Adapting and validating a measure of diabetes-specific self-compassion

A scoping review of the self-reported compassion measurement tools

BACKGROUND

Compassion is closely linked to psychological well-being, and several assessment tools have been developed and studied to assess the level of compassion in different populations and for more precise measurement. There is currently a scarcity of comprehensive knowledge about compassion-related assessment tools, and our research provides an overview of these tools.

AIMS

To identify scales used to measure compassion from different flows, and to assess their measurement properties and quality.

METHODS

Focusing on compassion assessment tools, the authors conducted a thorough search of 10 Chinese and English databases from their establishment until August 14, 2022. Data extracted included the author, year, country, objectives, target population, as well as the primary evaluation content. Using the COSMIN checklist, the methodological quality and measurement properties of the included studies were appraised. This scoping review was registered with the Open Science Framework and followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist.

RESULTS

There were 15,965 papers searched, and 36 compassion-related measurement tools were identified in this study. None of the 36 studies provided possessed all nine psychometric properties, as outlined by the COSMIN criteria. On the basis of a systematic evaluation of quality, measurement qualities were ranked. The results for internal consistency and content validity were relatively favorable, whereas the results for structural validity were variable and the results for the remaining attributes were either uncertain or negative. A Venn diagram was used to illustrate the overlapping groups of compassion measurement tools based on the three-way flow of compassion. An overview of the reference instrument and theoretical basis for the included studies was provided, and half of them did not contain any theoretical or scale-based evidence.

CONCLUSION

In this study, 36 compassion-related measuring instruments were identified, and the methodological quality and measurement properties of the included studies were acceptable. The included measurements were consistent with flows of compassion. A further focus of further research should be on developing theories in the compassion domain and developing instruments for measuring compassion that are multidimensional, multi-populations, and culturally relevant.

Measuring Self-management Among People with Diabetes Mellitus: A Systematic Review of Patient-Reported Diabetes-Specific Instruments in English and Chinese

INTRODUCTION

Effective behavioral management is critical for people with diabetes to achieve glycemic control. Many instruments have been developed to measure diabetes-specific self-management. This review aimed to retrieve existing self-management-related instruments and identify well-validated instruments suitable for clinical research and practice.

METHODS

First, PubMed, Psych INFO, ERIC, and two Chinese databases (CNKI and Wanfang Data) were searched to identify existing instruments for self-management in diabetes systematically. Second, instruments were screened based on the pre-specified inclusion and exclusion criteria. Third, the psychometric property data of each included instrument were retrieved, and instruments with poor psychometric properties were excluded. Fourth, selected instruments were categorized into four categories: knowledge and health literacy, belief and self-efficacy, self-management behaviors, and composite scales. Finally, recommendations were made according to the application status and quality of the instruments. Instruments in English and Chinese were screened and summarized separately.

RESULTS

A total of 406 instruments (339 English instruments and 67 Chinese instruments) were identified. Forty-three English instruments were included. Five focused on knowledge and literacy, 12 on belief and self-management perception-related constructs, 21 on self-management and behaviors, and 5 on composite measures. We further recommended 19 English scales with relatively good quality and are frequently applied. Twenty-five Chinese instruments were included, but none were recommended because of a lack of sufficient psychometric property data.

CONCLUSION

Many English instruments measuring diabetes self-management have been developed and validated. Further research is warranted to validate instruments adapted or developed in the Chinese population.

The role of self-compassion in diabetes management: A rapid review

Aim

This study aimed to assemble and critically reflect on previously acquired insights from investigations that have already been conducted into the role of self-compassion in diabetes and its management.

Methods

This study implemented a rapid review approach to assess the pre-existing knowledge in a time-sensitive manner. A rapid review involves the synthesis of existing knowledge using a simplified systematic review process.

Results

A total of 16 articles were identified for this rapid review. The main findings from these articles included that self-compassion is associated with improved outcomes (psychologically and medically), self-compassion can be improved through interventions, and that many extraneous factors influence levels of self-compassion.

Conclusion

It is apparent that self-compassion plays a rather significant role in the management of diabetes, and that interventions aimed at developing self-compassion showed success in improving health-related outcomes. It is suggested that future research should build on the possibility of using positive psychology interventions to improve the quality of life of those living with diabetes, and work to better understand the influence of aspects such as gender and diabetes duration on self-compassion.

The role of protective psychological factors, self-care behaviors, and HbA1c in young adults with type 1 diabetes

OBJECTIVE

To investigate whether protective psychological factors in young adults with type 1 diabetes are associated with more optimal self-care behaviors and HbA1c, and to explore possible mediators between protective psychological factors and HbA1c.

RESEARCH DESIGN AND METHODS

This cross-sectional study examined the associations between protective psychological factors (optimism, positive efficacy expectancies, and self-compassion), maladaptive psychological factors (depression, anxiety, and stress), self-care behaviors, and HbA1c in 113 young adults (17-25 years) with type 1 diabetes in Auckland, New Zealand. Pearson's correlations, multiple linear regressions, and multiple mediation analyses were used to examine associations and mediators.

RESULTS

Higher positive efficacy expectancies (beliefs about coping with difficulties) were associated with more optimal HbA1c (β = -0.26, 95% CI: -1.99 to -0.45) and more optimal self-care behaviors (β = 0.33, 95% CI: 0.28 to 0.92) in the adjusted models. Higher levels of self-compassion were associated with more optimal self-care behaviors (β = 0.27, 95% CI: 0.09 to 0.43). Depression was associated with less optimal self-care behaviors (β = -0.35, 95% CI: -1.33 to -0.43) and stress was associated with less optimal HbA1c (β = 0.26, 95% CI: 0.27 to 1.21). Mediation results suggested that self-care behaviors mediated the relationship between all three of the protective psychological factors and more optimal HbA1c, and that lower stress also mediated the relationship between higher self-compassion and more optimal HbA1c.

CONCLUSIONS

This study adds to the emerging literature that protective psychological factors may play an adaptive role in improving health outcomes in young adults with type 1 diabetes. Interventions targeting protective psychological factors present a promising approach to optimizing wellbeing and self-care in youth with type 1 diabetes.

Chronotype and well-being in adults with established type 2 diabetes: A cross-sectional study

AIMS

'Chronotype' describes an individual's sleep-wake schedule, and can be classified into morning, intermediate or evening types. Evening chronotype has been widely associated with increased cardiometabolic risk and mortality in people with type 2 diabetes. We explored associations between chronotype and markers of well-being in people with type 2 diabetes.

METHODS

Participants of the 'Chronotype of Patients with Type 2 Diabetes and Effect on Glycaemic Control' (CODEC) observational study completed questionnaires to determine chronotype (Morningness-Eveningness Questionnaire, MEQ) and concurrent measures of well-being (Diabetes-related Distress scale, Patient Health Questionnaire-9 to measure depression, and Self-Compassion Scale), as a secondary endpoint of the study. Adjusted generalised linear models were used to compare well-being between chronotype subgroups in this cohort.

RESULTS

Of the 808 individuals included in the CODEC study, from convenience sampling, 476 individuals completed the psychosocial questionnaire substudy. Of these, 67% (n = 321) were male, and 86% (n = 408) were white European. From the MEQ, 24% (n = 114) were morning chronotype, 24% (n = 113) were evening and 52% (n = 249) were intermediate chronotype. Diabetes-related distress was significantly higher in evening chronotypes (exponentiated adjusted coefficient = 1.18 (CI: 1.05-1.32)), compared to morning (p_adjusted  = 0.005) and intermediate chronotypes (p_adjusted  = 0.039). Similarly, depression was significantly higher in evening chronotypes (exponentiated adjusted coefficient = 1.84 (CI: 1.28-2.65)) compared to morning (p_adjusted  = 0.001) and intermediate chronotypes (p_adjusted  = 0.016).

DISCUSSION

Evening chronotype in people with type 2 diabetes may be associated with higher levels of diabetes-related distress and depression. These findings warrant further investigation to establish causality and evidence-based interventions that negate the effects of evening chronotype in people with type 2 diabetes.

Diabetes-Specific Self-Compassion: A New Measure for Parents of Youth With Type 1 Diabetes

OBJECTIVE

Given the high daily demands of managing type 1 diabetes (T1D), parents of youth with T1D can experience high levels of emotional distress, burden, and self-criticism, with implications for parent and child well-being and parent self-efficacy for managing diabetes. Diabetes-specific self-compassion (SC), or being kind to oneself when facing challenges related to managing diabetes, may serve as protective for parents. This study aimed to create and assess the psychometric properties of a new tool, the diabetes-specific Self-Compassion Scale (SCS-Dp), to assess diabetes-specific SC in parents of youth with T1D.

METHODS

We adapted a parent diabetes-specific SC measure; surveyed parents (N = 198; parent: 88% female; 95% non-Hispanic White; M age = 44 ± 8.9; child: 46% female; M age = 13 ± 3.4, range 2-18 years; 83% insulin pump users; 40% continuous glucose monitor (CGM) users; HbA1c from clinic data available for 76 participants: M HbA1c = 8.1 ± 1.3%) and conducted confirmatory factor analysis, and reliability and construct validity analyses. Validity measures included diabetes distress, diabetes empowerment, diabetes numeracy, and HbA1c.

RESULTS

A bifactor structure provided the best fit, with one general factor and two wording-related group factors (positively and negatively worded items). The final 19-item SCS-Dp demonstrated excellent internal consistency (α =.94; range of item-total correlations: .52-.81) and good construct validity. As predicted, greater SC was associated with lower distress (r = -.68, p < .001) and greater empowerment (r = .43, p < .001) and was not associated with diabetes numeracy (p = .61). Diabetes-specific Self-Compassion Scale was not associated with HbA1c (p = .28).

CONCLUSIONS

Results provide initial evidence of good reliability and validity of the SCS-Dp to assess diabetes-specific SC in parents.

Self-Compassion, Adaptive Reactions and Health Behaviours Among Adults With Prediabetes and Type 1, Type 2 and Gestational Diabetes: A Scoping Review

Engaging in health-promoting behaviours has health benefits for people with prediabetes or diabetes. People experience negative affect after diagnoses, which can impede self-regulation of health behaviours. Self-compassion, extending care to oneself in difficult times, can mitigate negative affect and promote self-regulation. This scoping review explored the relationship between self-compassion and adaptive affect, self-regulation and engagement in health-promoting/management behaviours among people with prediabetes or diabetes. We conducted a scoping literature search from 6 databases for studies and conference abstracts. Randomized controlled trials and cross-sectional, longitudinal, observational and qualitative designs focused on self-compassion were included. Eligible studies included adults with diabetes (prediabetes, type 1, type 2 and gestational), measured self-compassion using a validated Self-Compassion Scale (quantitative) or included the 3 components (qualitative) and investigated: negative affect, health promoting/management behaviours and/or self-regulation. After deduplication, 5,338 quantitative and 953 qualitative abstracts, and 18 conference proceedings were screened leaving 35 articles. Full-text screening retained 11 eligible studies (6 cross-sectional studies, 2 randomized controlled trials, 2 longitudinal studies and 1 qualitative study). Higher self-compassion was associated with decreased negative affect in 9 studies and was positively associated with well-being in 1 cross-sectional study. Self-compassion led to decreased negative affect and improved blood glucose in 2 interventions. Five studies found positive associations between self-compassion and health-promoting/management behaviours. One qualitative study found self-compassion to benefit affective reactions, health-promoting behaviours and self-regulation. This review shows that self-compassion is linked to adaptive behavioural and affective responding among people with prediabetes and diabetes, and the need for more research on self-compassion and self-regulation in these populations.

Communication matters: The role of autonomy-supportive communication by health care providers and parents in adolescents with type 1 diabetes

AIMS

Although research exists on parental communication in adolescents with type 1 diabetes (T1D), the role of communication by health care providers remains understudied. Grounded in Self-Determination Theory, this study examined the role of autonomy-supportive communication (i.e., providing meaningful rationale and offering choices with regard to treatment recommendations) by providers and parents, and how they interact in the prediction of diabetes outcomes.

METHODS

In this cross-sectional study, 135 adolescents (mean age 14.3 ± 2.1SD years), 171 mothers, and 121 fathers reported on autonomy-supportive communication from health care providers and parents, and on adolescent treatment adherence. HbA1c values were retrieved from the medical record.

RESULTS

In adolescent reports, perceived autonomy-supportive communication from providers but not from parents was positively related to treatment adherence. A significant interaction between autonomy-supportive communication from providers and parents pointed to the highest level of treatment adherence when adolescents perceived both providers and parents as autonomy-supportive. In contrast, parental reports revealed that parental autonomy-supportive communication was positively related to treatment adherence, whereas autonomy-supportive communication by providers was not.

CONCLUSIONS

Autonomy-supportive communication by providers and parents is associated with better treatment adherence in adolescents with T1D. Interventions to improve autonomy-supportive communication by parents and providers may improve treatment adherence of adolescents (e.g., communication training).

'I'm on the train and I can't stop it': Western Canadians' reactions to prediabetes and the role of self-compassion

Prediabetes, a condition characterised by impaired glucose regulation, is on the rise worldwide. This condition puts people at risk for cardiovascular disease, and 50% of people with prediabetes will develop type 2 diabetes (T2D). People with prediabetes can reduce their risk of developing T2D through lifestyle changes such as regular physical activity and healthy eating. However, the experience of health risks can be associated with negative reactions that can undermine people's ability to self-regulate the health behaviours that would reduce such risk. Self-compassion, or treating oneself kindly in the face of challenge, is known to help people manage negative emotions and facilitate self-regulation. Therefore, self-compassion may be helpful for people with prediabetes who have to manage their health behaviours in the context of a health threat. The purpose of this study was to explore how people, from a small Canadian city who learn that they have prediabetes, react emotionally to their prediabetes diagnosis. We also explored participants' receptivity to applying self-compassion in the context of their prediabetes. Twenty-one adults, recently notified by their doctors as having HbA1c scores indicative of prediabetes (M_age  = 57.76, SD = 5.43), engaged in a semi-structured interview between June 2017 and January 2018. Inductive thematic analysis was used to analyse the data and four themes emerged. Participants' reactions to learning that they had prediabetes were characterised by (a) distress and concern, (b) downplay of T2D risks, (c) guilt and shame, and participants were receptive to (d) self-compassion as a beneficial approach to take in relation to their prediabetes. Findings suggest that people experience negative reactions to their prediabetes diagnosis yet are receptive to self-compassion, which could mitigate these reactions. These findings can inform lifestyle behaviour change programmes for individuals living with prediabetes by providing a better understanding of their perspectives of disease diagnosis.