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      The development of instruments to measure the work disability assessment behaviour of insurance physicians


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          Variation in assessments is a universal given, and work disability assessments by insurance physicians are no exception. Little is known about the considerations and views of insurance physicians that may partly explain such variation. On the basis of the Attitude - Social norm - self Efficacy (ASE) model, we have developed measurement instruments for assessment behaviour and its determinants.


          Based on theory and interviews with insurance physicians the questionnaire included blocks of items concerning background variables, intentions, attitudes, social norms, self-efficacy, knowledge, barriers and behaviour of the insurance physicians in relation to work disability assessment issues. The responses of 231 insurance physicians were suitable for further analysis. Factor analysis and reliability analysis were used to form scale variables and homogeneity analysis was used to form dimension variables. Thus, we included 169 of the 177 original items.


          Factor analysis and reliability analysis yielded 29 scales with sufficient reliability. Homogeneity analysis yielded 19 dimensions. Scales and dimensions fitted with the concepts of the ASE model. We slightly modified the ASE model by dividing behaviour into two blocks: behaviour that reflects the assessment process and behaviour that reflects assessment behaviour.

          The picture that emerged from the descriptive results was of a group of physicians who were motivated in their job and positive about the Dutch social security system in general. However, only half of them had a positive opinion about the Dutch Work and Income (Capacity for Work) Act (WIA). They also reported serious barriers, the most common of which was work pressure. Finally, 73% of the insurance physicians described the majority of their cases as 'difficult'.


          The scales and dimensions developed appear to be valid and offer a promising basis for future research. The results suggest that the underlying ASE model, in modified form, is suitable for describing the assessment behaviour of insurance physicians and the determinants of this behaviour. The next step in this line of research should be to validate the model using structural equation modelling. Finally, the predictive value should be tested in relation to outcome measurements of work disability assessments.

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          Most cited references42

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          Journal of Happiness Studies, 3(1), 71-92
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            Is General Self-Efficacy a Universal Construct?1

            Summary Perceived self-efficacy represents an optimistic sense of personal competence that seems to be a pervasive phenomenon accounting for motivation and accomplishments in human beings. The General Self-Efficacy scale, developed to measure this construct at the broadest level, has been adapted to many languages. The psychometric properties of this instrument is examined among 19,120 participants from 25 countries. The main research question is whether the measure is configurally equivalent across cultures, that is, whether it corresponds to only one dimension. The findings confirm this assumption and suggest the globality of the underlying construct. They also point to a number of cross-cultural differences that merit further investigation.
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              Self-efficacy: the third factor besides attitude and subjective norm as a predictor of behavioural intentions


                Author and article information

                BMC Public Health
                BMC Public Health
                BioMed Central
                3 January 2011
                : 11
                : 1
                [1 ]TNO Work and Employment, PO Box 718, 2130 AS Hoofddorp, the Netherlands
                [2 ]VU University Medical Center, Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Amsterdam, the Netherlands
                [3 ]UWV, Employee Benefits Insurance Authority, Amsterdam, the Netherlands
                [4 ]Research Center for Insurance Medicine, AMC-UWV-VUmc, Amsterdam, the Netherlands
                Copyright ©2011 Steenbeek et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<url>http://creativecommons.org/licenses/by/2.0</url>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 20 April 2010
                : 3 January 2011
                Research Article

                Public health
                Public health


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