for the use of these measures to assess parent and child self-efficacy beliefs for the child functioning normally when in pain
. When viewed at baseline, these scales can provide the clinician with an idea about how disabled the child feels and how disabling the parent believes the pain has become for the child. Importantly, it also allows the clinician to compare responses to determine whether child or parent is least sure of the child's ability to function in pain, and which activities pose the biggest perceived challenges. Such information can be valuable for intervention planning. When viewed at follow-up, it is anticipated that the present measures will assist in the assessment of the impact of interventions geared towards increasing self-efficacy to function with pain. Additionally, the measures may prove helpful in explaining variance in assessments of self-management behaviors, including treatment adherence. These components of the research are underway.
The potential weaknesses of our study are related to our sample composition, our sample size, and the research design. First, our patients were recruited from university-based tertiary care clinics. This means that most of them had already been evaluated and treated by a primary care physician and/or by another specialist. Consequently, our finding might not generalize to children and adolescents with less severe chronic pain, or with less extensive experience with the health care system, and their parents. For example, with greater variance in pain severity, we would expect a relationship of this variable with self-efficacy. Second, the vast majority of our parent participants were female (mothers), indicating that we do not know if male caregivers would have similar perceptions. Third, we had complete data for 67 children and parents. It might be that with a larger sample, we would have obtained different results. Fourth, our study is cross-sectional in design prohibiting any conclusions regarding the ability of these measures to detect intervention effects or regarding the value of the measure in predicting self-management behaviors, such as adherence, and children's well-being and adjustment, after controlling for demographic variables and relevant clinical variables. Replication with a larger sample size, more complex modeling, and prospective studies are indicated.