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The SMHF scale contains 22 items designed to reflect patients’ abilities to maintain illness stability and manage symptoms when they occur. The scoring of the 22 items reflect self-care maintenance behaviors that promote the avoidance of symptoms through treatment adherence and management of symptoms when they occur. Three subscales (maintenance, decision-making [later renamed management], and self-confidence) are produced. A maximum total score of 27 on this version indicates better self-management.