Exploring item comprehension and evaluation in the SELC scale: a qualitative pre-testing study

BACKGROUND: Lifestyle counselling is part of healthcare professionals' work, but when focused on individual lifestyle counselling, its effects are often limited or context-dependent, highlighting the need for a person-centered approach where motivation, readiness for change, and relational aspects are key. The SELC scale measures self-efficacy, relevant to care professionals' engagement, but interpretation needs further study. The aim of this study was to explore how participants understood and evaluated items in the SELC scale and to identify potential issues related to clarity, relevance, and response options through qualitative pre-testing interviews. METHODS: Qualitative pre-testing interviews with eight strategically selected participants explored how SELC items were understood and evaluated, using a structured guide with probing, and were analyzed with deductive qualitative content analysis. RESULTS: Participants found most items clear and easy to understand, although some terms were perceived as ambiguous. Items were generally perceived as relevant and consistently structured. Response alternatives were regarded as easy to distinguish, and the instructions were clear and straightforward. However, the open-ended item was unclear, and comments suggested that item order and the expert-driven perspective reduced the instrument's practical usefulness. In the revised SELC 20 + 20, terminology was clarified, items neutrally phrased, sequence aligned with real-life conversations, and visual and structural consistency improved. CONCLUSIONS: Pre-testing interviews identified strengths and improvement areas in the SELC scale and guided its refinement. Combined with previously published psychometric testing, results suggest the SELC scale has potential for assessing self-efficacy among healthcare professionals and in educational settings, although further validation is needed.