Factor analyses of an Adult Epilepsy Self-Management Measurement Instrument (AESMMI)

Published:August 08, 2015DOI:


      • A 65-item Adult Epilepsy Self-Management Measurement Instrument resulted from factor analyses.
      • It had 11 factors related to epilepsy self-management.
      • Key factors were Health-care Communication, Coping, Treatment Management, Seizure Tracking, and Social Support.


      The purpose of this study was to test the psychometric properties of an enhanced Adult Epilepsy Self-Management Measurement Instrument (AESMMI). An instrument of 113 items, covering 10 a priori self-management domains, was generated through a multiphase process, based on a review of the literature, validated epilepsy and other chronic condition self-management scales and expert input. Reliability and exploratory factor analyses were conducted on data collected from 422 adults with epilepsy. The instrument was reduced to 65 items, converging on 11 factors: Health-care Communication, Coping, Treatment Management, Seizure Tracking, Social Support, Seizure Response, Wellness, Medication Adherence, Safety, Stress Management, and Proactivity. Exploratory factors supported the construct validity for 6 a priori domains, albeit with significant changes in the retained items or in their scope and 3 new factors. One a priori domain was split in 2 subscales pertaining to treatment. The configuration of the 11 factors provides additional insight into epilepsy self-management behaviors. Internal consistency reliability of the 65-item instrument was high (α = .935). Correlations with independent measures of health status, quality of life, depression, seizure severity, and life impact of epilepsy further validated the instrument. This instrument shows potential for use in research and clinical settings and for assessing intervention outcomes and self-management behaviors in adults with epilepsy.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Epilepsy & Behavior
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Barlow J.
        • Wright C.
        • Sheasby J.
        • Turner A.
        • Hainsworth J.
        Self-management approaches for people with chronic conditions: a review.
        Patient Educ Couns. 2002; 48: 177-187
        • Clark N.
        • Becker M.
        • Janz N.
        • Lorig K.
        • Rakowski W.
        • Anderson L.
        Self management of chronic disease by older adults: a review and questions for research.
        J Aging Health. 1991; 3: 3-27
        • Clark N.M.
        Management of chronic disease by patients.
        Annu Rev Public Health. 2003; 24: 289-313
        • Lorig K.R.
        • Holman H.R.
        Self-management education: history, definition, outcomes, and mechanisms.
        Ann Behav Med. 2003; 26: 1-7
        • Lorig K.R.
        • Sobel D.S.
        • Stewart A.L.
        • Byron William Brown J.
        • Bandura A.
        • Ritter P.
        • et al.
        Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial.
        Med Care. 1999; 37: 5-14
        • Bodenheimer T.
        • Lorig K.
        • Holman H.
        • Grumbach K.
        Patient self-management of chronic disease in primary care.
        JAMA. 2002; 288: 2469-2475
        • Creer T.L.
        • Holroyd K.A.
        Self-management of chronic conditions: the legacy of Sir William Osler.
        Chronic Illn. 2006; 2: 7-14
        • Lorig K.
        Living a healthy life with chronic conditions: self-management of heart disease, arthritis, diabetes, asthma, bronchitis, emphysema & others.
        3rd ed. Bull Pub. Company, Boulder, CO2006
        • Clark N.M.
        • Mitchell H.E.
        • Rand C.S.
        Effectiveness of educational and behavioral asthma interventions.
        Pediatrics. 2009; 123: S185-S192
        • Clark N.M.
        • Nothwehr F.
        Self-management of asthma by adult patients.
        Patient Educ Couns. 1997; 32: S5-S20
        • Clark N.M.
        • Valerio M.A.
        • Gong Z.M.
        Self-regulation and women with asthma.
        Curr Opin Allergy Clin Immunol. 2008; 8: 222-227
        • Janevic M.R.
        • Ellis K.R.
        • Sanders G.M.
        • Nelson B.W.
        • Clark N.M.
        Self-management of multiple chronic conditions among African American women with asthma: a qualitative study.
        J Asthma. 2014; 51: 243-252
        • Buelow J.M.
        Epilepsy management issues and techniques.
        J Neurosci Nurs. 2001; 33: 260-269
        • DiIorio C.
        Epilepsy self-management.
        in: Handbook of health behavior research II: provider determinants. Plenum Press, New York1997: 213-230
        • DiIorio C.
        • Hennessy M.
        • Manteuffel B.
        Epilepsy self-management: a test of a theoretical model.
        Nurs Res. 1996; 45: 211-217
        • Shafer P.O.
        Nursing support of epilepsy self-management.
        Clin Nurs Pract Epilepsy. 1994; 2: 11-12
        • Buelow J.M.
        • Johnson J.
        Self-management of epilepsy — a review of the concept and its outcomes.
        Dis Manag Health Out. 2000; 8: 327-336
        • Bradley P.M.
        • Lindsay B.
        Care delivery and self-management strategies for adults with epilepsy.
        Cochrane Database Syst Rev. 2008; : CD006244
        • DiIorio C.
        • Bamps Y.
        • Walker E.R.
        • Escoffery C.
        Results of a research study evaluating WebEase, an online epilepsy self-management program.
        Epilepsy Behav. 2011; 22: 469-474
        • DiIorio C.
        • Escoffery C.
        • McCarty F.
        • Yeager K.A.
        • Henry T.R.
        • Koganti A.
        • et al.
        Evaluation of WebEase: an epilepsy self-management Web site.
        Health Educ Res. 2009; 24: 185-197
        • DiIorio C.K.
        • Bamps Y.A.
        • Edwards A.L.
        • Escoffery C.
        • Thompson N.J.
        • Begley C.E.
        • et al.
        The prevention research centers' managing epilepsy well network.
        Epilepsy Behav. 2010; 19: 218-224
        • Lindsay B.
        • Bradley P.M.
        Care delivery and self-management strategies for children with epilepsy.
        Cochrane Database Syst Rev. 2010; : CD006245
        • Ramaratnam S.
        • Baker G.A.
        • Goldstein L.H.
        Psychological treatments for epilepsy.
        Cochrane Database Syst Rev. 2006; 4
        • Mittan R.J.
        Psychosocial treatment programs in epilepsy: a review.
        Epilepsy Behav. 2009; 16: 371-380
        • DiIorio C.
        Epilepsy self-management scale [Internet].
        Managing Epilepsy Well. 2010 ([[cited 2015 July 13]. Available from:])
        • DiIorio C.
        • Shafer P.O.
        • Letz R.
        • Henry T.
        • Schomer D.
        • Yeager K.
        • et al.
        Project EASE: a study to test a psychosocial model of epilepsy medication management.
        Epilepsy Behav. 2004; 5: 926-936
      1. Living well with epilepsy.
        in: Report of the 1997 National Conference on Public Health and Epilepsy. Epilepsy Foundation, Landover, MD1998
        • Shafer P.O.
        Epilepsy and seizures: advances in seizure assessment, treatment, and self-management.
        Nurs Clin North Am. 1999; 34: 743-759
        • Institute of Medicine
        Epilepsy across the spectrum.
        Promoting health and understanding. National Academies Press, Washington, DC2012
        • Escoffery C.
        • Bamps Y.
        • LaFrance Jr., W.C.
        • Stoll S.
        • Buelow J.
        • Shafer P.
        • et al.
        Development of the Adult Epilepsy Self-Management Measurement Instrument (AESMMI).
        Epilepsy Behav. 2015; 50 (this issue): 172-183
        • Cramer J.A.
        • Perrine K.
        • Devinsky O.
        • Bryant-Comstock L.
        • Meador K.
        • Hermann B.P.
        Development and cross-cultural translation of a 31-item quality of life questionnaire (QOLIE-31).
        Epilepsia. 1998; 39: 81-88
      2. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System [Internet]. Atlanta, GA: Centers; 2015 [cited 2015 May 4]. Available from:

        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.
        The PHQ-9: validity of a brief depression severity measure.
        J Gen Intern Med. 2001; 16: 606-613
        • Baker G.A.
        • Smith D.F.
        • Jacoby A.
        • Hayes J.A.
        • Chadwick D.W.
        Liverpool Seizure Severity Scale revisited.
        Seizure. 1998; 7: 201-205
        • Gaitatzis A.
        • Carroll K.
        • Majeed A.
        • Sander JW
        The epidemiology of the comorbidity of epilepsy in the general population.
        Epilepsia. 2004; 45: 1613-1622
        • DiIorio C.
        Measurement in health behavior.
        Methods for research and education. 1st ed. Wiley, John & Sons, Incorporated, San Francisco, CA2005
        • de Vet H.C.W.
        • Terwee C.B.
        • Mokkink L.B.
        • Knol D.L.
        Measurement in medicine.
        Cambridge University Press, Boston, MA2011
        • Costello A.B.
        • Osborne J.W.
        Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis.
        Pract Assess Res Eval. 2005; 10
        • Comrey A.L.
        • Lee H.B.
        A first course in factor analysis.
        2nd ed. Lawrence Erlbaum Associates, Hillsdale, NJ1992
        • Tabachnick B.G.
        • Fidell LS
        Using multivariate statistics.
        5th ed. Allyn & Bacon, Boston2007
        • Nunnally J.C.
        • Bernstein I.H.
        Psychometric theory.
        3rd ed. McGraw-Hill, New York1994
        • Furr R.M.
        • Bacharach V.31R.T.O.
        Psychometrics: an introduction.
        Sage Publications, Inc., Thousand Oaks, CA2008
        • Tavakol M.
        • Dennick R.
        Making sense of Cronbach's alpha.
        Int J Med Educ. 2011; 2: 53-55
        • Fiest K.M.
        • Dykeman J.
        • Patten S.B.
        • Wiebe S.
        • Kaplan G.G.
        • Maxwell C.J.
        • et al.
        Depression in epilepsy a systematic review and meta-analysis.
        Neurology. 2013; 80: 590-599
        • LaFrance Jr., W.C.
        • Alosco M.L.
        • Davis J.D.
        • Tremont G.
        • Ryan C.E.
        • Keitner G.I.
        • et al.
        Impact of family functioning on quality of life in patients with psychogenic nonepileptic seizures versus epilepsy.
        Epilepsia. 2011; 52: 292-300
        • Devinsky O.
        • Penry J.K.
        Quality of life in epilepsy: the clinician's view.
        Epilepsia. 1993; 34: S4-S7
        • Loring D.W.
        • Meador K.J.
        • Lee G.P.
        Determinants of quality of life in epilepsy.
        Epilepsy Behav. 2004; 5: 976-980
        • Gaitatzis A.
        • Trimble M.R.
        • Sander J.W.
        The psychiatric comorbidity of epilepsy.
        Acta Neurol Scand. 2004; 110: 207-220
        • Wagner E.H.
        The role of patient care teams in chronic disease management.
        BMJ. 2000; 320: 569-572