Mishel Uncertainty in Illness Scale (MUIS) Print E-mail

Original Citation – Mishel MH. The measurement of uncertainty in illness. Nurs Res. 1981 Sep-Oct;30(5):258-63. View in PubMed

Contact Information
Merle Mishel
UNC School of Nursing
CB# 7460
Chapel Hill, NC 27599-7460
(919) 966-6610
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Price & Availability – See instrument website, scale and manual available for a fee. Must request permission for use. Can download sample instrument from website.

Brief Description of Instrument – 30-item scale tapping the uncertainty in symptomatology, diagnosis, treatment, relationship with caregivers, and planning for the future for patients with cancer.

Scale Format – 5-point Likert.

Administration Technique – Self-administered questionnaire.

Factors and Norms – Two factors: 1) multi-attributed ambiguity and 2) unpredictability.

Internal Consistency – Multi-attributed ambiguity alpha ranges from = 0.89-0.91, unpredictability alpha = 0.64-0.72.

Construct Validity – Tested to see if experiencing an uncertain event in the clinical setting is reflected in the scale score. Significant effect found on both factors. Tested to determine the relationship between uncertainty and degree of stress experienced, MUIS administered with the Hospital Stress Events Scale. Level of perceived uncertainty was strongly related to stress, multi-attributed ambiguity factors accounted for 12 percent of the variation in stress scores. Also tested uncertainty relationship with lack of comprehension by administering scale with Comprehension Interview. High level of uncertainty was correlated with a lower level of comprehension.

Content & Face Validity – Scale development based on theoretical framework of cognitive appraisal model and perceived uncertainty in illness model as well as interviews with patients and health provider review. Factors identified by factor analysis, and confirmed by replication with new sample.

Strengths – Instrument measures uncertainty in illness and recovery, scale consists of two factors confirmed by psychometric testing. Evidence to support construct validity of the scale.

Updates – Various scales available from instrument website:
Parents' Perception of Uncertainty in Illness Scale - Family Member
Parents' Perception of Uncertainty in Illness Scale
Adult Uncertainty in Illness Scale (Community Form)
Adult Uncertainty in Illness Scale

Published APN Studies using instrument –- Ritz LJ, Nissen MJ, Swenson KK, Farrell JB, Sperduto PW, Sladek ML, Lally RM, Schroeder LM. Effects of advanced nursing care on quality of life and cost outcomes of women diagnosed with breast cancer. Oncol Nurs Forum. 2000 Jul;27(6):923-32. View in PubMed

Related Methods Articles (Not Reviewed) – Mishel, M. H. (1981). The measurement of uncertainty in illness. Nursing Research, 30 (5), 258-263. Mishel, M. H. (1983). Parents' perception of uncertainty concerning their hospitalized child: Reliability and validity of a scale. Nursing Research, 32 (6), 324-330.
Mishel, M. (1984). Perceived uncertainty and stress in medical patients. Research in Nursing and Health, 7, 163-171.

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