Patient-Reported Experience and Outcome Measures in People Living with Diabetes: A Scoping Review of Instruments

Patient-Reported Experience and Outcome Measures of Patients Living With Diabetes: Associations Among Different Factors

OBJECTIVES

This study aimed to explore the association between demographic characteristics and patient-reported experiences (PREs) and patient-reported outcomes (PROs) in individuals living with diabetes, using the Swedish National Diabetes Register questionnaire. The study sought to understand how baseline attributes such as age, gender, and education affect patients' experiences and management of diabetes.

METHODS

We used a cross-sectional survey approach with 544 patients diagnosed as having type 1 or type 2 diabetes mellitus at the University of Pécs. An exploratory factor analysis was conducted to identify the key dimensions of diabetes-related experiences, followed by a confirmatory factor analysis to validate these dimensions. Regression analysis was used to examine the impact of demographic variables on the derived factors.

RESULTS

The factor analysis revealed 5 key dimensions: diabetes-related obstacles, diabetes coping mechanisms, flexibility of healthcare providers, general well-being, and social support. Regression analysis indicated that older patients perceived fewer obstacles and demonstrated better coping mechanisms. Higher educational levels were significantly associated with greater satisfaction with healthcare provider flexibility. Females reported poorer overall well-being but better coping mechanisms than males.

CONCLUSIONS

The findings suggest that demographic characteristics significantly influence patient experiences and outcomes in diabetes care. Tailored interventions that address specific demographic needs can enhance patient-centered care and improve management strategies. These insights underscore the importance of considering patient diversity in developing healthcare interventions and underscore the utility of the Swedish National Diabetes Register questionnaire in assessing diverse patient experiences in diabetes management.

Open-Source Versus Commercial Automated Insulin Delivery System for Type 1 Diabetes Management: A Prospective Observational Comparative Study from Canada

Objective: This study compares unregulated open-source (OS) automated insulin delivery (AID) systems and commercial-AID (C-AID) systems regarding glucose management, patient-reported outcomes (PROs), and safety among adults with type 1 diabetes (T1D). Methods: We conducted a 12-week, prospective, observational, noninferiority, comparative, real-world study involving 78 adults with T1D and having used an AID system for ≥3 months (26 OS-AID and 52 C-AID users). A total of 4-week data from a blinded continuous glucose monitor was used to assess the effectiveness in glucose management (primary outcome: 24 h time in range [TIR%] for 4 weeks, with a noninferiority margin of 5%). Results: Our study suggested that OS-AIDs were noninferior to C-AIDs regarding the 24 h TIR% (78.3% [standard deviation or SD 11.0] vs. 71.2% [SD 10.9], mean difference 7.2% [95.08% confidence interval or CI: 1.9% to 12.5%], P < 0.001), even after adjusting for various confounding factors. OS-AIDs spent more time in hypoglycemia (<3.9 mmol/L) than C-AIDs (3.9% [SD 3.1] vs. 1.8% [SD 1.3], P < 0.001) yet within the recommended range. OS-AID users reported less fear of hypoglycemia, while other PRO measures (diabetes distress, hypoglycemia awareness, sleep, fear of hypoglycemia, treatment satisfaction, and overall quality of life) were not different between groups. No severe hypoglycemia or diabetic ketoacidosis was reported in either group, with a similar occurrence rate of technical issues during the 12-week study period. Conclusions: OS-AIDs are safe and noninferior to C-AIDs for TIR% among adults with T1D in real-world settings. Both OS-AID and C-AID systems can be considered for T1D management.

Spanish Validation of the Problem Area in Diabetes-Pediatric Version Survey and Its Weak Association with Metabolic Control Parameters in Pediatric Diabetes: A Cross-Sectional Multicenter Study

Background: Type 1 diabetes mellitus (T1DM) in pediatric patients often leads to emotional distress, impacting self-management. The PAID-Peds survey measures diabetes-related emotional burden but lacks a validated Spanish version. This study aimed to validate the Spanish PAID-Peds survey in children and adolescents with T1DM and correlate it with diabetic metabolic control parameters. Methods: A cross-sectional study was conducted from October 2022 to December 2023, recruiting 636 patients aged 8-17 years from three Spanish hospitals. Psychometric properties were assessed using Cronbach's alpha for reliability and confirmatory factor analysis for construct validity. Associations between PAID-Peds scores and clinical measures, such as HbA1c, were examined. Results: The final sample consisted of 538 participants (84.59% response rate). The PAID-Peds survey showed high internal consistency (Cronbach's alpha = 0.90). The confirmatory factor analysis indicated a satisfactory model fit (χ2 = 812.28, p < 0.001; RMSEA = 0.08). Weak correlations were found between PAID-Peds scores and HbA1c (r = 0.14, p < 0.001). Conclusions: The Spanish PAID-Peds survey is a reliable tool for assessing emotional burden in pediatric T1DM patients. Integrating it into clinical practice may improve early identification of emotional distress, aiding in better diabetes management. Further research should explore its application over time and in intervention studies.

Surgical patient-reported experience measures and qualitative experience studies: systematic review

BACKGROUND

Patient-reported experience measures are tools used to gather feedback from patients about their experiences of healthcare services, which are crucial for improving the quality of care from the perspective of patients. The aim of this systematic review was to identify surgery-related patient-reported experience measures, evaluate their psychometric properties, appraise and identify recurring themes within qualitative studies on surgical care, and identify potential bias in study designs.

METHODS

PubMed, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature database, and the Cochrane Library, along with clinical trial registries, were searched for articles on surgery-specific patient-reported experience measures and qualitative studies on patients' experiences up to 21 September 2023. Manual coding was used for theme identification and grouping based on thematic synthesis principles. Joanna Briggs Institute tools were used for risk-of-bias assessment and a revised version of the COnsensus-based Standards for the selection of health Measurement INstruments checklist was used for appraisal of patient-reported experience measures.

RESULTS

A total of 14 studies met the inclusion criteria, identifying seven patient-reported experience measures. Key patient experience themes included communication with healthcare providers, care setting environment, overall satisfaction, pre-admission information, coordination of care, waiting time, surgical experience, post-surgery support, impact on life, and healthcare information and technology management. Internal consistency was reported adequately across all patient-reported experience measures. Other psychometric properties were questionable.

CONCLUSION

Inadequate psychometric evaluations of some patient-reported experience measures in surgery highlight the need for rigorous validity and reliability assessments. Identification of thematic patterns emphasizes the importance of ongoing research to explore patients' experiences in surgical contexts. Clinical staff can use this information to enhance communication, reduce waiting time, and improve the overall patient experience by addressing highlighted areas.

Patient Experiences With Hospitalization Due to Diabetes in Alberta, Canada: A Cohort Study Using Survey and Administrative Data

OBJECTIVES

Individuals living with diabetes are often hospitalized. Despite this, little is known about their experiences with hospital care. In this study, we examined the comprehensive experiences of patients hospitalized due to diabetes in Alberta, Canada, and compared them with those of patients hospitalized for other chronic conditions.

METHODS

We conducted a retrospective cohort study that linked survey data with inpatient records. Survey data were collected using the Canadian Patient Experiences Survey-Inpatient Care (CPES-IC) instrument. Results from 37 questions were classified as percent in "top box," which reflects the most positive answer choice. We also examined the association between overall experience and demographic and clinical factors among those living with diabetes.

RESULTS

Over a 7-year period, 12,593 surveys (2,288 with diabetes and 10,305 with other chronic conditions) were obtained. Patients hospitalized due to diabetes had lower "top-box" scores on 24 questions, higher scores on 3 questions, and the remaining 10 questions showed no difference between groups. Those hospitalized due to diabetes indicated potential areas for improvement. These included receiving information about their condition and about the admission process, the nighttime quietness of their hospital room, being informed about possible side effects of new medications, and pain control. Overall experience was also shown to vary according to demographic and clinical factors.

CONCLUSIONS

We found that individuals hospitalized due to diabetes reported lower experience scores than those hospitalized due to other chronic conditions. Our findings may be used to develop strategies to improve the patient experience among this cohort.

Psychosocial-Spiritual Experiences and Outcomes in Parents of Children with Type 1 Diabetes Mellitus from the Middle East and North Africa Region: A Systematic Review

Background

Type 1 diabetes mellitus (T1DM) is prevalent in the Middle East and North Africa (MENA). Parents of children or young people (CYP) with T1D experience shock, devastation, guilt, and societal blame, which impact both physical and psychosocial-spiritual aspects of their lives. However, our knowledge of the breadth of these psychosocial-spiritual experiences and how they are assessed is limited.

Aim

(1) To examine the diabetes-specific psychosocial experiences of parents of CYP with T1D in the MENA region; (2) to assess the person-reported outcome measures (PROMs) that measure the psychosocial-spiritual outcomes in this population; and (3) to assess their reliability and validity.

Materials and Methods

A systematic review methodology was implemented using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Ovid MEDLINE, Embase, APA PsycINFO, CINAHL, and Global Health databases were searched for relevant articles. A narrative synthesis approach was used for data analysis.

Results

Twenty-three studies were included. We identified four categories: (1) spiritual functioning, parents' ability to accept and cope with their CYP's condition, (2) psychological functioning, parents' emotional distress due to insufficient diabetes-related knowledge and skills, (3) social functioning, describing financial challenges, social support experiences, and cultural concerns faced by parents, and (4) physical functioning, parents' struggle with sleep deprivation. Our results revealed methodological and conceptual limitations of the current tools measuring these experiences. Some of the limitations of this review are (1) heterogeneity in the tools captured perhaps some but not all domains of the parents' psychosocial experiences, (2) only English studies were included, as no Arabic studies were found.

Conclusion

Our studied population experiences psychosocial-spiritual distress by managing the condition of their CYP and needs culturally specific psychosocial-spiritual support. Further studies are needed to develop a new measure to specifically assess the psychosocial-spiritual outcomes of this population.

Influence of socioeconomic factors on glycemic control, therapeutic adherence and quality of life in children and adolescents with type 1 diabetes

OBJECTIVE

To stablish the relationship between socioeconomic status of a cohort of children and adolescents with type 1 diabetes (T1D) with glycemic control, therapeutic adherence and diabetes quality of life (DQoL).

PATIENTS Y METHODS

A cross-sectional, observational study with consecutive inclusion was carried out. Participants aged 8-18 years with T1D duration >1 year. Data on family structure, family income, parents' educational level and parental role on primary diabetes care supervision were registered. Adherence (DMQ-Sp) and DQoL (PedsQl) were analyzed. Linear and logistic regression models adjusted for demographics, family structure and parental role on primary diabetes care responsibility were applied.

RESULTS

A total of 323 patients (T1D duration 5,3 ± 3,3 years; HbA1c 7,7 ± 1,0%; age 13,3 ± 2,8 years; 49,8% females) were included. Patients living in a nuclear family and those whose main diabetes care supervision was shared by both parents showed lower HbA1c [adjusted for demographics and family structure (7,06; CI 95% 6,52-7,59); adjusted for demographics and role on primary diabetes care supervision (7,43; CI 95% 6,57-8,28)]. DMQ-Sp score (adjusted for demographics and role on main supervision) was higher in patients whose parents shared the diabetes care supervision (84,56; CI 95% 73,93-95,19). Parents sharing diabetes care supervision showed a significantly higher PedsQl score (both 74,63 ± 12,70 vs mother 68,53 ± 14,59; p = 0,001).

CONCLUSIONS

Children and adolescents with T1D had lower HbA1c, better therapeutic adherence and better DQoL when lived in a nuclear family, with higher socioeconomic status and the responsibility for supervising diabetes care was shared by both parents.

Treatment of Diabetic Foot Ulcers Based on an Interdisciplinary Team Approach: Exploratory Cross-Sectional Study of Patients' Views on Quality of Care

PURPOSE

The purpose of this study was to evaluate patients' perception and quality of diabetic foot ulcer (DFU) care delivered by an interdisciplinary team approach (ITA).

DESIGN

Exploratory cross-sectional study.

SUBJECTS AND SETTING

Twenty patients with a healed plantar DFU were recruited from an interdisciplinary Wound Care clinic of a Canadian University affiliated hospital. Their mean age was 64 years (75% were males [n = 15]), 18 (90%) were living with type 2 diabetes, and 45% (n = 9) had osteomyelitis in the previous year of their enrollment in the study.

METHODS

The validated short form of the Quality From the Patient's Perspective questionnaire was used to evaluate quality of care dimensions (medical-technical competence of the caregivers; physical-technical conditions of the care organization; degree of identity-orientation in the attitudes and actions of the caregivers; and sociocultural atmosphere of the care organization).

RESULTS

Respondents reported experiencing a high level of quality care with an ITA. All indicators of patient-perceived reality of care delivered were superior or equal related to their subjective importance in all dimensions of quality care (with scores ranging from 3.85 to 4.00 on a 4-Point Likert scale). Patients' satisfaction regarding the ITA was high.

CONCLUSIONS

Study findings suggest that an ITA model provided high quality of care for treating DFUs for all quality dimensions judged important for patients.

The diabetes management experiences questionnaire: Psychometric validation among adults with type 1 diabetes

AIMS

To examine the psychometric properties of the Diabetes Management Experiences Questionnaire (DME-Q). Adapted from the validated Glucose Monitoring Experiences Questionnaire, the DME-Q captures satisfaction with diabetes management irrespective of treatment modalities.

METHODS

The DME-Q was completed by adults with type 1 diabetes as part of a randomized controlled trial comparing hybrid closed loop (HCL) to standard therapy. Most psychometric properties were examined with pre-randomization data (n = 149); responsiveness was examined using baseline and 26-week follow-up data (n = 120).

RESULTS

Pre-randomization, participants' mean age was 44 ± 12 years, 52% were women. HbA1c was 61 ± 11 mmol/mol (7.8 ± 1.0%), diabetes duration was 24 ± 12 years and 47% used an insulin pump prior to the trial. A forced three-factor analysis revealed three expected domains, that is, 'Convenience', 'Effectiveness' and 'Intrusiveness', and a forced one-factor solution was also satisfactory. Internal consistency reliability was strong for the three subscales (α range = 0.74-0.84) and 'Total satisfaction'( α  = 0.85). Convergent validity was demonstrated with moderate correlations between DME-Q 'Total satisfaction' and diabetes distress (PAID: rs  = -0.57) and treatment satisfaction (DTSQ; rs  = 0.58). Divergent validity was demonstrated with a weak correlation with prospective/retrospective memory (PRMQ: rs  = -0.16 and - 0.13 respectively). Responsiveness was demonstrated, as participants randomized to HCL had higher 'Effectiveness' and 'Total satisfaction' scores than those randomized to standard therapy.

CONCLUSIONS

The 22-item DME-Q is a brief, acceptable, reliable measure with satisfactory structural and construct validity, which is responsive to intervention. The DME-Q is likely to be useful for evaluation of new pharmaceutical agents and technologies in research and clinical settings.

Person-reported outcomes in diabetes care: What are they and why are they so important?

In this review, we aim to show how person-reported outcomes (PROs) and person-reported experiences (PREs) can significantly contribute to the way diabetes care is delivered, the involvement of people with diabetes in diabetes care, and the collaboration between health care professionals and people with diabetes. This review focuses on the definition and measurement of PROs and PREs, the importance of PROs and PREs for person-centred diabetes care, and integrating the perspectives of people with diabetes in the evaluation of medical, psychological and technological interventions. PROs have been increasingly accepted by Health Technology Assessment bodies and are therefore valued in the context of reimbursement decisions and consequently by regulators and other health care stakeholders for the allocation of health care resources. Furthermore, the review identified current challenges to the assessment and use of PROs and PREs in clinical care and research. These challenges relate to the combination of questionnaires and ecological momentary assessment for measuring PROs and PREs, lack of consensus on a core outcome set, limited sensitivity to change within many measures and insufficient standardization of what can be considered a minimal clinically important difference. Another issue that has not been sufficiently addressed is the involvement of people with diabetes in the design and development of measures to assess PROs and PREs.

Outcomes measured in studies assessing health systems interventions for type 1 diabetes management: A scoping review

AIMS

Describe the outcomes reported in research on health systems interventions for type 1 diabetes management in comparison to the outcomes proposed by a core outcome set (COS) for this condition, an essential list of outcomes that studies should measure.

METHODS

Systematic search of studies published between 2010 and 2021 reporting health systems interventions directed to improve the management of type 1 diabetes using PubMed, EMBASE and CENTRAL. Information on the outcomes was extracted and classified according to a COS: self-management, level of clinical engagement, perceived control over diabetes, diabetes-related quality of life, diabetes burden, diabetes ketoacidosis, severe hypoglycemia, and glycated hemoglobin (HbA1C).

RESULTS

187 studies were included. Most of the studies included either children (n = 82/187) or adults (n = 82/187) living with type 1 diabetes. The most common outcome measured was HbA1C (n = 149/187), followed by self-management (n = 105/187). While the least measured ones were diabetes ketoacidosis (n = 15/187), and clinical engagement (n = 0/187). None of the studies measured all the outcomes recommended in the COS. Additionally, different tools were found to be used in measuring the same outcome.

CONCLUSIONS

This study provides a description of what researchers are measuring when assessing health systems interventions to improve type 1 diabetes management. In contrast to a COS, it was found that there is a predominance of clinical-based outcomes over patient-reported outcome measures.

Patient-reported outcome measures in type 1 diabetes outpatient care

Background: Patient-reported outcome measures (PROMs) assess how individuals perceive the disease and its impact on quality of life, representing an important complement to the metabolic evaluation in type 1 diabetes mellitus (T1DM). This study aimed to assess the PROMs and their association with metabolic control.

Methods

A cross-sectional study of adults with T1DM was conducted in the outpatient Endocrinology department between October 2022 and May 2023. Clinical, demographic, and continuous glucose monitoring (CGM) data were collected. Three PROMs were applied: the diabetes psychological adjustment scale (ATT18), the World Health Organization well-being index (WHO-5), and the patient health questionnaire (PHQ-9). Descriptive and bivariate statistical analyses were performed.

Results

We included 56 participants, aged 41.2 ± 14.6 years, 58 % female, and 64 % of medium-high socioeconomic class. The disease duration of the cohort was 21 ± 14.6 years, with 44.6 % on continuous subcutaneous insulin infusion (CSII) and 39.3 % presenting microvascular complications. Glycated hemoglobin of the cohort was 8.0 ± 1.4 %, time in range (TIR) 52 ± 22 %, coefficient of variation (CV) 37 ± 8 %, and median time below range (TBR) 2 %. Individuals on CSII had higher TIR (p =0.03). CV was related to TBR (ρ =0.643, p <0.001). The majority had satisfactory psychological adjustment to diabetes (ATT18 ≥60), which correlated directly with WHO-5 (r =0.511, p <0.001) and inversely with depression symptoms (r =-0.676, p <0.001). No relationships were identified between metabolic control and PROMs (p =0.63).

Conclusions

Including PROMs alongside detailed metabolic evaluation allows for individualized decision-making and active patient participation in diabetes management. These results underscore the importance of preventing depression, promoting well-being, and enhancing diabetes psychological adjustment in these patients, aiming to improve their quality of life. HIPPOKRATIA 2024, 28 (1):17-21.

Patient-reported outcomes for people with diabetes: what and how to measure? A narrative review

Patient-reported outcomes (PROs) are valuable for shared decision making and research. Patient-reported outcome measures (PROMs) are questionnaires used to measure PROs, such as health-related quality of life (HRQL). Although core outcome sets for trials and clinical practice have been developed separately, they, as well as other initiatives, recommend different PROs and PROMs. In research and clinical practice, different PROMs are used (some generic, some disease-specific), which measure many different things. This is a threat to the validity of research and clinical findings in the field of diabetes. In this narrative review, we aim to provide recommendations for the selection of relevant PROs and psychometrically sound PROMs for people with diabetes for use in clinical practice and research. Based on a general conceptual framework of PROs, we suggest that relevant PROs to measure in people with diabetes are: disease-specific symptoms (e.g. worries about hypoglycaemia and diabetes distress), general symptoms (e.g. fatigue and depression), functional status, general health perceptions and overall quality of life. Generic PROMs such as the 36-Item Short Form Health Survey (SF-36), WHO Disability Assessment Schedule (WHODAS 2.0), or Patient-Reported Outcomes Measurement Information System (PROMIS) measures could be considered to measure commonly relevant PROs, supplemented with disease-specific PROMs where needed. However, none of the existing diabetes-specific PROM scales has been sufficiently validated, although the Diabetes Symptom Self-Care Inventory (DSSCI) for measuring diabetes-specific symptoms and the Diabetes Distress Scale (DDS) and Problem Areas in Diabetes (PAID) for measuring distress showed sufficient content validity. Standardisation and use of relevant PROs and psychometrically sound PROMs can help inform people with diabetes about the expected course of disease and treatment, for shared decision making, to monitor outcomes and to improve healthcare. We recommend further validation studies of diabetes-specific PROMs that have sufficient content validity for measuring disease-specific symptoms and consider generic item banks developed based on item response theory for measuring commonly relevant PROs.

Patient-reported outcome measures for assessing health-related quality of life in people with type 2 diabetes: A systematic review

Patient-Reported Outcome Measures (PROMs) are important tools to assess outcomes relevant to patients, with Health-Related Quality Of Life (HRQOL) as an important construct to be measured. Many different HRQOL PROMs are used in the type 2 diabetes field, however a complete overview of these PROMs is currently lacking. We therefore aimed to systematically describe and classify the content of all PROMs that have specifically been developed or validated to measure (aspects of) HRQOL in people with type 2 diabetes. A literature search was performed in PubMed and EMBASE until 31 December 2021. Studies on the development or validation of a PROM measuring HRQOL, or aspects of HRQOL, in people with type 2 diabetes were included. Title and abstract and full-text screening were conducted by two independent researchers and data extraction was performed independently by one of the researchers. Data were extracted on language in which the PROM was developed, target population, construct(s) being measured, names of (sub)scales and number of items per (sub)scale. In addition, all PROMs and subscales were classified according to specific aspects of HRQOL based on the Wilson & Cleary model (symptom status, functional status, general health perceptions) to aid researchers in PROM selection. In total 220 studies were identified that developed or validated PROMs that measure (aspects of) HRQOL in people with type 2 diabetes. Of the 116 unique HRQOL PROMs, 91 (of the subscales) measured symptom status, 60 measured functional status and 26 measured general health perceptions. In addition, 16 of the PROMs (subscales) measured global quality of life. 61 of the 116 PROMs (subscales) also include characteristics of the individual (e.g. aspects of personality, coping) or environment (e.g. social or financial support) and patient-reported experience measures (PREMs, e.g. measure of a patient's perception of their personal experience of the healthcare they have received, e.g. treatment satisfaction), which are not part of the HRQOL construct. Only 9 of the 116 PROMs measure all aspects of HRQOL based on the Wilson & Cleary model. Finally, 8 of the 116 PROMs stating to measure HRQOL, measured no HRQOL construct. In conclusion, a large number of PROMs are available for people with type 2 diabetes, which intend to measure (aspects of) HRQOL. These PROMs measure a large variety of (sub)constructs, which are not all HRQOL constructs, with a small amount of PROMs not measuring HRQOL at all. There is a need for consensus on which aspects of HRQOL should be measured in people with type 2 diabetes and which PROMs to use in research and daily practice. PROSPERO: CRD42017071012. COMET database: http://www.comet-initiative.org/studies/details/956 .

Psychometric Evaluation of the Korean Version of PROMIS Self-Efficacy for Managing Symptoms Item Bank: Item Response Theory

PURPOSE

To evaluate the psychometric properties of the Patient-Reported Outcomes Measurement Information System (PROMIS) self-efficacy for managing symptoms of the version 1.0 item bank in Korea.

METHODS

This study consisted of two phases: first, developing the Korean version of the item bank following the translation guidelines; and second, performing a cross-sectional study to evaluate its psychometric properties using the item response theory. This study enrolled 323 patients with type 2 diabetes mellitus between July and August 2020. Cronbach's α was used to assess the reliability of this item bank. Confirmatory factor analysis, using diagonally weighted least squares, was used to identify the assumptions of item response theory. Item parameter estimates including discrimination and thresholds were derived using the graded response model of the item response theory to reflect patient-reported outcomes as individualized responses.

RESULTS

The Korean version of the item bank demonstrated good reliability (Cronbach's α = .98) and its discrimination ranged from 1.82 to 4.93. The thresholds resulted in the establishment of a category response curve for each item. However, no overlap was observed among the category curves. Moreover, the differential item functioning was not significant for age, gender, and income variables.

CONCLUSION

The graded response model and differential item functioning provided qualitative evidence that demonstrated acceptable psychometric properties of symptom management self-efficacy among patients. This item bank is expected to provide adequate assessments of self-efficacy of symptom management for patients with a chronic disease, which can contribute to nursing research and intervention.

Content Validity of Patient-Reported Outcome Measures Developed for Assessing Health-Related Quality of Life in People with Type 2 Diabetes Mellitus: a Systematic Review

PURPOSE OF REVIEW

We aimed to systematically evaluate the content validity of patient-reported outcome measures (PROMs) specifically developed to measure (aspects of) health-related quality of life (HRQOL) in people with type 2 diabetes. A systematic review was performed in PubMed and Embase of PROMs measuring perceived symptoms, physical function, mental function, social function/participation, and general health perceptions, and that were validated to at least some extent. Content validity (relevance, comprehensiveness, and comprehensibility) was evaluated using COSMIN methodology.

RECENT FINDINGS

We identified 54 (different versions of) PROMs, containing 150 subscales. We found evidence for sufficient content validity for only 41/150 (27%) (subscales of) PROMs. The quality of evidence was generally very low. We found 66 out of 150 (44%) (subscales of) PROMs with evidence for either insufficient relevance, insufficient comprehensiveness, or insufficient comprehensibility. For measuring diabetes-specific symptoms, physical function, mental function, social function/participation, and general health perceptions, we identified one to 11 (subscales of) PROMs with sufficient content validity, although quality of the evidence was generally low. For measuring depressive symptoms, no PROM with sufficient content validity was identified. For each aspect of HRQL, we found at least one PROM with sufficient content validity, except for depressive symptoms. The quality of the evidence was mostly very low.

Quality of patient-reported outcome reporting in trials of diabetes in pregnancy: A systematic review

AIMS

Patient-reported outcomes (PROs) are reports of the patient's health status that come directly from the patient without interpretation by the clinician or anyone else. They are increasingly used in randomised controlled trials (RCTs). In this systematic review we identified RCTs conducted in women with diabetes in pregnancy which included PROs in their primary or secondary outcomes. We then evaluated the quality of PRO reporting against an internationally accepted reporting framework (Consolidated Standards of Reporting Trials (CONSORT-PRO) guidelines).

METHODS

We searched online databases for studies published 2013-2021 using a combination of keywords. Two authors reviewed all abstracts independently. Data on study characteristics and the quality of PRO reporting were extracted from relevant studies. We conducted a multiple regression analysis to identify factors associated with high quality reporting.

RESULTS

We identified 7122 citations. Thirty-five articles were included for review. Only 17% of RCTs included a PRO as a primary or secondary outcome. Out of a maximum score of 100 the median score was 46, indicating sub-optimal reporting. A multiple regression analysis did not reveal any factors associated with high quality reporting.

CONCLUSIONS

Researchers should be mindful of the importance of PRO inclusion and reporting and include reliable PROs in trials.

Development and validation in Ecuador of the EPD Questionnaire, a diabetes-specific patient-reported experience and outcome measure: A mixed-methods study

Introduction

The global prevalence of diabetes in 2019 in adults was estimated to be 9.3%. This study developed in Ecuador, for the first time, instruments to assess patient‐reported outcomes and experiences.

Methods

The Experiences of the Person with Diabetes (EPD) Questionnaire is a diabetes‐specific instrument. A mixed‐methods study was conducted. First, a qualitative item development phase that included four focus groups and six semi‐structured interviews with patients was conducted in different rural and urban areas of Ecuador to obtain information on culture, beliefs, demographics, diet and social perspectives. A second quantitative phase for psychometric validation was carried out in primary care settings of rural and urban areas of Ecuador.

Results

Forty‐two and four hundred and eighty‐nine participants were included in each phase, respectively. The item development phase resulted in a questionnaire of 44 items (23 for perceived outcomes and 21 for experiences). In the validation study, most participants were women (58%) and from urban areas (57%). Exploratory factor analysis revealed three dimensions for each instrument. Outcomes instrument dimensions were symptoms and burnout, worries and fears and social limitations. Experiences instrument dimensions were information, patient‐centred care and care delivery. Cronbach's α values of the total score and dimensions were high, ranging between .81 and .93 in both instruments. Confirmatory factor analysis showed an acceptable fit of the data.

Conclusion

The EPD Questionnaire is probably the first instrument developed to assess patient‐reported experiences and perceived outcomes in a middle‐income country that included patients to capture all dimensions relevant for the intended population. Its psychometric properties are robust and could provide valuable information for clinicians and policymakers in the region.

Patient or Public Contribution

The development of these instruments has taken into consideration patients and the public since their conception. A qualitative approach gathered relevant information related to the cultural, social and economic burden of different populations in Ecuador. Before validation, a pilot test was carried out with users of the National Health Services to obtain their perspectives and insights of the developed instrument. Finally, during the data analysis, we have given special consideration to social variables such as rural and urban populations.