Health Confidence Score (HCS) – development and validation

Benson T, Potts HWW, Bark P, Bowman C. Development and testing of a Health Confidence Score (HCS). Research Paper 17/02 v2 September 2017, updated June 2018


Understanding how confident patients are in looking after their own health is essential to improve patient outcomes and clinical support. With few suitable tools available to measure self-care health confidence, we developed and validated a short, generic survey instrument.


The Health Confidence Score (HCS) was developed through literature review, patient and expert focus groups and discussions, before being further validated over a 3-year period.

This report covers results of two studies testing construct and concurrent validity: an online survey (n=1031, study1), and a face-to-face survey (n=378, study2). Scores were correlated against the My Health Confidence (MHC) rating scale, howRu (health status) and relevant demographics.


The Health Confidence Score is short (50 words) with good readability (reading age 8). Items are reported independently and as a summary score. The HCS has four items covering health knowledge, ability to self-manage, access to help and shared decision-making, each having four response options.

In study2, the mean summary score was 76.7 (SD 20.4) on 0-100 scale. Cronbach’s alpha = 0.82. Exploratory factor analysis suggests that the four items relate to a single dimension. Correlation of the HCS summary score with MHC was high (Spearman r=0.76). It was also associated with health status (Spearman r=0.49), but negatively with number of medications taken (r=–0.29) and age (r=–0.22). It was not associated significantly with ethnicity, having children or education level.


The Health Confidence Score is short, easy to use, with good psychometric properties and construct validity. The summary score gives an overall picture of confidence and each item is meaningful independently. It can be integrated into electronic records.

HCS research paper

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