Health is defined as “a state of complete physical, social and mental well-being and not merely the absence of disease or infirmity” . However, it can be also considered from a more dynamic perspective as the ability to adapt and self-care in order to face physical, social and emotional challenges . Self-care is considered as an important and valuable principle because it emphasizes the active role of people in maintaining their own wellbeing. Nowadays, there is resurgent interest in the concept and practice of self-care as an essential component of health promotion to improve health, wellness and wellbeing of individuals, and as a strategy to reduce the high costs of medical services [3, 4].
Psychological impact of COVID-19 lockdown
The current ongoing pandemic coronavirus disease 2019 (COVID-19) has spread around the world while driving global actions. In addition to the fear of contracting the virus, this situation has led to significant changes to our daily lives. In order to support efforts to contain and slow down the spread of the virus, lockdown or mandatory quarantine was globally established. Despite the need of this Public Health recommended measure, our movements are restricted; people are facing new realities of working from home, temporary unemployment, home schooling of children, and lack of physical contact with other family members, friends and colleagues . As result, people are very likely to develop a wide range of symptoms of psychological stress and disorder, including low mood, insomnia, stress, anxiety, anger, irritability, emotional exhaustion, depression and post-traumatic stress symptoms. Low mood and irritability specifically stand out as being very common . However, getting involved in self-care activities as part of hygienic practices can help to manage stress and prevent difficulties and symptoms of health problems . This scenario allows examining the main strategies that people are using for personal self-care, since confinement restrictions entail important changes on their daily habits and routines. This fact leads us to consider that a population brief screening of self-care activities might be used as an important strategy to look for as-yet-unrecognised health risk factors, which later, formal evaluation and intervention strategies can be addressed to.
Self-care conceptual model
Although the concept of self-care has been broadly used in healthcare literature, many disciplines have provided definitions of self-care from specific perspectives [8-10]. Specifically, Orem’s Self Care Model is the most well-known theory on self-care . This theory identifies two components: the self-care agency (i.e., the ability of a person to engage in self-care) and the self-care behaviours (i.e., the activities performed by a person to maintain life and promote well-being). However, various definitions of self-care have emerged as a result of the lack of consensus, and multiple terms are used as synonyms for self-care, such as, self-agency, self-efficacy, self-management, self-monitoring, and self-help, so it is not always clear how the term is defined .
A recent systematic review and concept analysis conducted by Matarese et al.  defines self-care as a broad concept that encompasses all the other related concepts which entails capacities, activities, and processes directed toward maintaining health, preserving life, and monitoring and managing acute and chronic conditions. People are supported in this natural process by their self-care abilities (self-care agency); which are prerequisites to care for one’s self, and by self-efficacy; which facilitates the achievement of desired outcomes. Besides, social support is an important part of self-care and people’s family and healthcare professionals are key agents to provide it . Nevertheless, conceptual models neither from academic or lay literature, conceptualize self-care in its totality, nor could explain the link between self-care activities, behaviour change and resource utilisation in the context of the prevailing culture and the external environment.
In an attempt to cover this gap, the Self-Care Matrix (SCM) proposed by El-osta et al.  has been proposed as a synthesis of 32 existing conceptual models and frameworks to capture the totality of self-care. This matrix of models includes four cardinal dimensions of self-care that could be addressed and measured separately as a macro, meso or micro-level strategy: (1) Self-Care Activities, (2) Self-Care Behaviours, (3) Self-Care Context, and (4) Self-Care Environment. At micro-level, which this study is aimed to, self-care is considered from a person-centred perspective and covers activities related directly to what individuals can do for themselves, as well as the knowledge required to inform suitable self-care choices. To address this first dimension, the Seven Pillars of Self-Care framework developed by the International Self-Care Foundation has been considered the best candidate to explore the self-care activities dimension . This model involves seven personal activities such as, knowledge, self-awareness and health literacy, psychological well-being, physical activity, healthy eating, good hygiene and the avoidance of risks such as, tobacco and excessive alcohol consumption and rational use of products and services.
Moreover, self-care activities are directly related to the health consciousness concept, which refers to self-awareness about one’s health, and the willingness to engage in health and wellness promoting behaviours [13-15]. In this way, self-care activities are a predictor of well-being, which may be determinant of wellness participation . It leads health conscious individuals to actively seek information about how to improve their health, and adhere to health behaviours accordingly [16-18]. Hence, individuals with high health consciousness have positive attitudes about self-care activities and have healthier lifestyles than individuals with low health consciousness [13, 19, 20].
Several instruments have been developed to assess self-care in many different populations, and for various health conditions, such as patients with type 2 diabetes, , people with hypertension , children , or general adult population .
A recent systematic review was specifically conducted on the instruments designed to assess self-care in health promotion and maintenance in the adult population  in which nine instruments were identified: Appraisal of Self-care Agency Scale (ASA-A) [26, 27], Denyes Self-Care Practice Instrument (DSCPI-90) , Denyes Self-Care Agency Instrument (DSCAI) , Exercise of Self-Care Agency (ESCA) , Lorensen’s Self-care Capability Scale (LSCS) , Perceived Self-Care Agency Questionnaire (PSCAQ) , Self-care Ability Scale for the Elderly (SASE) , Self-as-Carer Inventory (SCI) , Self-Care of Home-Dwelling Elderly (SCHDE) . In the above-mentioned revision most of the selected studies presented methodological limitations and their quality was rated as “negative or indeterminate” .
Despite the number of developed instruments related to the self-care concept, most of them are mainly based on the self-care agency attribute, which is deﬁned as the capabilities of an individual to recognize his or her own needs and to assess personal and environmental resources . However, to our knowledge, none has been identified to screen, assess or evaluate the specific dimension of self-care activities considering health consciousness as a key element of self-care.
Therefore, there is a need to develop a brief screening tool with appropriate psychometric properties (reliability and validity), to take measures to evaluate the self-care activities, including health consciousness dimension and that can be applied in similar situations when health and well-being is compromised. In this way, the focus of this study is to build a valid and reliable short tool for screening self-care activities in Spanish-speaker population during COVID-19 lockdown.
The specific objectives covered in this study were: (1) to design and explore the factorial structure of an original set of items to screen self-care activities in a COVID-19 confined sample, and (2) to confirm the factor structure of the tool in an independent COVID-19 confined sample. In addition, we examine the reliability of the proposed scale and its convergent validity with well-being and stress measures.