Cognitive appraisal has been identified as an integral process within the stress and coping paradigm. The purpose of this study was to develop and evaluate the psychometric properties of the Cognitive Appraisal of Health Scale (CAHS), a multi-item measure of both primary and secondary appraisals. A second purpose was to begin testing the validity of the Appraisal of Health Scale (AOH), a single item measure for primary appraisals. The CAHS and AOH were developed consistent with the Transactional Model of stress and coping. The instruments were developed from interviews with individuals, a review of theoretical literature and other appraisal instruments, and a review by experts to support content validity. Four primary appraisal scales of threat, challenge, harm/loss and benign/irrelevant and items to measure secondary appraisal were developed for the CAHS. Four single items to measure primary appraisals were developed for the AOH. The CAHS and the AOH were tested in a sample of 175 women with breast cancer. A cross-sectional design was used. In addition to measuring cognitive appraisal, emotional responses, quality of life, and selected sociodemographic and clinical characteristics were measured. Psychometric properties of the CAHS were tested through item analysis, tests of reliability, and tests of construct validity using factor analysis and hypothesized relationships. The validity of the AOH was tested through hypothesized relationships. The CAHS was decreased from 32 items to 28 items based on psychometric testing. The primary appraisal scale estimates of internal consistency (alpha and theta) were all $>$.70. During factor analysis, a forced, four factor solution explained 60% of the total variance and represented the proposed primary appraisal dimensions. Intercorrelations among appraisals and the other variables were consistent with theory $(p<.01).$ The AOH validity estimates were as predicted but failed to do as well as the multi-item CAHS, suggesting primary appraisals may be inadequately captured by a single item. Thus, the use of a single item measure should be re-examined. Initial support for reliability and construct validity of the CAHS was established. The CAHS should undergo continued psychometric testing in other larger samples of individuals facing potentially stressful events.
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