The Development of the Working Alliance in Self-Management Education (WASME) Scale

Chronic conditions present a growing challenge to healthcare systems due to increasing prevalence rates and the associated financial burden for the individuals, their family and the wider economy. Good self-management has been shown to reduce morbidity and mortality rates of those with chronic disease (Sabaté, 2003) and has led to the development of self-management education programs. Little is known about what factors improve individuals’ adherence to treatment recommendations. The current literature review sought to investigate the relationship between the patient-clinician working alliance and adherence in people with long-term physical health conditions. A synthesis of nine eligible studies revealed that eight of the nine studies identified significant positive correlations between working alliance and adherence across a variety of chronic conditions and settings. Investigation of the predictive power of working alliance on adherence in five studies elicited inconsistent results preventing generalisations. The review was limited by the paucity of research and the heterogeneity of measures used to assess working alliance and adherence. The research report aimed to develop and examine the structure and psychometric properties of the Working Alliance in Self-Management Education (WASME) Scale. A collaborative and iterative process involving educators, self-management research staff and a clinical sample across five phases were used to develop the scale. Following the development and revision of initial items, 59 participants were recruited from a convenience sample of group self-management courses. A 15-item unidimensional scale was created which demonstrated excellent internal consistency. The WASME scale demonstrated good concurrent validity with the Consultations and Relational Empathy Measure (CARE) and was also moderately correlated to the Client Satisfaction Questionnaire (CSQ-8). Clinical implications and suggestions for future research were discussed. The critical appraisal presents a reflective account of the development of the research and the trainees’ decision making process to maximise transparency.