Translation and culture adaptation of the Simplified Diabetes Knowledge Test, the Literacy Assessment for Diabetes and the Diabetes Numeracy Test

Validation and Psychometric Evaluation of Diabetes Literacy, Numeracy, and Knowledge Tools in the Arabic Context

PURPOSE

The purpose of this study was to validate the Literacy Assessment for Diabetes (LAD), the Diabetes Numeracy Test (DNT), and the Simplified Diabetes Knowledge Test (DKT) in the Arabic language and context.

METHODS

Three hundred eighty four, ≥18-year-old patients with type 1, type 2, or gestational diabetes mellitus were recruited from 3 endocrinology clinics in the United Arab Emirates. Exploratory factor analysis using principal component was performed. Achieved scores were compared using Pearson bivariate correlation.

RESULTS

All 60 LAD items loaded on 1 factor accounting for 66.7% of the variance, with internal consistency α = .991. Average score = 68.7%. Nineteen out of 26 items were retained on the DNT and grouped into 4 factors, prescription reading and directions, proper dose coverage, nutrition, and insulin, with good internal consistency (α = .721). Average score = 73.2%. All 20 DKT items loaded on 3 factors accounting for 41.2% of the variance, causes and consequences of the high blood sugar level, prevention of the disease, and misconceptions about diabetes self-management, with good internal consistency (α = .799). Average score = 71.9%. A moderate and significant correlation between the DKT and DNT (r = .56, P < .001) was observed.

CONCLUSIONS

Three tools to assess diabetes literacy, numeracy, and knowledge were psychometrically tested to establish their validity and reliability in the Arabic language and context. The tools could be used to assess patient skills and competence in navigating the health care system and managing their diabetes.

The dietary knowledge measurement instruments in diabetes: A systematic psychometric review

AIMS

To identify, critically appraise, and summarize instruments to measure dietary knowledge in patients with diabetes mellitus type 1 or 2.

DESIGN

Psychometric systematic review.

DATA SOURCES

A comprehensive search was carried out during March 2020 in the followed databases: Medline, Web of Science, Open Grey, Cochrane Library, COSMIN database, and Scielo.

REVIEW METHODS

In accordance with the most up-to-date COnsensus-based Standards for the selection of health status Measurement INstruments methodology (COSMIN) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements. A systematic review of the measurement properties of the instruments that assess the level of dietary knowledge in the diabetic population was carried out. The COSMIN checklist was used to assess the measurement properties of existing patient-reported outcome measures to select the most appropriate outcome measurement instrument. The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42020186516).

RESULTS

Nine instruments were identified. The Michigan Diabetes Knowledge Test (DKT) was the questionnaire included in the largest volume of studies. The Diabetes Knowledge Questionnaire (DKQ) was the questionnaire with the most evaluated psychometric characteristics. The Personal Diabetes Questionnaire (PDQ) was the second with the highest number of psychometric characteristics evaluated and with a better score regarding the quality of the evidence.

CONCLUSION

According to the quality methodological results; DKT, DKQ and PDQ are the recommended instruments to assess dietary knowledge in people with diabetes types 1 and 2.

IMPACT STATEMENT

What problem did the study address? One of the main factors that lead to greater difficulty for patients with diabetes mellitus is dietary management, and it is necessary to evaluate whether the patient has sufficient knowledge about dietetics to practice a healthy diet. What were the main findings? Nine instruments were identified that were specifically designed to assess dietary knowledge in patients with diabetes mellitus (DM) type 1 or 2. Michigan Diabetes Knowledge Test, Diabetes Knowledge Questionnaire, and Personal Diabetes Questionnaire are the recommended instruments to assess dietary knowledge in people with diabetes. Where and on whom will the research have impact? The evaluation of this construct is very useful both in clinical practice; at hospital, community and primary care levels, in patients with type 1 and / or 2 diabetes mellitus (DM), as in research.

The impact of a self-management educational program coordinated through WhatsApp on diabetes control

Background:

Social media can effectively mediate digital health interventions and thus, overcome barriers associated with face-to-face interaction.

Objective:

To assess the impact of patient-centered diabetes education program administered through WhatsApp on glycosylated hemoglobin (HbA1c) values, assess the correlation, if any, between health literacy and numeracy on intervention outcomes

Methods:

During an ‘intervention phase’ spread over six months, target diabetic patients (N=109) received structured education through WhatsApp as per the American Association of Diabetes Educators Self-Care Behaviors recommendations. The control group with an equal number of participants received ‘usual care’ provided by health professionals void of the social media intervention. Changes in HbA1c levels were recorded thrice (at baseline, 3 and 6 months) for the test group and twice (baseline and 6 months) for the control group. Change in HbA1c values were compared and statistical significance was defined at p<0.05. Baseline health literacy and diabetes numeracy were assessed for both groups (N=218) using the Literacy Assessment for Diabetes (LAD), and the Diabetes Numeracy Test (DNT), respectively, and values were correlated with HbA1c change p<0.05. Participants’ satisfaction with the intervention was also assessed.

Results:

The average age of respondents was 41.98 (SD 15.05) years, with a diabetes history of 10.2 (SD 8.5) years. At baseline, the average HbA1c in the control and test groups were 8.4 (SD 1.06) and 8.5 (SD 1.29), respectively. After six months, a significant drop in HbA1c value was noticed in intervention group (7.7; SD 1.35; p= 0.001); with no significance in the control group (8.4; SD 1.32; p=0.032, paired t-test). Moreover, the reduction in HbA1c was more in the test group (0.7%) than the control group (0.1%) with a difference of 0.6% which is considered clinically significant. There was no significant correlation between LAD score and HbA1c at baseline (r=-0.203, p=0.064), 3 months (r=-0.123, p=0.266) and 6 months (r=-0.106, p= 0.337) Pearson correlation. A similar result was observed with DNT, where DNT score and HbA1c at baseline, 3 months and 6 months showed no correlation (r=0.112, 0.959 and 0.886; respectively) with HbA1c levels. Eighty percent of the respondents found the social media intervention ‘beneficial’ and suggested it be used long term.

Conclusions:

Diabetes education via WhatsApp showed promising outcomes regardless of the level of patients’ health literacy or numeracy.