Development and Psychometric Testing of a Theory-based Tool to Measure Self-care in Diabetes Patients: the Self-Care of Diabetes Inventory

Overview

Journal BMC Endocr Disord

Publisher Biomed Central

Specialty Endocrinology

Date 2017 Oct 18

PMID 29037177

Citations 32

Authors

Davide Ausili

Claudio Barbaranelli

Emanuela Rossi

Paola Rebora

Diletta Fabrizi

Chiara Coghi

Michela Luciani

Ercole Vellone

Stefania Di Mauro

Barbara Riegel

Affiliations

Soon will be listed here.

Abstract

Background: Self-care is essential for patients with diabetes mellitus. Both clinicians and researchers must be able to assess the quality of that self-care. Available tools have various limitations and none are theoretically based. The aims of this study were to develop and to test the psychometric properties of a new instrument based on the middle range-theory of self-care of chronic illness: the Self-Care of Diabetes Inventory (SCODI).

Methods: Forty SCODI items (5 point Likert type scale) were developed based on clinical recommendations and grouped into 4 dimensions: self-care maintenance, self-care monitoring, self-care management and self-care confidence based on the theory. Content validity was assessed by a multidisciplinary panel of experts. A multi-centre cross-sectional study was conducted in a consecutive sample of 200 type 1 and type 2 diabetes patients. Dimensionality was evaluated by exploratory factor analyses. Multidimensional model based reliability was estimated for each scale. Multiple regression models estimating associations between SCODI scores and glycated haemoglobin (HbA1c), body mass index, and diabetes complications, were used for construct validity.

Results: Content validity ratio was 100%. A multidimensional structure emerged for the 4 scales. Multidimensional model-based reliabilities were between 0.81 (maintenance) and 0.89 (confidence). Significant associations were found between self-care maintenance and HbA1c (p = 0.02) and between self-care monitoring and diabetes complications (p = 0.04). Self-care management was associated with BMI (p = 0.004) and diabetes complications (p = 0.03). Self-care confidence was a significant predictor of self-care maintenance, monitoring and management (all p < 0.0001).

Conclusion: The SCODI is a valid and reliable theoretically-grounded tool to measure self-care in type 1 and type 2 DM patients.

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Riegel B, De Maria M, Barbaranelli C, Luciani M, Ausili D, Dickson V J Cardiovasc Nurs. 2024; 40(2):103-113.

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Transcultural adaptation and theoretical models validation of the Spanish version of the Self-Care of Diabetes Inventory.

Martinez-Tofe J, Ausili D, Soto-Ruiz N, Santolalla-Arnedo I, Durante A, Di Nitto M Front Med (Lausanne). 2024; 11:1423948.

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References

Ausili D, Bezze S, Canizzaro C, Bulgheroni M, Toolbert D, Genovese S . [Self-care assessment in type-2 diabetes: the Italian translation and validation of the Summary of Diabetes Self-Care Activities]. Prof Inferm. 2015; 68(1):9-18. DOI: 10.7429/pi.2015.681009. View

Dickson V, Buck H, Riegel B . A qualitative meta-analysis of heart failure self-care practices among individuals with multiple comorbid conditions. J Card Fail. 2011; 17(5):413-9. DOI: 10.1016/j.cardfail.2010.11.011. View

Koponen A, Simonsen N, Suominen S . Determinants of physical activity among patients with type 2 diabetes: the role of perceived autonomy support, autonomous motivation and self-care competence. Psychol Health Med. 2016; 22(3):332-344. DOI: 10.1080/13548506.2016.1154179. View

Riegel B, Jaarsma T, Stromberg A . A middle-range theory of self-care of chronic illness. ANS Adv Nurs Sci. 2012; 35(3):194-204. DOI: 10.1097/ANS.0b013e318261b1ba. View

Lin C, Anderson R, Chang C, Hagerty B, Loveland-Cherry C . Development and testing of the Diabetes Self-management Instrument: a confirmatory analysis. Res Nurs Health. 2008; 31(4):370-80. DOI: 10.1002/nur.20258. View

Ausili D, Rebora P, Di Mauro S, Riegel B, Valsecchi M, Paturzo M . Clinical and socio-demographic determinants of self-care behaviours in patients with heart failure and diabetes mellitus: A multicentre cross-sectional study. Int J Nurs Stud. 2016; 63:18-27. DOI: 10.1016/j.ijnurstu.2016.08.006. View

Nicolucci A, Kovacs Burns K, Holt R, Comaschi M, Hermanns N, Ishii H . Diabetes Attitudes, Wishes and Needs second study (DAWN2™): cross-national benchmarking of diabetes-related psychosocial outcomes for people with diabetes. Diabet Med. 2013; 30(7):767-77. DOI: 10.1111/dme.12245. View

Bentler P . Alpha, Dimension-Free, and Model-Based Internal Consistency Reliability. Psychometrika. 2010; 74(1):137-143. PMC: 2786226. DOI: 10.1007/s11336-008-9100-1. View

Sicuro J, Charrier L, Berchialla P, Cavallo F, Merlo S, Mazzeo A . Self-management education by group care reduces cardiovascular risk in patients with type 2 diabetes: analysis of the ROMEO clinical trial. Diabetes Care. 2014; 37(9):e192-3. DOI: 10.2337/dc14-1054. View

10.

IDF Diabetes Atlas Group . Update of mortality attributable to diabetes for the IDF Diabetes Atlas: Estimates for the year 2013. Diabetes Res Clin Pract. 2015; 109(3):461-5. DOI: 10.1016/j.diabres.2015.05.037. View

11.

Kargar Jahromi M, Ramezanli S, Taheri L . Effectiveness of diabetes self-management education on quality of life in diabetic elderly females. Glob J Health Sci. 2015; 7(1):10-5. PMC: 4796384. DOI: 10.5539/gjhs.v7n1p10. View

12.

Hernandez C . The development and pilot testing of The Diabetes Activities Questionnaire (TDAQ): an instrument to measure adherence to the diabetes regimen. Appl Nurs Res. 1998; 10(4):202-11. DOI: 10.1016/s0897-1897(97)80596-4. View

13.

Terwee C, Bot S, de Boer M, van der Windt D, Knol D, Dekker J . Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2006; 60(1):34-42. DOI: 10.1016/j.jclinepi.2006.03.012. View

14.

Lu Y, Xu J, Zhao W, Han H . Measuring Self-Care in Persons With Type 2 Diabetes: A Systematic Review. Eval Health Prof. 2015; 39(2):131-84. PMC: 4792777. DOI: 10.1177/0163278715588927. View

15.

Wallston K, Rothman R, Cherrington A . Psychometric properties of the Perceived Diabetes Self-Management Scale (PDSMS). J Behav Med. 2007; 30(5):395-401. DOI: 10.1007/s10865-007-9110-y. View

16.

Shreck E, Gonzalez J, Cohen H, Walker E . Risk perception and self-management in urban, diverse adults with type 2 diabetes: the improving diabetes outcomes study. Int J Behav Med. 2013; 21(1):88-98. PMC: 4406407. DOI: 10.1007/s12529-013-9291-4. View

17.

Terwee C, Mokkink L, Knol D, Ostelo R, Bouter L, de Vet H . Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist. Qual Life Res. 2011; 21(4):651-7. PMC: 3323819. DOI: 10.1007/s11136-011-9960-1. View

18.

Flora D, Curran P . An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data. Psychol Methods. 2004; 9(4):466-91. PMC: 3153362. DOI: 10.1037/1082-989X.9.4.466. View

19.

Adepoju O, Bolin J, Phillips C, Zhao H, Ohsfeldt R, McMaughan D . Effects of diabetes self-management programs on time-to-hospitalization among patients with type 2 diabetes: a survival analysis model. Patient Educ Couns. 2014; 95(1):111-7. PMC: 4009353. DOI: 10.1016/j.pec.2014.01.001. View

20.

Yuan C, Lai C, Chan L, Chow M, Law H, Ying M . The effect of diabetes self-management education on body weight, glycemic control, and other metabolic markers in patients with type 2 diabetes mellitus. J Diabetes Res. 2014; 2014:789761. PMC: 4127232. DOI: 10.1155/2014/789761. View