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English Version. ECQ. Essen Coping Questionnaire - Manual

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ECQ
Essen Coping Questionnaire
Test Manual

Authors: G. H. Franke & M. Jagla

This test is available for free at www.psychometrikon.de

© G.H. Franke & M. Jagla (2016)
G. H. Franke & M. Jagla.: ECQ 2

Contact:
Gabriele Helga Franke
Prof. Dr. habil. Dipl.-Psych., Qualified Psychotherapist
University of Applied Sciences Magdeburg-Stendal
Department of Applied Human Sciences
Psychology of Rehabilitation
Psychodiagnostics
Osterburger Straße 25, House 3, Room 1.18
39576 Stendal
Germany
Phone: +49 3931 2187 4862
Fax: +49 3931 2186 4872
Email: gabriele.franke@hs-magdeburg.de

Published by:
PSYCHOMETRIKON – psychological medical test portal
www.psychometrikon.de
Contact: info@psychometrikon.de

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G. H. Franke & M. Jagla.: ECQ 3

Table of Contents

Page
Table of Contents 3
Test Abstract 4
Goal 4
Description 4
Fields of Application 4
Theoretical Background 5
Test Design 5
Item generation 5
Creation and test version 6
Analysis samples 7
Psychometric parameters 8
Scale structure 8
Item values 8
Quality criteria 10
Construct validity 10
Sensitivity to change 12
Sociodemographic influence on the ECQ scales 13
Utilisation 13
Test execution 13
Test instruction 13
Test evaluation 13
Test interpretation 15
Utilisation and versions in different languages 16
Modification of items, discussion and outlook 16
References 17

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G. H. Franke & M. Jagla.: ECQ 4

Test Abstract
Goal:
The Essen Coping Questionnaire (ECQ) is an assessment instrument that can be used
for several diseases that assesses a person’s coping efforts on an emotional, cognitive
and behavioural level.

Description:
The nine a priori scales each comprise five items with a five-tier scale (0 = „not at all“, to 4
= „extremely“) and describe the following areas:

1. Acting, problem-oriented coping (APC)

2. Distance and self-promotion (DSP)
3. Information seeking and exchange of experiences (ISE)
4. Trivialisation, wishful thinking and defence (TWD)
5. Depressive processing (DP)
6. Willingness to accept help (WAH)
7. Active search for social integration (ASS)
8. Trust in medical care (TMC)
9. Finding of inner stability (FIS).

Fields of Application:
The Essen Coping Questionnaire can be used for patients suffering from all chronic phys-
ical diseases and has already stood the test in this field. Its usage for acute physical and
mental diseases has so far not been documented in a scientific publication. Researching
them as potential fields of application would be very interesting.

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G. H. Franke & M. Jagla.: ECQ 5

Theoretical Background
Especially in western industrial nations the range of diseases is shifting towards chronic diseases
(Bengel et al., 2003). Chronic diseases are characterized as being of multifactorial origin, taking a
long-term course while often being progressive and having multiple restricting physical and psy-
chosocial effects. “Medical-psychological research of the last two decades indicates high preva-
lence for mental comorbidity in patients with chronic diseases and a high psychosocial need for
communication (Koch et al., 2011, p. 31)“.

Appropriate diagnostics of mental aspects, especially how to cope with a disease, in physical dis-
eases, and their treatment can lead to a higher compliance, adjustment and quality of life (Härter,
2000; 2002). Jeske et al. (2009) were able to show that parental coping influences the health-
related quality of life of their children. This shows that assessing the coping with a disease not
only helps patients in their coping process but also by intervening indirectly supports their family
and surroundings (cf. Franke, K., 2003).
According to Mayer und Filipp (2002, p. 307) for recording of coping with a disease „…all at-
tempts […] that people make in the context of a disease to cope with the internal and external
requirements that come with the new life situation“, there are various methods and approaches in
the German-speaking region. Franke et al. (2007) provide an overview of German-speaking psy-
chological diagnostic methods for the assessment of stress and coping with a disease. Franke
(2008) provides additional observations regarding burnout and coping.
There are two methods for the assessment of coping in the German-speaking region that are
mostly used: the Freiburg Coping Questionnaire (FKV) (Freiburger Fragebogen zur Krank-
heitsverarbeitung; Muthny, 1989) and the Trier Coping Scales (TSK) (Trierer Skalen zur Krank-
heitsbewältigung; Klauer & Filipp, 1993). Both are critically discussed in literature (for example
Jagla & Franke, 2012). In the psychometric review of the FKV by Hardt and colleagues (2003)
three of the five scales showed insufficient reliability. The factor structure could not be replicated.
The authors suggest a two-factor solution with the scales “Active Coping” and “Depressive Pro-
cessing”. Dörner and Muthny (2008) compared FKV and TSK using 224 cardiological patients in
rehabilitation with the result that reliability in the TSK scales was altogether a little higher. This
was attributed to the higher number of items on each scale and their definition. In contrast to the
psychometric analyses by Hardt and colleagues (2002) the FKV in a sample of the cardiological
patients still showed an acceptable psychometric quality.

This manual introduces the ECQ (Franke et al., 2000) to the English speaking user group: a
questionnaire that specifically assesses the characteristics of the individual coping with a disease.

Test Design
The essential studies for the development of the EQC were conducted in the ophthalmic clinic of
the Essen University Hospital between 1995 and 2000. The total sample of N=210 visually im-
paired patients consisted of 117 patients with malignant choroidal melanoma after having finished
radiotherapy (48.7% men, average age early 60s) and 93 patients with degenerative retina dis-
eases (64.5% men, average age early 40s). All patients had a visual impairment that occurred
during adulthood and affected at least one eye.

Item generation:

The following methods for the assessment of coping were critically analysed for the construction
of the ECQ:

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G. H. Franke & M. Jagla.: ECQ 6

• the Ways of Coping Checklist (WCCL, Vitaliano, Russo & Carr, 1985) in German by Fer-
ring and Filipp (1989),
• the Questionnaire for the Assessing of Ways of Coping (FEKB) (Fragebogen zur Erfas-
sung von Formen der Krankheitsbewältigung , Klauer, Filipp & Ferring, 1989) and the en-
suing Trier Coping Scales (TSK) (Trierer Skalen zur Krankheitsbewältigung, Klauer & Fil-
ipp, 1993) and
• the brief version of the Freiburg Coping Questionnaire (FKV-LIS) (Kurzversion des Frei-
burger Fragebogens zur Krankheitsverarbeitung, Muthny, 1988).

Regarding the WCCL only little evidence for convergent validity could be found exemplarily (Eng-
lert et al., 1993). The main objection regarding the FKV-LIS is that is does not use the full poten-
tial of the scale since only 23 of 35 items are used for its construction. In contrast to the FKV-LIS
for the ECQ the items should be presented in the first person to address the patients directly and
in contrast to the FEKB the time frame of the acquisition should be in the present to avoid possi-
ble selection and memory effects to a large extent. The instruction is therefore: “How do you cur-
rently deal with your disease? Please read each statement carefully and tick the appropriate
number to the right.” The ECQ was developed as a brief screening method with 45 items for sev-
eral diseases. A five-tier Likert scale, ranging from „0 = not at all“, to „4 = extremely“, was used to
answer to the items. Since the recording of further relevant medical and psychological constructs
is already a strain, the ECQ is designed to record the current coping efforts on an emotional, cog-
nitive and behavioural level. During the creation of the ECQ items concepts were developed using
international literature that have proven to be test theoretically stable. For this purpose nine areas
of coping with five items each were drafted:

1. APC, acting, problem-oriented coping: active, cognitively structuring coping, e.g. item no.
4 „I make plans and stick to them“.
2. DSP, distance and self-promotion: search for self-affirmation and encouragement and dis-
traction, distance and self-promoting strategies, e.g. item no. 3 „I try to find distance and
rest“.
3. ISE, information seeking and exchange of experiences: active search for information
about one‘s disease in conversations with other affected persons and search for litera-
ture, e.g. item no. 1 „I actively look for information about my disease in books, magazines
or the internet“.
4. TWD, trivialisation, wishful thinking and defence: ignoring and wishful thinking and down-
play, e.g. item no. 39 „I downplay the significance and importance“.
5. DP, depressive processing: self-pity and retreat, e.g. item no. 29 „I withdraw from other
people“.
6. WAH, willingness to accept help: readiness to open up towards others and accept their
support, e.g. item no. 34 „I accept help from other people“.
7. ASS, active search for social integration: active efforts to maintain and recreate social con-
tacts, e.g. item no. 38 „I actively make new acquaintances or refresh old acquaintances“.
8. TMC, trust in medical care: trust in doctors’ work and compliance (two items are inverted),
e.g. item no. 24 „I trust my doctors“.
9. FIS, finding of inner stability: finding of inner stability through religious or alternative self-
strengthening behavioural patterns, e.g. item no. 28 „I start to see a purpose in the dis-
ease“.

Creation and test version:

Instructions and evaluation were presented similar to the SCL-90 methods (Franke, 2014). The
FKV-LIS (Muthny, 1989) and the 22 item brief version of the Questionnaire for Social Support (F-
SozU) (Fragebogen zur sozialen Unterstützung; Fydrich et al., 2007) were used additionally for
the 210 visually impaired patients. This psychometric test of the ECQ was published in 2000

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G. H. Franke & M. Jagla.: ECQ 7

(Franke et al., 2000). To summarise, the scales APC, ISE, DP and TMC could be completely rep-
licated in an explorative factor analysis (varimax rotation). The scales DSP, TWD, ASS and FIS
showed four of five and WAH showed three of five items grouped on one factor. There were cor-
relative connections between scales of the ECQ and the FKV-LIS that corresponded particularly
closely with regards to content. As expected the total value of the F-SOZU-K22 also correlated
positively with ASS (r = .30) and with APC and TMC (both r = .23) and negatively with DP (r = -
.37).

Chart 1: Socio-demographic characteristic of 1,815 analysed chronic patients.

Attributes Group A: Group N: Group G: Sum Stat.

Chronic oph- Chronic renal Mixed sample infer-
thalmic pa- insufficient of chronic ence
tients patients patients

Sample size 555 529 731 1.815

Gender
Male 238 (42.9%) 298 (56.3%) 351 (48%) 887 (48.9%) X² =
Female 317 (57.1%) 231 (43.7%) 380 (52%) 928 (51.1%) 19.97 p<
.0001

Age
Average age in 53.8 ±14.1 46.7 ±13.1 45.1 ±16.9 48.2 ±15.5 F = 56.31
years (16-86) p< .0001
16 – 24 years 12 (2.2%) 22 (4.2%) 99 (13.5%) 133 (7.3%) X² =
25 – 34 years 47 (8.5%) 99 (18.7%) 89 (12.2%) 235 (12.9%) 189.2 p<
35 – 44 years 94 (16.9%) 106 (20%) 161 (22%) 361 (19.9%) .0001
45 – 54 years 110 (19.8%) 112 (21.2%) 165 (22.6%) 387 (21.3%)
55 – 64 years 164 (29.5%) 157 (29.7%) 111 (15.2%) 432 (23.8%)
65 – 74 years 93 (6.3%) 32 (6%) 79 (10.8%) 204 (11.2%)
75 – 86 years 35 (6.3%) 1 (0.2%) 27 (3.7%) 63 (3.5%)

Analysis samples:

The psychometric analyses that are being reported here are based on a total sample that consists
of three data sets. The partial samples A and N (see chart 1) were collected at Essen University
Hospital between 1995 and 2005 during regular visits of outpatients and in case of inpatients at
the bedside. The data for the partial sample G were collected in several out-patient and in-patient
facilities mostly in eastern Germany and mainly in Saxony-Anhalt (there is a positive vote under
reference number AZ 4973-8 of the Ethics Commission of the Department for Applied Human
Sciences of the University of Applied Sciences Magdeburg-Stendal). To be able to participate in
the study patients had to suffer from at least one chronic disease.
Sample A comprised visually impaired or ophthalmic patients with different diseases of the eye
(malignant choroidal melanoma, Graves' ophthalmopathy, uveitis, retinopathy). Sample N com-
prised patients before and after renal transplantation and sample G comprised patients in internal
medicine, gynaecology, neurology and orthopaedy (Jagla & Franke, 2009; 2010).
In groups A and G there were more women than men, in group N there were more men than
women. Group A with 54 years (±14) was older than groups N (47 years, ±13) and G (45 years
±17).
The total sample for analysis comprised 1,815 chronic patients.

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G. H. Franke & M. Jagla.: ECQ 8

Psychometric parameters
Scale structure:

The ECQ comprises of the following dimensions with five items each. The reliability of the scales
APC, ISE, DP and ASS was higher than .70; in case of DSP, WAH, TMC and FIS only higher
than .60 and in case of TWD only .51:

1. APC: Acting, problem-oriented coping (Cronbach‘s α = .80)

2. DSP: Distance and self-promotion (α = .64)
3. ISE: Information seeking and exchange of experiences (α = .79)
4. TWD: Trivialisation, wishful thinking and defence (α = .51)
5. DP: Depressive processing (α = .74)
6. WAH: Willingness to accept help (α = .65)
7. ASS: Active search for social integration (α = .78)
8. TMC: Trust in medical care (α = .65)
9. FIS: Finding of inner stability (α = .65).

Item values:

Chart 2 shows the distribution of answers to the 45 items.

Chart 2: Answer overview of the 45 reviewed items of the 1,815 chronic patients.

No.a Item description Answer categoryb

0 1 2 3 4

16 I follow the medical advice very closely 2.7 6.3 22.9 32.6 35.5
24 I trust my doctors 3.2 6.5 24.2 33.3 32.7
41 I have a high degree of confidence in my medical treatment 4.5 9.9 24.7 33.7 27.2
17 I spend good times with other people 5.4 12.8 23.4 30.7 27.7
6 I solve problems step by step 7.4 14.7 33.3 28.9 15.7
22 I reassure myself 7.9 16.1 28.8 28.1 19.1
26 I start to see my situation realistically and to act accordingly 8 12.3 31 30.2 18.5
34 I accept help from other people 8.8 31.9 31.3 18.5 9.5
12 I try to actively tackle my problems 9.2 15.3 32.8 26.4 16.3
44 I try to help other people 9.3 20.8 32 24.6 13.4
42 I regain my inner strength 10.1 17.5 32.3 28.2 12
27 I try to figure out how to come to terms with my disease 10.4 11.9 27.8 32.7 17.2
7 I try to distract myself and to recover 10.8 17.9 31 27.2 13.2
18 I start to indulge myself 12.6 24.9 27.7 21.3 13.6
14 I find out as much as possible about my disease 15.2 22.9 25 20.2 16.7
32 I go out with friends 15.5 24.6 27.2 18.6 14.2
4 I make plans and stick to them 16.2 20.2 31 20.2 12.4
3 I try to find distance and rest 20.4 27.3 26 17.7 8.5
36 I seek success and self-affirmation 22 25 26.1 18.1 8.8
15 I start to open up towards other people 22 30.9 26.6 13.1 7.4
45 I like to be looked after and taken care of 23.5 32.6 23.5 12.7 7.7
43 I do not think about my illness anymore 24.1 32.2 23.6 13.3 6.8
19 I have doubts that my medical treatment is good enough 25.6 17.1 11.6 15.5 30.2
2 I visit other people or invite them to visit me 26.2 23.9 24 15.6 10.2
23 I keep on living as if nothing has happened 26.8 19.4 23.6 18.6 11.7
38 I actively make new acquaintances or refresh old acquaintances 29 29.1 21.7 13.4 6.8
1 I actively look for information about my disease in books, maga- 31.5 31.8 16.8 11.1 8.8
zines or the internet

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G. H. Franke & M. Jagla.: ECQ 9

Continuation
No.a Item description Answer categoryb

0 1 2 3 4

30 I start to show my feelings to other people 31.1 32.8 21.5 10.5 4.1
37 I start to accept the disease as my fate 32.8 22 21.8 15.1 8.3
8 I exchange experiences in dealing with the disease with other pa- 32.8 29.7 16.6 12.6 8.3
tients
10 I look for alternative cures and methods of treatment 33.8 26 18 13.2 9.1
40 I start to think and to ponder 35.8 33.1 17.3 9.8 4.1
9 I recollect previous experiences with blows of fate 36.5 27.2 17.1 12.6 6.7
33 I mistrust the doctors and have the diagnosis checked 37.1 8.6 4 8.7 41.7
20 I seek contact with other people who have experienced a similar 41.5 29.9 15.1 8.8 4.7
situation
5 I lose myself in daydreams 41.9 28.6 11.7 10.2 7.5
11 I pick myself up through prayer, meditation or intense contact with 43.7 20.2 14.7 12.1 9.2
nature
39 I downplay the significance and importance 45.1 29.6 15.8 6.5 3
13 I refuse to accept my condition 51.8 23.2 12.5 7.2 5.3
21 I become irritated and impatient with other people 54.3 26.7 11.2 5.1 2.7
31 I pray and seek solace in faith 54.5 19 10 8.3 8.3
35 I am angry with my fate 55.2 25.7 9.1 5.4 4.6
28 I start to see a purpose in the disease 58.7 18.3 11.7 6.6 4.7
29 I withdraw from other people 69.9 17.7 6.1 3.9 2.4
25 I start feeling sorry for myself 74.8 18.5 3.4 2.2 1.2

a b
Note: Position of the item in the original version of the check list; 0 = not at all, 1 = somewhat, 2 = moderately, 3 =
strongly, 4 = extremely

The 45 items underwent a factor analysis with subsequent varimax rotation (Chart 3). Initially 10
factors ensued with an Eigen value λ ≥ 1 (Eigen value 8.8, 3.8, 2.3, 2.1, 1.9, 1.6, 1.4, 1.3, 1.2,
1.0). After the execution of a Scree-test five dimensions (explained variance 19.5 %, 8.5 %, 5.2
%, 4.8 %, 4.2 % und 3.5 %) were determined that explained altogether 45.7% of variance.
The five factors were found: „1. Social support“, with eleven items, „2. Trust and drive“, with elev-
en items, „3. Search for information and meaning” and „4. Depressive trivialising coping”, with
eight items each and „5. Distrust and retreat“, with four items. Three items had a loading of under
.40 and item no. 31 showed double loadings on the factors three and five. The ECQ scales APC,
ISE, DP and ASS were complete, WAH showed four; and TWD and TMC three items on one fac-
tor; the items of the scales DSP and FIS were spread.

Chart 3: Result of the factor analytical assessment of the reviewed items from 1,815 chronic pa-
tients (h² = commonality, F1 to F5 = Loading of the items on the five new factors).

Content h² F1 F2 F3 F4 F5

32 ASS go out with friends .59 .74

38 ASS actively make new acquaintances or refresh old acquaintances .52 .70
17 ASS spend good times with other people .50 .65
30 WAH start to show my feelings to other people .44 .62
2 ASS visit other people or invite them to visit me .45 .62
18 DSP start to indulge myself .40 .57
34 WAH accept help from other people .42 .56
15 WAH start to open up towards other people .47 .55
36 DSP seek success and self-affirmation .38 .50
44 ASS try to help other people .36 .44
45 WAH like to be looked after and taken care of .27 .40

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G. H. Franke & M. Jagla.: ECQ 10

Continuation
Content h² F1 F2 F3 F4 F5

41 TMC have a high degree of confidence in my medical treatment .47 .67

24 TMC trust my doctors .43 .64
16 TMC follow the medical advice very closely .42 .62
26 APC start to see my situation realistically and to act accordingly .45 .60
6 APC solve problems step by step .43 .58
12 APC try to actively tackle my problems .49 .58
22 DSP reassure myself .41 .54
27 APC try to figure out how to come to terms with my disease .43 .51
42 FIS regain my inner strength .47 .48
7 DSP try to distract myself and to recover .40 .47
4 APC make plans and stick to them .39 .45
43 TWD do not think about my illness anymore .25 -
10 ISE look for alternative cures and methods of treatment .47 .65
14 ISE find out as much as possible about my disease .56 .65
1 ISE actively look for information about my disease in books, magazines .41 .63
or the internet
20 ISE seek contact with other people who have experienced a similar .46 .61
situation
8 ISE exchange experiences in dealing with the disease with other pa- .47 .59
tients
11 FIS pick myself up through prayer, meditation or intense contact with .47 .53
nature
9 WAH recollect previous experiences with blows of fate .31 .44
28 FIS start to see a purpose in the disease .26 .40
40 DP start to think and to ponder .53 .69
35 DP am angry with my fate .48 .68
25 DP start feeling sorry for myself .44 .62
29 DP withdraw from other people .42 .61
21 DP become irritated and impatient with other people .37 .58
5 TWD lose myself in daydreams .34 .56
39 TWD downplay the significance and importance .35 .51
13 TWD refuse to accept my condition .27 .44
3 DSP try to find distance and rest .27 -
33 TMC mistrust the doctors and have the diagnosis checked .62 .78
19 TMC have doubts that my medical treatment is good enough .58 .76
31 FIS pray and seek solace in faith .44 .43 .49
23 TWD keep on living as if nothing has happened .34 .43
37 FIS start to accept the disease as my fate .24 -

Quality criteria
Construct validity:

In partial sample B (529 chronic patients with renal insufficiency) correlations between the ECQ
and the Scales of the Brief Symptom Checklist (BSCL) (Brief Symptom Checkliste, Franke, 2016,
formerly BSI, Franke, 1997, 2000) and the total value of the German Social Support Scale with 22
items (Fydrich et al., 2007) were found (chart 4).

The ECQ scale WAH did not correlate statistically significant with the BSCL. Only very weak con-
nections were found between psychological distress recorded in the BSCL scales and APC, DSP,
ISE and FIS. Very weak and weak connections were found between the BSCL scales and TWD,
ASS and TMC. Weak connections between the ECQ TWD and distress were found in the BSCL
scales PSY (r = .25), DEP (r = .21) and ANX and PAR (both r = .20); all other connections were
very weak. Besides very weak connections between ECQ ASS and the BSCL, weak connections
were found with DEP (r = .26), PHOB (r = .23), I-S (r = .22), PSY (r = .21) and SOM (r = .20). Be-
sides very weak connections, ECQ TMC showed weak connections with PAR (r = -.27), with DEP

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G. H. Franke & M. Jagla.: ECQ 11

and PSY (r = -.26), with HOS and O-C (both r = -.24), with SOM and I-S (both r = -.23). The
strongest connections between psychological distress and coping was found with the ECQ scale
DP. Besides the weak connection between BSCL and ECQ regarding SOM (r = .37) and PHOB (r
= .39) one very strong and six strong connections were found. In detail the ECQ DP correlated
very strongly with DEP (r = .62) and strongly with HOS (r = .55), I-S (r = .51), with PSY and O-C
(both r = .50), with ANX (r = .48) and with PAR (r = .45).
In the construction study (Franke et al., 2000) as expected the total value of the F-SOZU-K22
(Fydrich et al.), correlated positively with ASS (r = .30) and with APC and TMC (both r = .23) and
negatively with DP (r = -.37). The negative correlation between the ECQ DP and social support (r
= -.30) was also found in partial sample B (chart 4). Medium, positive connections were found
between social support and ASS (r = .59) and APC (r = .42) and weak connections with WAH (r =
.39), TMC (r = .27) und DSP (r = .25).
The intercorrelation matrix of the ECQ scales showed ample differences between the scales but
also various statistically significant connections (chart 4).

Chart 4: Correlative connection between the nine scales of the ECQ and the scales of the BSCL
(Franke, 2016; formerly BSI, Franke, 1997, 2000) and the F-Sozu-K22 (Fydrich et al., 2007) in
partial sample B (n = 529 chronic patients with renal insufficiency) and intercorrelations between
the ECQ scales in the total sample of chronic patients (N = 1.815)

APC DSP ISE TWD DP WAH ASS TMC FIS

N = 529
HOS -.09+ .06 .10+les .16** .55** -.02 -.15** .24** .07
ANX -.12* .04 .09+ .20** .48** -.03 -.19** -.19** .06
DEP -.14** .04 .13* .21** .62** -.01 -.26** -.26* .03
PAR -.06 .17** .16** .20** .45** .05 -.11+ -.27** .07
PHOB -.15** .02 .03 .16** .39** -.04 -.23** -.18** .11+
PSY -.13* .08 .11* .25** .50** -.02 -.21** -.26** .11+
SOM -.09+ .01 .09+ .14** .37** .00 -.20** -.23** .02
I-S -.13* .08 .02 .17** .51** -.04 -.22** -.23** -.00
O-C -.14* .03 .08 .16** .50** .03 -.19** -.24 .02

SOZU- .42** .25** .07 -.01 -.30** .39** .59** .27** .12*
K22

N = 1.815
APC - .63** .43** .21** -.04 .45** .50** .20** .42**
DSP - .43** .31** .18** .56** .49** .18** .44**
ISE - .13** .19** .45** .34** .17** .35**
TWD - .28** .20** .20** -.01 .26**
DP - .18** -.07 .03 .07*
WAH - .55** .20** .46**
ASS - .07* .39**
TMC - .06+

+ = p < .05; * = p < .01; ** = p < .001

HOS=Hostility, ANX=Anxiety, DEP=Depression, PAR=Paranoid Ideation, PHOB=Phobic Anxiety,
PSY=Psychoticism, SOM=Somatization, I-S=Interpersonal Sensitivity, O-C=Obsessive-Compulsive

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© G.H. Franke & M. Jagla (2016)
G. H. Franke & M. Jagla.: ECQ 12

Chart 5: Repeated measures on stanine level with n=48 patients at the beginning and at the end
of neurological rehabilitation phase II (t-tests for paired samples)

Scale T1 T2 t p<
M ±SD M ±SD
APC 4.06 ±2.24 4.71 ±2.01 -2.46 .02
DSP 4.06 ±2.08 4.65 ±1.76 -2.55 .01
ISE 4.06 ±2.28 4.73 ±1.92 -2.03 .05
TWD 4.17 ±2.21 4.52 ±1.87 -1.13 .26
DP 4.75 ±2.14 5.13 ±2.12 -1.17 .25
WAH 3.77 ±1.93 4.31 ±1.60 -2.24 .03
ASS 3.71 ±2.17 4.60 ±2.11 -3.62 .001
TMC 5.15 ±2.38 3.10 ±1.46 5.24 .0001
FIS 3.67 ±1.69 4.19 ±1.53 -2.12 .04
Sensitivity to change:

Replicability of the ECQ was not researched. As the time frame of the ECQ focuses on the cur-
rent situation, already from theoretical considerations it is not to be expected that the replies will
remain steady. Additionally, practically it would mean to study a group of chronic patients again
within a defined interval – without intervention – using the ECQ. This approach did not seem rea-
sonable as it is impossible to ensure that the studied patients do not receive interventions.
Therefore a group of 48 patients was studied at the beginning and at the end of the neurological
rehabilitation phase II using the ECQ (Müller et al., 2014). The patients suffered from cerebrovas-
cular diseases (stroke, cerebral haemorrhage), diseases of the nervous system (multiple sclero-
sis, polyneuropathy, epilepsy) or intracranial injuries (craniocerebral injury). By using the results
of repetitive measuring presented in chart 5 it is possible to determine how sensitive to change
the ECQ is. Chart 5 gives an overview of the extent of the statistical effects of this repetitive
measuring on the level of stanine scores (M = 5, ±2). At the end of the rehabilitation measure the
averages of the scales ASS, DSP, APC and WAH were statistically significantly higher. The neu-
rological patients thus reported at the end of the complex intervention that they were more active-
ly looking for social support, were seeking more distraction and self-affirmation, were using more
active, problem oriented coping strategies, were more willing to accept help and were looking for
more information about their disease. The stanine score of the respective scales on average rose
from stanine = 4 to stanine = 5 and thereby drew nearer towards average scores. Trust in medical
care decreased most to a score that was almost below average from about stanine = 5 to about
stanine = 3.
Summing up, the ECQ can be seen as sensitive to change.

Chart 6: Socio-demographic influence on the ECQ scales: factor gender with N = 1,815 chronic
patients

Scale Men Women t p<

N=877 N=928
APC 2.25 ±0.90 2.24 ±0.87 0.29 .77
DSP 1.94 ±0.81 1.98 ±0.75 -1.22 .22
ISE 1.33 ±0.93 1.51 ±0.93 -3.96 .0001
TWD 1.22 ±0.70 1.23 ±0.71 -0.23 .82
DP 0.70 ±0.71 0.72 ±0.69 -0.81 .42
WAH 1.46 ±0.78 1.49 ±0.73 -.87 .38
ASS 1.94 ±0.88 1.93 ±0.91 .21 .84
TMC 2.42 ±0.78 2.50 ±0.79 -2.21 .03
FIS 1.33 ±0.82 1.31 ±0.80 0.59 .56

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G. H. Franke & M. Jagla.: ECQ 13

Chart 7: Socio-demographic influence on the ECQ scales: facto rage with N = 1,815 chronic pa-
tients

Scale 16-34 yrs 35-44 yrs 45-54 yrs 55-64 yrs 65-86 yrs Stat. examination
N=368 N=361 N=387 N=432 N=267
APC 2.10 ±0.83 2.30 ±0.88 2.32 ±0.86 2.29 ±0.92 2.19 ±0.91 F=5.06 p<.003 η²=.01
DSP 1.94 ±0.75 1.96 ±0.80 1.96 ±0.75 1.99 ±0.77 1.94 ±0.84 F=0.35 p<.84
ISE 1.32 ±0.89 1.38 ±0.91 1.46 ±0.93 1.49 ±0.92 1.45 ±1.04 F=2.01 p<.09
TWD 1.20 ±0.71 1.16 ±0.73 1.19 ±0.65 1.27 ±0.76 1.32 ±0.65 F=2.55 p<.04 η²=.01
DP 0.89 ±0.72 0.76 ±0.75 0.64 ±0.66 0.66 ±0.67 0.58 ±0.63 F=10.30 p<.0001
η²=.02
WAH 1.56 ±0.81 1.49 ±0.75 1.43 ±0.75 1.45 ±0.74 1.46 ±0.73 F=1.82 p<.12
ASS 2.09 ±0.95 1.95 ±0.93 1.91 ±0.85 1.85 ±0.82 1.86 ±0.93 F=4.31 p<.002 η²=.01
TMC 2.46 ±0.79 2.45 ±0.83 2.49 ±0.80 2.38 ±0.71 2.55 ±0.80 F=2.09 p<.08
FIS 1.11 ±0.75 1.26 ±0.82 1.32 ±0.81 1.43 ±0.80 1.49 ±0.85 F=11.17 p<.0001
η²=.02

Socio-demographic influence on the ECQ scales:

In the total sample of 1,815 the influence of the two socio-demographic variables gender and age
(in five nearly equal groups) was looked into. Although the simultaneous multivariate examination
of both variables in the factor analytical model showed a statistically significant interaction be-
tween the two sociodemographic factors (F = 1.62, p < .01), the interaction could not be con-
firmed in the subsequent individual tests.
The factor gender had a main effect (F = 2.91, p < ,002, η²= .01); it was shown (chart 6) that fe-
male chronic patients were looking for information and exchange of experiences at a larger de-
gree and had more trust in medical care than male patients. The factor age showed clearer ef-
fects (F = 6.69, p < .0001, η² = .03) that could be proven with subsequent small effect sizes for
the scales APC, TWD, DP, ASS und FIS (see chart 7). The most distinct age effect showed with
FIS (η² = .02) where older (55-64 yrs.) and old (65-86 yrs.) chronic patients reported higher values
than younger (16-34 yrs.) patients. Similar age differences were also found with the ECQ scale
TWD (η² = .01). On the other hand with DP (η² = .02) and ASS (η² = .01) usage of the strategy de-
creased with the age of the patient. In contrast the distribution over the age groups of the scale
APC was not linear with low values with the young and very old patients and higher values in the
age groups between 35 and 64 yrs. (η² = .01).

Utilisation
The ECQ is easy to use, has a high acceptance by patients and is a very sensitive indicator for
the coping process of chronic patients.

Test execution:

Answering to all questions of the ECQ takes less than ten minutes.

Test instruction:

Patients are told that the questionnaire examines the current handling of their disease. They are
asked to tick the appropriate box of a five-tier Likert scale from „0 = not at all“, to „4 = extremely“.
Patients are asked to answer all of the questions.

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© G.H. Franke & M. Jagla (2016)
G. H. Franke & M. Jagla.: ECQ 14

Test evaluation:

All items on a scales are summed and divided by the respective number of items (for each of the
nine scales by five). Chart 8 shows the allocation of the items to the scales. In case of missing
data the divider has to be reduced.

Chart 8: Allocation of the items to the nine scales of the ECQ

Scale Items
(1) APC: Acting, problem-oriented coping 4, 6, 12, 26, 27
(2) DSP: Distance and self-promotion 3, 7, 18, 22, 36
(3) ISE: Information seeking and exchange of experiences 1, 8, 10, 14, 20
(4) TWD: Trivialisation, wishful thinking and defence 5, 13, 23, 39, 43
(5) DP: Depressive processing 21, 25, 29, 35, 40
(6) WAH: Willingness to accept help 9, 15, 30, 34, 45
(7) ASS: Active search for social integration 2, 17, 32, 38, 44
(8) TMC: Trust in medical care 16, 19(i), 24, 33(i), 41
(9) FIS: Finding of inner stability 11, 28, 31, 37, 42

This mean value per patient has little significance and therefore should be transformed into sta-
nine scores using chart 9. Starting in the left column, chart 9 shows the cumulated value followed
by the mean value. The following nine columns show the stanine scores of the nine ECQ scales.
Normalization was performed in the complete analysis sample of N = 1,815 (chart 1).

Chart 9: Stanine scores of the ECQ based on N = 1,815 chronic patients

Sum M APC DSP ISE TWD DP WAH ASS TMC FIS

0 0 1 1 1 1 2 1 1 1 1
1 0.2 1 1 2 2 4 2 1 1 2
2 0.4 1 1 3 3 5 2 1 1 3
3 0.6 2 2 3 3 5 3 2 1 3
4 0.8 2 2 4 4 6 3 3 1 4
5 1 2 3 4 5 6 4 3 1 5
6 1.2 3 3 5 5 7 4 3 1 5
7 1.4 3 4 5 6 7 5 4 2 5
8 1.6 3 4 6 6 7 5 4 3 6
9 1.8 4 5 6 7 8 6 5 3 6
10 2 4 5 6 7 8 6 5 4 7
11 2.2 5 6 7 8 8 7 6 4 7
12 2.4 5 6 7 8 9 7 6 5 7
13 2.6 6 7 7 8 9 8 6 6 8
14 2.8 6 7 8 9 9 8 7 6 8
15 3 7 8 8 9 9 9 7 6 9
16 3.2 7 8 8 9 9 9 8 7 9
17 3.4 8 9 9 9 9 9 8 7 9
18 3.6 8 9 9 9 9 9 9 8 9
19 3.8 9 9 9 9 9 9 9 8 9
20 4 9 9 9 9 9 9 9 9 9

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G. H. Franke & M. Jagla.: ECQ 15

Chart 10: Comparative data of N = 1,815 chronic patients (M = mean, ± = standard deviation, Min
= minimum, Max = maximum, Rel = reliability, Cronbach's Alpha, Conf = confidence interval when
measuring at a point in time, RCI= Reliable Change Index at measurement of change)

No scale M ± Min Max Rel Raw Score Stanine Score

Conf RCI Conf RCI
1 APC: Acting, problem-oriented 2.24 0.88 0 4 .80 0.77 0.92 1.75 2.09
coping
2 DSP: Distance and self- 1.96 0.78 0 4 .64 0.92 1.09 2.35 2.80
promotion
3 ISE: Information seeking and 1.42 0.93 0 4 .79 0.84 0.99 1.80 2.14
exchange of experiences
4 TWD: Trivialisation, wishful think- 1.22 0.71 0 4 .51 0.97 1.16 2.74 3.27
ing and defence
5 DP: Depressive Processing 0.71 0.70 0 4 .74 0.70 0.83 2.00 2.38
6 WAH: Willingness to accept help 1.48 0.76 0 4 .65 0.88 1.05 2.32 2.76
7 ASS: Active search for social 1.93 0.89 0 4 .78 0.82 0.97 1.84 2.19
integration
8 TMC: Trust in medical care 2.46 0.79 0 4 .65 0.92 1,09 2.32 2.76
9 FIS: Finding of inner stability 1.32 0.81 0 4 .65 0.94 1,12 2.32 2.76

Test interpretation:

The questionnaire provides information about the current coping with a disease. Comparative
data about scale statistics regarding average, standard deviation, minimum, maximum, reliability,
confidence interval and Reliable Change Index is shown in chart 10.

Utilisation and versions in different languages:

There are versions in German, English and Turkish at Psychometrikon. All colleagues are asked
to support translations of the method into further languages.
To date the ECQ has been used in different clinical areas, emphasising on transplantation medi-
cine. Hautz et al. (2010) and Kumnig et al. (2012, 2014) report that the ECQ, along with the BSCL
(Franke, 2016) and other methods are used as a matter of routine in the Innsbruck programme for
psychological diagnostic examination of potential reconstructive transplant patients. Wick et al.
(2015) were using the ECQ to examine patients who were on a waitlist for a donor kidney or liver.
A main focus are studies about usage of the ECQ for kidney transplants in Austria (Kumnig et al.,
2012) and Germany (Bernhardt et al., 2010; Franke, 2010; Jagla et al. 2009).
In the area of ophthalmology usage of the ECQ is discussed for patients in general (Franke et al.,
2003) and for patients suffering from uveitis particularly (Franke et al., 2005; Khanfer et al., 2012;
Schütte et al., 2004).
Further areas of usage of the ECQ are for example patients suffering from COPD (Vaske, 2015;:
Vaske et al., 2016) and nicotine- and alcohol-dependent patients (Metz, 2004), patients with
rheumatic diseases (Vollmann et al., 2016), HIV carriers (Jagla et al., 2014; Ronel, 2003), onco-
logical patients (Berend, 2005), somatoform complaints (Hölig, 2014), patients in inpatient gynae-
cology (Jagla et al., 2012, 2013), patients with polycystic ovary syndrome (Jauca et al., 2010),
neurological patients (Müller et al., 2014) and several other groups of patients (Jagla et al., 2009).
Its usage for acute physical and mental diseases (Kampa, 2013) has so far not been documented
in a scientific publication. Researching them as potential fields of application would be very inter-
esting.

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© G.H. Franke & M. Jagla (2016)
G. H. Franke & M. Jagla.: ECQ 16

Modification of items, discussion and outlook:

The English version of the ECQ available at Psychometrikon has been linguistically revised
(changes that serve linguistical improvement, and modern means for research).
The ECQ is a workable method for the recording of coping with a disease of chronic patients. The
complete usage of information, addressing the patient in the first person and positioning the items
in the present have proven to be workable and beneficial for multiple applications. Psychometric
tests performed on 1,815 patients were presented that show a weakness of the method regarding
internal consistency as a reliability factor. This particular problem is not only found in the case of
the ECQ but also in other coping methods (e.g. Hardt et al., 2003). The item statistics indicated
left-skewed and right-skewed distributions amongst the answers in the reviewed sample. Howev-
er, it is not possible to exclude items from further psychometric analyses, using simple empirical
formulas, like the search for items with less than 25% agreement or disagreement.
Older correlative analyses showed that the ECQ scales correlate with the FKV-LIS scales that
correspond as regards content (Franke et al., 2000). Connections between coping strategies,
psychological distress and social support in partial sample B were shown. The strongest positive
correlative connections were found between ECQ Depressive Processing and distress, the
strongest negative connections with social support.
Particularly impressive is the ECQ’s sensitivity to change. For seven out of the nine ECQ scales
statistically significant changes of the ECQ values could be reported over time. The ECQ mean
value increased for six scales and for the scale Trust in Medical Care the values decreased con-
siderably. From a medical and rehabilitational psychological view such change measurements are
especially significant.
Beside the question if more differentiated stanine values are necessary, factorial validity has to be
researched more specifically using confirmatory approaches in the middle term. Merging several
scales or item groups to a smaller number of scales is possible. However, the two main factors
(„active“, and „depressive“, coping) that are discussed in literature according to the results at
hand do not seem to be sufficient. After explorative factor analysis this study found five scales
that were named according to their content: „1. Social support”, “2. Trust and drive“, „Search for
information and meaning“, „4. Depressive trivialising processing“ and „5. Mistrust and retreat“. It
can be said that apart from depressive (factor 4) and active (factor 2) there are other coping strat-
egies. These mainly focus on an active social life (factor 1) and the search for information and
meaning (factor 3). It is interesting that in addition to factor 4 that includes depressive trivialising
coping strategies there is also factor 5 that describes distrustful strategies and social retreat.

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