The Diabetes Self-Management Questionnaire (DSMQ): development and evaluation of an instrument to assess diabetes self-care activities associated with glycaemic control

Andreas Schmitt, Annika Gahr, Norbert Hermanns, Bernhard Kulzer, Jörg Huber, Thomas Haak, Andreas Schmitt, Annika Gahr, Norbert Hermanns, Bernhard Kulzer, Jörg Huber, Thomas Haak

Abstract

Background: Though several questionnaires on self-care and regimen adherence have been introduced, the evaluations do not always report consistent and substantial correlations with measures of glycaemic control. Small ability to explain variance in HbA1c constitutes a significant limitation of an instrument's use for scientific purposes as well as clinical practice. In order to assess self-care activities which can predict glycaemic control, the Diabetes Self-Management Questionnaire (DSMQ) was designed.

Methods: A 16 item questionnaire to assess self-care activities associated with glycaemic control was developed, based on theoretical considerations and a process of empirical improvements. Four subscales, 'Glucose Management' (GM), 'Dietary Control' (DC), 'Physical Activity' (PA), and 'Health-Care Use' (HU), as well as a 'Sum Scale' (SS) as a global measure of self-care were derived. To evaluate its psychometric quality, 261 patients with type 1 or 2 diabetes were assessed with the DSMQ and an established analogous scale, the Summary of Diabetes Self-Care Activities Measure (SDSCA). The DSMQ's item and scale characteristics as well as factorial and convergent validity were analysed, and its convergence with HbA1c was compared to the SDSCA.

Results: The items showed appropriate characteristics (mean item-total-correlation: 0.46 ± 0.12; mean correlation with HbA1c: -0.23 ± 0.09). Overall internal consistency (Cronbach's alpha) was good (0.84), consistencies of the subscales were acceptable (GM: 0.77; DC: 0.77; PA: 0.76; HU: 0.60). Principal component analysis indicated a four factor structure and confirmed the designed scale structure. Confirmatory factor analysis indicated appropriate fit of the four factor model. The DSMQ scales showed significant convergent correlations with their parallel SDSCA scales (GM: 0.57; DC: 0.52; PA: 0.58; HU: n/a; SS: 0.57) and HbA1c (GM: -0.39; DC: -0.30; PA: -0.15; HU: -0.22; SS: -0.40). All correlations with HbA1c were significantly stronger than those obtained with the SDSCA.

Conclusions: This study provides preliminary evidence that the DSMQ is a reliable and valid instrument and enables an efficient assessment of self-care behaviours associated with glycaemic control. The questionnaire should be valuable for scientific analyses as well as clinical use in both type 1 and type 2 diabetes patients.

References

    1. Spellman CW. Achieving glycemic control: cornerstone in the treatment of patients with multiple metabolic risk factors. J Am Osteopath Assoc. 2009;109(Suppl 5):8–13.
    1. Stettler C, Allemann S, Jüni P, Cull CA, Holman RR, Egger M, Krähenbühl S, Diem P. Glycemic control and macrovascular disease in types 1 and 2 diabetes mellitus: Meta-analysis of randomized trials. Am Heart J. 2006;152:27–38. doi: 10.1016/j.ahj.2005.09.015.
    1. Akalin S, Berntorp K, Ceriello A, Das AK, Kilpatrick ES, Koblik T, Munichoodappa CS, Pan CY, Rosenthall W, Shestakova M, Wolnik B, Woo V, Yang WY, Yilmaz MT. Global Task Force on Glycaemic Control. Intensive glucose therapy and clinical implications of recent data: a consensus statement from the Global Task Force on Glycaemic Control. Int J Clin Pract. 2009;63:1421–1425. doi: 10.1111/j.1742-1241.2009.02165.x.
    1. Johnson SB. Methodological issues in diabetes research. Measuring adherence. Diabetes Care. 1992;15:1658–1867. doi: 10.2337/diacare.15.11.1658.
    1. Albisser AM, Harris RI, Albisser JB, Sperlich M. The impact of initiatives in education, self-management training, and computer-assisted self-care on outcomes in diabetes disease management. Diabetes Technol Ther. 2001;3:571–579. doi: 10.1089/15209150152811199.
    1. Williams GC, McGregor HA, Zeldman A, Freedman ZR, Deci EL. Testing a Self-Determination Theory Process Model for Promoting Glycemic Control Through Diabetes Self-Management. Health Psychol. 2004;23:58–66.
    1. Piette JD, Richardson C, Valenstein M. Addressing the needs of patients with multiple chronic illnesses: the case of diabetes and depression. Am J Manag Care. 2004;10:152–162.
    1. Peyrot M, McMurry JF Jr, Kruger DF. A biopsychosocial model of glycemic control in diabetes: stress, coping and regimen adherence. J Health Soc Behav. 1999;40:141–158. doi: 10.2307/2676370.
    1. Gonzalez JS, Peyrot M, McCarl LA, Collins EM, Serpa L, Mimiaga MJ, Safren SA. Depression and diabetes treatment nonadherence: a meta-analysis. Diabetes Care. 2008;31:2398–2403. doi: 10.2337/dc08-1341.
    1. Gonzalez JS, Delahanty LM, Safren SA, Meigs JB, Grant RW. Differentiating symptoms of depression from diabetes-specific distress: relationships with self-care in type 2 diabetes. Diabetologia. 2008;51:1822–1825. doi: 10.1007/s00125-008-1113-x.
    1. Aikens JE, Perkins DW, Lipton B, Piette JD. Longitudinal analysis of depressive symptoms and glycemic control in type 2 diabetes. Diabetes Care. 2009;32:1177–1181. doi: 10.2337/dc09-0071.
    1. Fisher L, Glasgow RE, Strycker LA. The relationship between diabetes distress and clinical depression with glycemic control among patients with type 2 diabetes. Diabetes Care. 2010;33:1034–1036. doi: 10.2337/dc09-2175.
    1. Fisher L, Mullan JT, Arean P, Glasgow RE, Hessler D, Masharani U. Diabetes distress but not clinical depression or depressive symptoms is associated with glycemic control in both cross-sectional and longitudinal analyses. Diabetes Care. 2010;33:23–28. doi: 10.2337/dc09-1238.
    1. Lustman PJ, Anderson RJ, Freedland KE, de Groot M, Carney RM, Clouse RE. Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care. 2000;23:934–942. doi: 10.2337/diacare.23.7.934.
    1. Pibernik-Okanovic M, Grgurevic M, Begic D, Szabo S, Metelko Z. Interaction of depressive symptoms and diabetes-related distress with glycaemic control in Type 2 diabetic patients. Diabet Med. 2008;25:1252–1254.
    1. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51:1173–1182.
    1. Lustman PJ, Clouse RE, Ciechanowski PS, Hirsch IB, Freedland KE. Depression-related hyperglycemia in type 1 diabetes: a mediational approach. Psychosom Med. 2005;67:195–199. doi: 10.1097/.
    1. Glasgow RE. In: Handbook of Psychology and Diabetes: a guide to psychological measurement in diabetes research and practice. Chur BC, editor. Switzerland: Harwood Academic; 1994. Social-environmental factors in diabetes: Barriers to diabetes self-care; pp. 335–349.
    1. Toobert DJ, Glasgow RE. In: Handbook of Psychology and Diabetes: a guide to psychological measurement in diabetes research and practice. Chur BC, editor. Switzerland: Harwood Academic; 1994. Assessing diabetes self-management: the summary of diabetes self-care activities questionnaire; pp. 351–375.
    1. Wang RH, Lin LY, Cheng CP, Hsu MT, Kao CC. The psychometric testing of the diabetes health promotion self-care scale. J Nurs Res. 2012;20:122–130. doi: 10.1097/jnr.0b013e318254eb47.
    1. Lee NP, Fisher WP Jr. Evaluation of the Diabetes Self-Care Scale. J Appl Meas. 2005;6:366–381.
    1. Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000;23:943–950. doi: 10.2337/diacare.23.7.943.
    1. Eigenmann CA, Colagiuri R, Skinner TC, Trevena L. Are current psychometric tools suitable for measuring outcomes of diabetes education? Diabet Med. 2009;26:425–436. doi: 10.1111/j.1464-5491.2009.02697.x.
    1. Bastos F, Severo M, Lopes C. Psychometric analysis of diabetes self-care scale (translated and adapted to Portuguese) Acta Med Port. 2007;20:11–20.
    1. Choi EJ, Nam M, Kim SH, Park CG, Toobert DJ, Yoo JS, Chu SH. Psychometric properties of a Korean version of the summary of diabetes self-care activities measure. Int J Nurs Stud. 2011;48:333–337. doi: 10.1016/j.ijnurstu.2010.08.007.
    1. Michels MJ, Coral MH, Sakae TM, Damas TB, Furlanetto LM. Questionnaire of Diabetes Self-Care Activities: translation, cross-cultural adaptation and evaluation of psychometric properties. Arq Bras Endocrinol Metabol. 2010;54:644–651. doi: 10.1590/S0004-27302010000700009.
    1. Vincent D, McEwen MM, Pasvogel A. The validity and reliability of a Spanish version of the summary of diabetes self-care activities questionnaire. Nurs Res. 2008;57:101–106. doi: 10.1097/01.NNR.0000313484.18670.ab.
    1. Kav S, Akman A, Dogan N, Tarakci Z, Bulut Y, Hanoglu Z. Turkish validity and reliability of the summary of diabetes self-care activities measure for patients with type 2 diabetes mellitus. J Clin Nurs. 2010;19:2933–2935. doi: 10.1111/j.1365-2702.2010.03329.x.
    1. Morris AD, Boyle DI, McMahon AD, Greene SA, MacDonald TM, Newton RW. Adherence to insulin treatment, glycaemic control, and ketoacidosis in insulin-dependent diabetes mellitus. The DARTS/MEMO Collaboration. Diabetes Audit and Research in Tayside Scotland. Medicines Monitoring Unit. Lancet. 1997;350:1505–1510. doi: 10.1016/S0140-6736(97)06234-X.
    1. Donnelly LA, Morris AD, Evans JM. DARTS/MEMO collaboration. Adherence to insulin and its association with glycaemic control in patients with type 2 diabetes. QJM. 2007;100:345–350. doi: 10.1093/qjmed/hcm031.
    1. Lawrence DB, Ragucci KR, Long LB, Parris BS, Helfer LA. Relationship of oral antihyperglycemic (sulfonylurea or metformin) medication adherence and hemoglobin A1c goal attainment for HMO patients enrolled in a diabetes disease management program. J Manag Care Pharm. 2006;12:466–471.
    1. Krapek K, King K, Warren SS, George KG, Caputo DA, Mihelich K, Holst EM, Nichol MB, Shi SG, Livengood KB, Walden S, Lubowski TJ. Medication adherence and associated hemoglobin A1c in type 2 diabetes. Ann Pharmacother. 2004;38:1357–1362. doi: 10.1345/aph.1D612.
    1. Cohen HW, Shmukler C, Ullman R, Rivera CM, Walker EA. Measurements of medication adherence in diabetic patients with poorly controlled HbA(1c) Diabet Med. 2010;27:210–216. doi: 10.1111/j.1464-5491.2009.02898.x.
    1. Thomas D, Elliott EJ. Low glycaemic index, or low glycaemic load, diets for diabetes mellitus. Cochrane Database Syst Rev. 2009;1 CD006296.
    1. Thomas DE, Elliott EJ. The use of low-glycaemic index diets in diabetes control. Br J Nutr. 2010;104:797–802. doi: 10.1017/S0007114510001534.
    1. Wikblad K, Montin K, Wibell L. Metabolic control, residual insulin secretion and self-care behaviours in a defined group of patients with type 1 diabetes. Ups J Med Sci. 1991;96:47–61. doi: 10.3109/03009739109179258.
    1. Schütt M, Kern W, Krause U, Busch P, Dapp A, Grziwotz R, Mayer I, Rosenbauer J, Wagner C, Zimmermann A, Kerner W, Holl RW. DPV Initiative. Is the frequency of self-monitoring of blood glucose related to long-term metabolic control? Multicenter analysis including 24,500 patients from 191 centers in Germany and Austria. Exp Clin Endocrinol Diabetes. 2006;114:384–388. doi: 10.1055/s-2006-924152.
    1. Malanda UL, Welschen LM, Riphagen II, Dekker JM, Nijpels G, Bot SD. Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin. Cochrane Database Syst Rev. 2012;1 CD005060.
    1. Poolsup N, Suksomboon N, Rattanasookchit S. Meta-analysis of the benefits of self-monitoring of blood glucose on glycemic control in type 2 diabetes patients: an update. Diabetes Technol Ther. 2009;11:775–784. doi: 10.1089/dia.2009.0091.
    1. Allemann S, Houriet C, Diem P, Stettler C. Self-monitoring of blood glucose in non-insulin treated patients with type 2 diabetes: a systematic review and meta-analysis. Curr Med Res Opin. 2009;25:2903–2913. doi: 10.1185/03007990903364665.
    1. St John A, Davis WA, Price CP, Davis TM. The value of self-monitoring of blood glucose: a review of recent evidence. J Diabetes Complications. 2010;24:129–141. doi: 10.1016/j.jdiacomp.2009.01.002.
    1. Hirsch IB, Bode BW, Childs BP, Close KL, Fisher WA, Gavin JR, Ginsberg BH, Raine CH, Verderese CA. Self-Monitoring of Blood Glucose (SMBG) in insulin- and non-insulin-using adults with diabetes: consensus recommendations for improving SMBG accuracy, utilization, and research. Diabetes Technol Ther. 2008;10:419–439. doi: 10.1089/dia.2008.0104.
    1. Polonsky WH, Fisher L. Self-monitoring of blood glucose in noninsulin-using type 2 diabetic patients: right answer, but wrong question: self-monitoring of blood glucose can be clinically valuable for noninsulin users. Diabetes Care. 2013;36:179–182. doi: 10.2337/dc12-0731.
    1. Speight J, Browne JL, Furler J. Challenging evidence and assumptions: is there a role for self-monitoring of blood glucose in people with type 2 diabetes not using insulin? Curr Med Res Opin. 2013;29:161–168. doi: 10.1185/03007995.2012.761957.
    1. Boulé NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA. 2001;286:1218–1227. doi: 10.1001/jama.286.10.1218.
    1. Thomas DE, Elliott EJ, Naughton GA. Exercise for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2006;3 CD002968.
    1. Tonoli C, Heyman E, Roelands B, Buyse L, Cheung SS, Berthoin S, Meeusen R. Effects of different types of acute and chronic (training) exercise on glycaemic control in type 1 diabetes mellitus: a meta-analysis. Sports Med. 2012;42:1059–1080.
    1. Parchman ML, Pugh JA, Noël PH, Larme AC. Continuity of care, self-management behaviors, and glucose control in patients with type 2 diabetes. Med Care. 2002;40:137–144. doi: 10.1097/00005650-200202000-00008.
    1. Sidorenkov G, Voorham J, Haaijer-Ruskamp FM, de Zeeuw D, Denig P. Association Between Performance Measures and Glycemic Control Among Patients With Diabetes in a Community-wide Primary Care Cohort. Med Care. 2013;51:172–179. doi: 10.1097/MLR.0b013e318277eaf5.
    1. Schectman JM, Schorling JB, Voss JD. Appointment adherence and disparities in outcomes among patients with diabetes. J Gen Intern Med. 2008;23:1685–1687. doi: 10.1007/s11606-008-0747-1.
    1. Karter AJ, Parker MM, Moffet HH, Ahem AT, Ferrara A, Liu JY, Selby JV. Missed appointments and poor glycemic control: An opportunity to identify high-risk diabetic patients. Med Care. 2004;42:110–115. doi: 10.1097/01.mlr.0000109023.64650.73.
    1. Nathan DM, Turgeon H, Regan S. Relationship between glycated haemoglobin levels and mean glucose levels over time. Diabetologia. 2007;50:2239–2244. doi: 10.1007/s00125-007-0803-0.
    1. Nathan DM, Kuenen J, Borg R, Zheng H, Schoenfeld D, Heine RJ. the A1c-Derived Average Glucose (ADAG) Study Group. Translating the A1C assay into estimated average glucose values. Diabetes Care. 2008;31:1473–1478. doi: 10.2337/dc08-0545.
    1. Bradley C. In: Handbook of Psychology and Diabetes: a guide to psychological measurement in diabetes research and practice. Chur BC, editor. Switzerland: Harwood Academic Publishers; 1994. Translation of questionnaires for use in different languages and cultures; pp. 43–55.
    1. Marsh HW, Hocevar D. Application of confirmatory factor analysis to the study of self-concept: First- and higher order factor models and their invariance across groups. Psychol Bull. 1985;97:562–582.
    1. Bentler PM. Comparative fit indexes in structural models. Psychol Bull. 1990;107:238–246.
    1. Browne MW, Cudeck R. In: Testing Structural Equation Models. Bollen KA, Long JS, editor. Beverly Hills, CA: Sage; 1993. Alternative ways of assessing model fit; pp. 136–162.
    1. Meng X, Rosenthal R, Rubin DB. Comparing correlated correlation coefficients. Psychol Bull. 1992;111:172–175.
    1. Nunnally J, Bernstein L. Psychometric theory. 3. New York: McGraw-Hill Higher, INC; 1994.
    1. Streiner DL. Starting at the beginning: an introduction to coefficient alpha and internal consistency. J Pers Assess. 2003;80:99–103. doi: 10.1207/S15327752JPA8001_18.
    1. Bornhöft G, Maxion-Bergemann S, Wolf U, Kienle GS, Michalsen A, Vollmar HC, Gilbertson S, Matthiessen PF. Checklist for the qualitative evaluation of clinical studies with particular focus on external validity and model validity. BMC Med Res Methodol. 2006;6:56. doi: 10.1186/1471-2288-6-56.
    1. Song M, Ratcliffe SJ, Tkacs NC, Riegel B. Self-care and health outcomes of diabetes mellitus. Clin Nurs Res. 2012;21:309–326. doi: 10.1177/1054773811422604.
    1. Amsberg S, Anderbro T, Wredling R, Lisspers J, Lins PE, Adamson U, Johansson UB. Experience from a behavioural medicine intervention among poorly controlled adult type 1 diabetes patients. Diabetes Res Clin Pract. 2009;84:76–83. doi: 10.1016/j.diabres.2008.12.011.
    1. Primožič S, Tavčar R, Avbelj M, Dernovšek MZ, Oblak MR. Specific cognitive abilities are associated with diabetes self-management behavior among patients with type 2 diabetes. Diabetes Res Clin Pract. 2012;95:48–54. doi: 10.1016/j.diabres.2011.09.004.
    1. Tan SL, Juliana S, Sakinah H. Dietary compliance and its association with glycemic control among poorly controlled type 2 diabetic outpatients in Hospital Universiti Sains Malaysia. Malays J Nutr. 2011;17:287–299.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir