Systematic review of the psychometric properties and theoretical grounding of instruments evaluating self-care in people with type 2 diabetes mellitus

Occupational therapy and registered dietitian services to reduce fall risk among home delivered meal clients: a randomized controlled feasibility trial

BACKGROUND

Older adults increasingly prefer to age in place, but health and safety risks often threaten this independence. Home delivered meals, a key service under the Older Americans Act, provide essential nutritional support to homebound older adults, the majority of whom are at elevated risk for fall-related morbidity and mortality. Given the complex health conditions of homebound older adults, we conducted a feasibility randomized controlled trial (RCT) to evaluate our methods for testing four different service models designed to help reduce fall risk among home delivered meal recipients: (1) meals alone; (2) meals + registered dietitian nutritionist (RDN) services; (3) meals + occupational therapy (OT) services; or (4) meals + RDN + OT services. Findings will inform protocol modifications for our definitive RCT to improve fall-related outcomes among this population.

METHODS

A four-arm, parallel-group feasibility RCT was conducted with one home delivered meal agency in the Midwest United States. Participants were eligible to participate if they were over 60 years old, were able to receive meals from our partner agency, had one diet-related health condition, and were at risk for falling. Feasibility outcomes included study eligibility, recruitment, retention, fidelity to RDN and OT services, and service acceptability.

RESULTS

Of 442 screened clients, 31% were eligible for participation, and 41% of eligible individuals were recruited (N = 56). Retention at three months was 79%. Fidelity rates were 84.5% for RDN services and 90.2% for OT services. Participants expressed high satisfaction with meal convenience and staff interactions but noted areas for improvement, including meal taste and inconsistent meal deliveries (e.g., timeliness; receiving correct meals).

CONCLUSIONS

The study identified several barriers to scaling this trial, including restrictive eligibility criteria and recruitment challenges. Protocol modifications for the definitive trial include broader eligibility, expanded recruitment areas, and increased flexibility in meal selection. Randomization procedures will also be adjusted to account for participants from the same household. This feasibility trial demonstrates the potential for integrating RDN and OT services into home delivered meal programs to address recipients' fall-related needs.

TRIAL REGISTRATION

Clinicaltrials.gov; NCT06059404; 22/09/2023.

Assessment of self-management questionnaire in diabetes mellitus (ASQ-DM-EX)-the validation of novel lived experience inventory

BACKGROUND

The optimal control of type 2 diabetes (T2D) is defined by the innate mastery of self-management behaviours. This study is designed to condense the lived experiences of people with T2D in relation to factors 'exterior' to themselves into a universal self-management inventory (Assessment of Self-Management Questionnaire in Diabetes Mellitus-External Reality; ASQ-DM-EX).

METHODS

We collected responses to an online and physical survey from people living with T2D through a quantitative cross-sectional study. First, we tested the contextual validity and cultural preciseness of ASQ-DM-EX prototype through a preliminary pilot testing phase. These processes culminated in the development of a 91-item version of the questionnaire which was disseminated widely to evaluate the predictive strength of the ASQ-DM-EX.

RESULTS

All constructs within ASQ-DM-EX showed internal consistencies within good to excellent range (Cronbach's ⍺ = 0.70-0.94), except for the Influence construct (Cronbach's ⍺ = 0.33). An increase in ASQ-DM-EX scores was associated with a reduction in HbA1c control (r = -0.17, P < 0.05). The ASQ-DM-EX model had excellent goodness-of-fit [root mean square error of approximation < 0.01; comparative fit index = 1.00; Tucker-Lewis index = 1.00].

CONCLUSION

The ASQ-DM-EX is a novel and holistic inventory that broadens the scope of diabetes assessment absent from contemporary self-management tools.

Development of a Self-Care Scale for Compound Caregivers

Background: Japan and other nations are experiencing rising demands for care, owing to declining birth rates and aging populations. This particularly affects compound caregivers, people who provide informal care for multiple individuals. Compound caregivers face unique challenges and higher risks of physical and mental health problems. However, existing self-care scales do not cover their needs. This cross-sectional study aimed to develop and validate the Self-Care Scale for Compound Caregivers (SCSCC) to assess specific self-care practices and promote targeted support. Methods: A cross-sectional study was conducted through an online survey of 400 compound caregivers. Reliability was assessed via item analysis, exploratory and confirmatory factor analyses, and Cronbach's alpha. Criterion validity was evaluated using a self-rated health scale. Results: Overall, 400 compound caregivers participated in the study. After item analysis, we excluded nine items, leaving eight for factor analysis. Exploratory factor analysis revealed a single-factor structure explaining 51.5% of the variance. Confirmatory factor analysis showed a good model fit after modifications (goodness of fit index = 0.964, adjusted goodness of fit index = 0.932, comparative fit index = 0.980, root mean square error of approximation = 0.054). The final version of the SCSCC demonstrated strong internal consistency (Cronbach's alpha = 0.859) and was positively correlated with self-rated health (r = 0.387, p < 0.001). Conclusions: The SCSCC is a reliable tool for assessing self-care in compound caregivers, supporting health promotion, interventions, and policies to improve their health within the community care system.

Dementia Prevention Self-Management in Older Thai Adults with Type 2 Diabetes: Development and Psychometric Properties of Two Questionnaires

BACKGROUND/OBJECTIVES

The prevalence of dementia, a complication of uncontrolled type 2 diabetes (T2DM), is rising among older adults. Effective self-management for dementia prevention is essential, but no validated questionnaires currently exist to evaluate these behaviors.

METHODS

The Dementia Preventive Individual and Family Self-Management Process Questionnaire (DP-IFSM-PQ) and the Dementia Preventive Self-Management Behavior Questionnaire (DPSMBQ) were developed based on the Individual and Family Self-Management Theory to evaluate dementia prevention self-management behaviors in older adults with T2DM. Items for the DP-IFSM-PQ (30 items) and DPSMBQ (29 items) were generated through literature review and tested for face validity. A quantitative cross-sectional study evaluated their psychometric properties using exploratory factor analysis (EFA) (n = 311) and confirmatory factor analysis (CFA) (n = 254).

RESULTS

The final DP-IFSM-PQ comprises four factors and 29 items, showing acceptable fit with limited discriminant validity. The DPSMBQ includes seven factors and 27 items, demonstrating good fit and acceptable discriminant validity.

CONCLUSIONS

The Thai-language DP-IFSM-PQ and DPSMBQ show reasonable psychometric properties for application in Thai older adults, but revisions of certain items and further studies are recommended to reassess their properties.

Requirements and Key Features of a Mobile Application for Adolescent Self-Care From a Stakeholders Perspective: A Qualitative Study

Adolescence is characterized by many changes and these changes differentiate adolescents' self-care needs. The use of smartphones and tablets to provide healthcare services has expanded, and the user-centered design could help to create mobile applications based on users' needs. Therefore, the present study aimed to identify the data requirements and key features of mobile application for adolescent self-care from a stakeholder perspective. This study was conducted with a qualitative approach to identify the key features of mobile application for adolescent's self-care as well as educational content axes for five component of self-care using conventional and directed content analysis respectively. From 3 sub-groups 30 participants were selected based on purposive sampling with maximum variety and sampling was performed until data saturation. Data were collected through in-depth semi-structured interviews. Participants' informed consent was obtained before the interview. The interview lasted 20-40 min and MAXQDA software version 10 was used for data analysis. In this study, four criteria of acceptability, reliability, transferability, and validity proposed by Guba and Lincoln were used to evaluate and validate the data. After conducting the interviews, 789 initial codes, 12 sub-categories, and 3 categories (app view, app content architecture, app self-care content) were emerged, which reflects the key features of a mobile application and the necessary educational content. The research findings could provide a guide for future mobile application development considering the viewpoints of health professionals, content, and software experts. Addressing the features and requirements in practice could lead to designing efficient and effective mobile applications.

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

Background

For patients with diabetes mellitus, self-care is crucial because it prevents complications and helps preserve quality of life. Clinicians and researchers require effective tools for assessing self-care behaviors across various dimensions to identify individual needs and maximize resource allocation. The aim of this study was to evaluate the validity and reliability of the Spanish version of the Self-Care of Diabetes Inventory (SCODI).

Methods

Two hundred eighteen participants with DMT1 and DMT2 who were recruited through convenience sampling from a university hospital participated in our cross-sectional study. After translation and cultural adaptation, the enrolled patients answered the questions. We performed an exploratory factor analysis (EFA) on each of the SCODI scales and Confirmatory factor analysis (CFA) was performed using our models which appropriate fit indices.

Results

The original structure of the four-dimensions tool was confirmed. The overall consistency across the four scales was assessed by Cronbach's alpha: self-care maintenance (0.766), self-care monitoring (0.790), self-care management (0.771), and self-care confidence (0.936). The model fit yielded a chi-square index of 1.028 with 773 degrees of freedom. Confirmatory factor analysis showed a good fit, thereby affirming the reliability of the model.

Conclusion

The internal consistency and reliability of the SCODI Spanish version are deemed adequate. This tool is appropriate when it is desired to evaluate the self-care practices of Spanish persons suffering from diabetes due to its good psychometric qualities.

A cross-sectional study on diabetes self-management practice and its association with glycemic control among type 2 Diabetes patients

Context

Diabetes has emerged as a major chronic public health problem throughout the world. Self-management by diabetes patients is very important for controlling blood sugar levels and preventing complications of diabetes.

Aims

The present study was conducted to study self-management practices among diabetes patients and to analyse socio-demographic factors associated with them.

Methods and Materials

A cross-sectional analytical study was conducted among 230 randomly selected diabetes patients in the Andaman and Nicobar Islands. The self-management practices were measured by the diabetes self-management questionnaire (DSMQ).

Statistical Analysis Used

The association of the DSMQ score with socio-demographic factors and blood sugar level was analysed by statistical tests like the T-test, analysis of variance (ANOVA) test, Tukey's honestly significant difference, and Chi-square test.

Results

The mean DSMQ score of the diabetes patients was 29.55 ± 5.98. There was a significant difference between the mean DSMQ score and the educational level (P value = 0.009), residential status (P value = 0.037), and duration of diabetes (P value = 0.006). The subcomponent analysis of the DSMQ score revealed that the glucose management score of rural people (9.38 ± 3.36) was significantly higher (P value = 0.006) than that of urban people (8.32 ± 2.46), and the diet control score was significantly higher (P value = 0.02) in patients with normal post-prandial blood sugar (PPBS) (7.64 ± 2.18) than in patients with raised PPBS (6.96 ± 2.12).

Conclusions

Higher educational level, rural background, and long duration of diabetes were associated with better self-management practices. The patients with normal blood sugar levels showed higher diet control scores than the patients with raised blood sugar levels.

Instruments for measuring self-management and self-care in geriatric patients - a scoping review

Introduction

With demographic changes, prioritizing effective care for geriatric patients to maintain functionality, independence, and quality of life is crucial. Well-developed self-management or self-care abilities, which can be maintained and improved through interventions, are of the utmost importance. To implement these interventions tailored and effectively, a thorough assessment of the individual's self-management and self-care abilities is required.

Objective

This scoping review aimed to identify self-management and self-care instruments suitable for geriatric patients, their underlying theories and definitions of self-management and self-care, and their similarities and differences in item content.

Methods

A systematic search of the PubMed and CINAHL databases was conducted to identify retrievable full-text articles published in English in the medical and nursing fields since the 1970s, which were validated on a sample with an average age of at least 70 years, used generic rather than disease-specific items, and addressed the broad range of self-management and self-care abilities.

Results

Of the 20 included articles, six instruments were identified that were based on different theories and offered varying definitions of self-management or self-care. Despite these differences, all emphasize empowered individuals taking an active role in their care. Most address actual behavior and abilities referring to lifestyle factors and (anticipated) adjustment behavior. However, crucial aspects, such as psychological factors, (instrumental) activities of daily living, and social environment are not fully addressed in these instruments, nor are the types of execution to which the items refer, such as wants, feelings, confidence, or attitudes.

Conclusion

To fully understand how geriatric patients implement daily self-management or self-care, a combination of instruments covering the important factors of self-management and self-care and addressing multiple types of item execution, such as behaviors, abilities, wants, or attitudes, is recommended. This review provides the first comprehensive overview of self-management and self-care instruments suitable for geriatric patients.

Relationship between diabetic knowledge, attitudes and practices among patients with diabetes in China: a structural equation model

OBJECTIVES

Whether the routine delivery of diabetes-related knowledge can change patients' attitudes and hence influence their self-management activities remains unknown in primary healthcare settings in China. Thus, this study aims to explore the complex transformation process between knowledge, attitude and practice (KAP) among patients with diabetes in a city in China.

DESIGN

A cross-sectional study.

SETTING

Yuhuan City, Zhejiang Province, China.

PARTICIPANTS

A total of 803 patients with diabetes were invited to attend a questionnaire survey and 782 patients with type 2 diabetes completed the survey. The average age of participants was 58.47 years old, 48.21% of whom only attended primary school or below.

PRIMARY AND SECONDARY OUTCOME MEASURES

A questionnaire based on existing scales and expert consultation was applied to assess patients' socio-demographic information (SI), disease progression risk and diabetes-related KAP. A structural equation model was built to analyse the relationships between patients' characteristics and KAP.

RESULTS

No significant association was found between patients' knowledge and attitude (β=0.01, p=0.43). Better knowledge and attitude were both found to be associated with better diet and physical activities (β=0.58, p<0.001; β=0.46, p=0.01). However, patients with a more positive attitude toward diabetic care showed worse foot care practice (β=-0.13, p=0.02), while better knowledge was associated with better foot care practice (β=0.29, p<0.001). In addition, patients with higher SI (β=0.88, p<0.001) and/or disease progression risk (β=0.42, p<0.001) tended to present higher levels of disease knowledge.

CONCLUSIONS

While successful KAP transformation has been achieved in practice for diet and physical activities, there is a need to improve foot care practice. Health education should also prioritise the prevention, detection and care of diabetic foot. Also, appropriate methods should be adopted to deliver health education to vulnerable patients, such as the elderly, those living in rural areas, those with minimal education, the unemployed and low-income patients.

Tools for measuring individual self-care capability: a scoping review

BACKGROUND

Our ability to self-care can play a crucial role in the prevention, management and rehabilitation of diverse conditions, including chronic non-communicable diseases. Various tools have been developed to support the measurement of self-care capabilities of healthy individuals, those experiencing everyday self-limiting conditions, or one or more multiple long-term conditions. We sought to characterise the various non-mono-disease specific self-care measurement tools for adults as such a review was lacking.

OBJECTIVE

The aim of the review was to identify and characterise the various non-mono-disease specific self-care measurement tools for adults. Secondary objectives were to characterise these tools in terms of their content, structure and psychometric properties.

DESIGN

Scoping review with content assessment.

METHODS

The search was conducted in Embase, PubMed, PsycINFO and CINAHL databases using a variety of MeSH terms and keywords covering 1 January 1950 to 30 November 2022. Inclusion criteria included tools assessing health literacy, capability and/or performance of general health self-care practices and targeting adults. We excluded tools targeting self-care in the context of disease management only or indicated to a specific medical setting or theme. We used the Seven Pillars of Self-Care framework to inform the qualitative content assessment of each tool.

RESULTS

We screened 26,304 reports to identify 38 relevant tools which were described in 42 primary reference studies. Descriptive analysis highlighted a temporal shift in the overall emphasis from rehabilitation-focused to prevention-focused tools. The intended method of administration also transitioned from observe-and-interview style methods to the utilisation of self-reporting tools. Only five tools incorporated questions relevant to the seven pillars of self-care.

CONCLUSIONS

Various tools exist to measure individual self-care capability, but few consider assessing capability against all seven pillars of self-care. There is a need to develop a comprehensive, validated tool and easily accessible tool to measure individual self-care capability including the assessment of a wide range of self-care practices. Such a tool could be used to inform targeted health and social care interventions.

Instruments Measuring Self-Care and Self-Management of Chronic Conditions by Community-Dwelling Older Adults: A Scoping Review

Given the high prevalence of chronic conditions and multimorbidity in older adults, there is a need to better conceptualize and measure self-care and self-management to promote a person-centered approach. This scoping review aimed to identify and map instruments measuring self-care and self-management of chronic conditions by older adults. We searched six electronic databases, charted data from the studies and tools and reported the results in accordance with the PRISMA-ScR guidelines. A total of 107 articles (103 studies) containing 40 tools were included in the review. There was substantial variation in the tools in terms of their aims and scope, structure, theoretical foundations, how they were developed, and the settings in which they have been used. The quantity of tools demonstrates the importance of assessing self-care and self-management. Consideration of the purpose, scope, and theoretical foundation should guide decisions about tools suitable for use in research and clinical practice.

The Impact of eHealth Interventions on the Improvement of Self-Care in Chronic Patients: An Overview of Systematic Reviews

Promoting self-care is one of the most promising strategies for managing chronic conditions. This overview aimed to investigate the effectiveness of eHealth interventions at improving self-care in patients with type-2 diabetes mellitus, cardiovascular disease, and chronic obstructive pulmonary disease when compared to standard care. We carried out a review of systematic reviews on PubMed, Scopus, Cochrane, PsychInfo, and CINAHL. AMSTAR-2 was used for quality appraisal. Eight systematic reviews (six with meta-analysis) were included, involving a total of 41,579 participants. eHealth interventions were categorized into three subgroups: (i) reminders via messaging apps, emails, and apps; (ii) telemonitoring and online operator support; (iii) internet and web-based educational programs. Six systematic reviews showed an improvement in self-care measurements through eHealth interventions, which also led to a better quality of life and clinical outcomes (HbA1C, blood pressure, hospitalization, cholesterol, body weight). This overview provided some implications for practice and research: eHealth is effective in increasing self-care in chronic patients; however, it is required to designate the type of eHealth intervention based on the needed outcome (e.g., implementing telemonitoring to increase self-monitoring of blood pressure). In addition, there is a need to standardize self-care measures through increased use of validated assessment tools.

Development and evaluation of a new questionnaire to assess social cognitive factors of self-management in patients with type 2 diabetes: a psychometric study

Background

Self-care behaviors are essential to control blood sugar and to prevent mortality and complications of diabetes. The evidence suggests that social cognitive factors play a crucial role in adopting self-care behaviors. This study aimed to develop and examine the psychometric properties of the Diabetes Self-Management Questionnaire based on the social cognitive theory (DSMQ-SCT).

Methods

The present methodological cross-sectional study investigated 460 patients with T2DM referred to the Isfahan Endocrine and Metabolism Research Centre, Isfahan, Iran using the convenience sampling method. We assessed the reliability (internal consistency), content validity, convergent validity and construct validity. Construct validity was evaluated using exploratory factor analysis (calibration sample = 230) and confirmatory factor analysis (validation sample = 230).

Results

In the EFA with the varimax rotation, we extracted four factors that could explain 65.9% of the total variance of the DSMQ-SCT scale. The CFA exhibited a satisfactory fit level for the four-factor structure extracted from the EFA with the following measures. CFI: .971, IFI: .971, NFI: .942, TLI: .966, RMSEA: .046).Internal consistency was good (Cronbach's alpha coefficient for the whole scale: 0.88; the subscales: 0.85 to 0.92). The convergent validity showed significant negative correlations between DSMQ-SCT subscales and HbA1c.

Conclusion

DSMQ-SCT is a valid and reliable instrument to assess social cognitive factors associated with self-management behaviors in patients with T2DM. Therefore, this instrument can be used in both future research and clinical practices.

A Self-Report Measure of Diabetes Self-Management for Type 1 and Type 2 Diabetes: The Diabetes Self-Management Questionnaire-Revised (DSMQ-R) – Clinimetric Evidence From Five Studies

Aims

Measurement tools to evaluate self-management behavior are useful for diabetes research and clinical practice. The Diabetes Self-Management Questionnaire (DSMQ) was introduced in 2013 and has become a widely used tool. This article presents a revised and updated version, DSMQ-R, and evaluates its properties in assessing self-management practices in type 1 diabetes (T1D) and type 2 diabetes (T2D).

Methods

The DSMQ-R is a multidimensional questionnaire with 27 items regarding essential self-management practices for T1D and T2D (including diabetes-adjusted eating, glucose testing/monitoring, medication taking, physical activity and cooperation with the diabetes team). For the revised form, the original items were partially amended and the wording was updated; eleven items were newly added. The tool was applied as part of health-related surveys in five clinical studies (two cross-sectional, three prospective) including a total of 1,447 people with T1D and T2D. Using this data base, clinimetric properties were rigorously tested.

Results

The analyses showed high internal and retest reliability coefficients for the total scale and moderate to high coefficients for the subscales. Reliability coefficients for scales including the new items were consistently higher. Correlations with convergent criteria and related variables supported validity. Responsiveness was supported by significant short to medium term changes in prospective studies. Significant associations with glycemic outcomes were observed for DSMQ-R-assessed medication taking, glucose monitoring and eating behaviors.

Conclusions

The results support good clinimetric properties of the DSMQ-R. The tool can be useful for research and clinical practice and may facilitate the identification of improvable self-management practices in individuals.

Validity and Reliability of the Korean Version of the Self-Care of Diabetes Inventory (SCODI-K)

This was a methodological study to evaluate the validity and reliability of the Korean version of the Self-Care of Diabetes Inventory (SCODI-K). A total of 210 patients with type 2 diabetes from a university hospital were enrolled. Content validity, construct validity, and criterion-related validity were evaluated. Cronbach's α was used to assess reliability. The SCODI-K consisted of 40 items in four dimensions (self-care maintenance, self-care monitoring, self-care management, and confidence). Four factors (activity-nutritional behavior, health-adherence behavior, health-promotion behavior, diet-restriction behavior) in the dimension of self-care maintenance, two factors (health status monitoring, symptom recognition) in the dimension of self-care monitoring, three factors (glucose self-control, problem-solving behavior, consultative self-care) in the dimension of self-care management, and one factor (self-care confidence) in the dimension of confidence were extracted. Confirmatory factor analysis supported a good fit with reliable scores for the SCODI-K model (normed chi-square(χ²/df) < 5, root mean square error of approximation (RMSEA) < 0.1, comparative fit index (CFI) ≥ 0.9, goodness-of-fit-index (GFI) ≥ 0.9). The SCODI-K showed a high positive correlation coefficient of 0.75 with the summary of diabetes self-care activities (SDSCA), confirming convergent validity. Cronbach's α was 0.92 for the overall scale and 0.69 to 0.90 for the four dimensions. Therefore, the SCODI-K is a valid and reliable instrument for assessing self-care of patients with type 2 diabetes in Korea.

Further Evidence of Psychometric Performance of the Self-care of Diabetes Inventory in Adults With Type 1 and Type 2 Diabetes

BACKGROUND

The Self-care of Diabetes Inventory (SCODI) is a theory-based tool that measures self-care, a key strategy in the appropriate treatment of diabetes. However, despite the clinical differences between people with Type 1 Diabetes Mellitus (T1DM) and Type 2 Diabetes Mellitus (T2DM), the psychometric properties of the SCODI were only tested in mixed samples.

PURPOSE

This study aims to test the psychometric performances of the SCODI in two separate groups of adults with T1DM and T2DM.

METHODS

This is a secondary analysis from two previous multicentre cross-sectional observational studies involving patients with T1DM (n = 181) and T2DM (n = 540). We tested dimensionality with confirmatory factor analysis and reliability with a multidimensional model-based coefficient for every scale of the SCODI: self-care maintenance, self-care monitoring, self-care management, and self-care self-efficacy.

RESULTS

We found that the SCODI showed the same dimensionality, with minimal variation in factor loadings for each factor and each scale among T1DM and T2DM groups. High reliability for each scale in both groups was also found (self-care maintenance: T1DM = 0.86, T2DM = 0.83; self-care monitoring: T1DM = 0.84, T2DM = 1.00; self-care management: T1DM = 0.87, T2DM = 0.86; self-care self-efficacy: T1DM = 0.88; T2DM = 0.86).

CONCLUSION

The SCODI can be used for measuring self-care in people with T1DM, T2DM, or mixed groups using identical scoring procedures. Considering the well-known differences between Type 1 and Type 2 diabetes diseases and patients' characteristics, our results support the generalizability of the self-care theory on which the instrument is based.

Validity and reliability of the Self-Care Activities Screening Scale (SASS-14) during COVID-19 lockdown

BACKGROUND

In a context where there is no treatment for the current COVID-19 virus, the combination of self-care behaviours together with confinement, are strategies to decrease the risk of contagion and remain healthy. However, there are no self-care measures to screen self-care activities in general population and which, could be briefly in a lockdown situation. This research aims to build and validate a psychometric tool to screen self-care activities in general population.

METHODS

Firstly, an exploratory factor analysis was performed in a sample of 226 participants to discover the underlying factorial structure and to reduce the number of items in the original tool into a significant pool of items related to self-care. Later a confirmatory factor analyses were performed in a new sample of 261 participants to test for the fit and goodness of factor solutions. Internal validity, reliability, and convergent validity between its score with perceived stress and psychological well-being measures were examined on this sample.

RESULTS

The exploratory analyses suggested a four-factor solution, corresponding to health consciousness, nutrition and physical activity, sleep, and intra-personal and inter-personal coping skills (14 items). Then, the four-factor structure was confirmed as the best model fit for self-care activities. The tool demonstrated good reliability, predictive validity of individuals' perception of coping with COVID-19 lockdown, and convergent validity with well-being and perceived stress.

CONCLUSIONS

This screening tool could be helpful to address future evaluations and interventions to promote healthy behaviours. Likewise, this tool can be targeted to specific population self-care's needs during a scalable situation.

Application of structural equation modeling in assessing the self-management activities of patients with type 2 diabetes

OBJECTIVE

This study aimed at assessing the self-management activities of type 2 diabetes patients using Structural Equation Modeling (SEM) which measures and analyzes the correlations between observed and latent variables. This statistical modeling technique explored the linear causal relationships among the variables and accounted for the measurement errors.

METHODS

A sample of 200 patients was recruited from the middle-aged population of rural areas of Pakistan to explore the self-management activities of type 2 diabetes patients using the validated version of the Urdu Summary of Diabetes Self-care Activities (U-SDSCA) instrument. The structural modeling equations of self-management of diabetes were developed and used to analyze the variation in glycemic control (HbA1c).

RESULTS

The validated version of U-SDSCA instrument showed acceptable psychometric properties throughout a consecutive reliability and validity evaluation including: split-half reliability coefficient 0.90, test-retest reliability (r = 0.918, P ≤ .001), intra-class coefficient (0.912) and Cronbach's alpha (0.79). The results of the analysis were statistically significant (α = 0.05, P-value < .001), and showed that the model was very well fitted with the data, satisfying all the parameters of the model related to confirmatory factor analysis with chi-squared = 48.9, CFI = 0.94, TLI = 0.95, RMSEA = 0.065, SPMR = 0.068. The model was further improved once the items related to special diet were removed from the analysis, chi-squared value (30.895), model fit indices (CFI = 0.98, TLI = 0.989, RMSEA = 0.045, SPMR = 0.048). A negative correlation was observed between diabetes self-management and the variable HbA1c (r = -0.47; P < .001).

CONCLUSIONS

The Urdu Summary of Diabetes Self-Care Activities (U-SDSCA) instrument was used for the patients of type 2 diabetes to assess their diabetes self-management activities. The structural equation models of self-management showed a very good fit to the data and provided excellent results which may be used in future for clinical assessments of patients with suboptimal diabetes outcomes or research on factors affecting the associations between self-management activities and glycemic control.

A systematic review of self-care measures for adolescents with health needs

PURPOSE

The current study sought to review instruments measuring self-care for adolescents with health needs to provide a summary of the tools available for conducting self-care research in this population.

METHOD

Studies were mainly identified through searches in three electronic bibliographic databases (i.e., PsycINFO, CINAHL, and PubMed) and additional sources to retrieve relevant articles. Studies were included if they focused on self-care measures, included samples of adolescents (ages 10-19), were published in English peer-reviewed journals, dissertations, and from the years 1980 through 2020. The COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN) was used to assess the methodological quality of each study and evaluate the measurement quality based on available studies.

RESULTS

A total of ten scales from 12 papers were identified to meet the search criteria and designed for adolescent patients with three types of health needs, including diabetes, cystic fibrosis, and others (female care and nutrition). There is a lack of a clear and comprehensive definition of self-care for different health needs. The dominant focus of the scales was the behavioral aspect of self-care (e.g., adherence to medication regimen), with only a few scales (e.g., female care) assessing the psychological aspect of self-care. The quality of the psychometric properties of the scales varied greatly.

CONCLUSIONS

Results highlighted the need for more research on developing and validating self-care measures for adolescents with health needs. The unique developmental characteristics of adolescents should be adequately considered, and the psychological aspect of self-care should be incorporated in measurement development.

How do self-care maintenance, self-care monitoring, and self-care management affect glycated haemoglobin in adults with type 2 diabetes? A multicentre observational study

PURPOSE

To evaluate how self-care maintenance, self-care monitoring, and self-care management affect glycated haemoglobin in type 2 diabetes mellitus patients and to set cut-off points of the Self-Care of Diabetes Inventory scales using glycated haemoglobin as outcome of interest.

METHODS

A secondary analysis of a previous multicentre observational cross-sectional study was conducted. Overall, 540 adults with type 2 diabetes mellitus confirmed diagnosis were involved. Socio-demographic and clinical data were collected. Self-care maintenance, self-care monitoring, and self-care management were measured by the Self-Care of Diabetes Inventory. Linear regression models were performed to assess the relationship between self-care maintenance, self-care monitoring, and self-care management and glycated haemoglobin. Receiver operating characteristics curves were carried out to identify the best cut-off score for each self-care scale considering glycated haemoglobin >7% as outcome of interest.

RESULTS

Self-care monitoring and self-care management were associated to glycated haemoglobin in both patients without (self-care monitoring p = 0.0008; self-care management p = 0.0178) and with insulin therapy (self-care monitoring p = 0.0007; self-care management p = 0.0224). Self-care maintenance was associated to glycated haemoglobin in patients without insulin therapy (p = 0.0118). Cut-off scores providing the best performance were 70 points for self-care maintenance and self-care monitoring, and 60 points for self-care management.

CONCLUSIONS

Self-care maintenance, self-care monitoring, and self-care management differently affect glycated haemoglobin in patients with type 2 diabetes mellitus. Clinicians could implement tailored interventions to improve glycaemic control considering the lacking area of self-care.

A New Self-management Scale with a Hierarchical Structure for Patients with Type 2 Diabetes

PURPOSE

The aims of this study were to develop a new instrument for measuring self-management with a hierarchical structure [the Diabetes Self-Management Scale (DSMS)] in patients with type 2 diabetes, and evaluate its psychometric properties.

METHOD

The DSMS instrument was developed in three phases: (1) conceptualization and item generation; (2) content validity and pilot testing; and (3) field testing of its psychometric properties. A convenience sample of 473 participants was recruited in three university hospitals and one regional health center, South Korea.

RESULTS

Exploratory and confirmatory factor analyses yielded two second-order component models explaining the common variance among six first-order factors. Principal axis factoring with a varimax rotation accounted for 60.88% of the variance. Confirmatory factor analysis of the hierarchical structure revealed the following fit indices: χ²/df = 1.373, standardized root-mean-square residual = .050, goodness-of-fit index = .935, incremental fit index = .975, comparative fit index = .974, and root-mean-square error of approximation = .039. All Cronbach' α values for internal consistency exceeded the criterion of .70. All of the intraclass correlation coefficients for test-retest reliability exceeded .70 except that for the taking-medication subscale. The components of the DSMS were moderately correlated with the comparator measures of self-efficacy and health literacy administered for convergent validity.

CONCLUSION

The DSMS is a new instrument for measuring the complex nature of self-management in patients with type 2 diabetes, comprising 17 items scored on a five-point Likert scale. The DSMS exhibits satisfactory psychometric properties for five reliability and validity metrics, and so is a suitable instrument to apply in both research and clinical practices.

The Summary of an Urdu Version of Diabetes Self-Care Activities Measure: Psychometric Evaluation and Validation

Objective: The English version of the Summary of Diabetes Self-Care Activities (SDSCA) measure is the most frequently used self-reporting instrument assessing diabetes self-management. This study is aimed at translating English SDSCA into the Urdu version and validating and evaluating its psychometric properties. Methods: The Urdu version of SDSCA was developed based on the guidelines provided by the World Health Organization for translation and adaptation of instruments. The panel of experts examined the content validity, reliability, and internal consistency of the instrument. The translation process from the English version to the Urdu version revealed excellent results at all the stages. Results: The instrument showed promising and acceptable results. Of particular mention are the results related to split-half reliability coefficient 0.90, test-retest reliability (r = 0.918, P < .001), intraclass coefficient (0.912), and Cronbach’s alpha (.79). The factor analysis (exploratory and confirmatory) was not performed in this study due to the small sample size (n = 30) as the objective was to validate the Urdu version of the SDSCA instrument. Conclusions: This study provided evidence for the reliability and validity of the Urdu Summary of Diabetes Self-Care Activities (U-SDSCA) instrument, which may be used in the future for the patients of diabetes in order to assess type 2 diabetes self-management activities in the rural area of Pakistan and other Urdu-speaking countries.

The effectiveness of partnership models in clinical nursing education - A scoping review

OBJECTIVES

To examine the effectiveness of partnership models in clinical nursing education with regards to cost effectiveness; student employability, work-readiness, confidence, and competence; and stakeholders' satisfaction.

DESIGN

Scoping review.

DATA SOURCES

Research studies published in English were searched electronically through EbscoHost (CINAHL and ERIC), Scopus, Medline (via Ovid), ProQuest Central, and Web of Science databases. Criteria were developed to guide the selection of original studies published in English before 2019 for review.

REVIEW METHODS

Arksey and Malley's framework (2005) and relevant enhancements guided the conduct of the review. An informal appraisal of selected studies was applied.

RESULTS

Two theses and 31 articles with a variation in methodologies, methods, sample sizes, research populations and quality of evidence were included for review. Four themes were identified: (i) Description of partnership models in clinical education, (ii) length of model implementation prior to evaluation, (iii) positive qualitative findings, and (iv) quantitative findings limited by data collection periods and methods.

CONCLUSIONS

Shared among the reviewed studies is stakeholder view of the positive impacts of partnership models on the clinical learning environment, and the increased level of support and individualised instruction for students. However, the use of not fully validated survey instruments and the lack of description about the implementation period before evaluation in many reviewed studies limit the interpretation of quantifiable effect of the partnership models. This review identifies a lack of attention on student employability, work-readiness, cost evaluation, patient perspective, and partnership models in low-income countries. Future research to address these knowledge gaps using high quality data collection methods and rigorous research design is warranted.

Measuring patient empowerment - A systematic review

OBJECTIVE

The purpose of this systematic review was to identify generic instruments measuring patient empowerment and related concepts and analyse the main content and psychometric properties of these instruments.

METHODS

A systematic search was conducted using empowerment and related concepts (enablement, activation, engagement, perceived control) as search terms. The main content of the instruments was analysed by classifying the subscales and items of the elements of empowerment into patient's capacities, patient's knowledge, patient's behaviour and support by others. Psychometric properties were analysed with the criteria of Terwee and colleagues (2007).

RESULTS

Thirteen instruments were identified; and out of them, five instruments covered all the four elements used to define of empowerment. Psychometric properties were variable; none of the instruments contained all the evaluated psychometric properties.

CONCLUSION

There are generic instruments measuring empowerment and its related concepts. The instruments were heterogeneous in structure and psychometric properties. Empowerment is more wide-ranging and multidimensional than its related concepts.

PRACTICE IMPLICATIONS

This review provides knowledge for healthcare professionals and researchers who want to support or evaluate patients' empowerment. With a generic instrument, it is possible to obtain comparable information from diverse patient groups. Further testing of psychometric properties of each instrument is recommended.

Polish Adaptation of the Self-Care of Diabetes Inventory (SCODI)

PURPOSE

As the guidelines indicate, education and self-care in diabetic patients are essential elements in the treatment process. The efficient evaluation of the level of self-care will enable the patient's needs to be identified and education and care to be optimised. The Self-Care of Diabetes Inventory (SCODI) is a valid and reliable tool which can measure self-care behaviours among patients with diabetes. The purpose of this study was to assess the reliability of the Polish version of the SCODI.

METHODS

The World Health Organization (WHO) translation protocol was used for the translation and cultural adaptation of the English version of the SCODI into Polish. The study included 276 Polish patients with type 2 diabetes (mean age 61.28±12.02 years). There were 145 men and 131 women in the study. The internal consistency of the SCODI was evaluated using Cronbach's Alpha.

RESULTS

The original four actor tool structure was confirmed. The mean overall levels of self-care in the four SCODI scales in the study group were self-care maintenance (67.66 pts; SD=18.55), self-care monitoring (61.81 pts; SD=24.94), self-care management (54.65 pts; SD=22.98) and self-care confidence (62.86 pts; SD=20.87). The item-total correlations were positive, so there is no need to change the scales of any of the questions. The overall consistencies for individual scales were assessed using Cronbach's Alpha: self-care maintenance (0.759), self-care monitoring (0.741), self-care management (0.695) and self-care confidence (0.932). Exploratory factor analysis and item factor loadings of the individual items ranged from 0.137 to 0.886 and, with two exceptions (questions number 23 and 32), were statistically significant (p<0.05).

CONCLUSION

The SCODI questionnaire has acceptable internal consistency and reliability in assessing self-care among diabetic patients in the Polish population. This reliable research tool can be managed in planned studies of Polish patients with diabetes.

STRATEGIES TO EDUCATE YOUNG PEOPLE WITH TYPE 1 DIABETES MELLITUS ON INSULIN THERAPY: SYSTEMATIC REVIEW

ABSTRACT Objective: to identify evidence available in the literature on educational strategies used in the teaching of insulin therapy to children and adolescents with Type 1 diabetes mellitus. Method: systematic review undertaken in five databases, using the descriptors Insulin/therapeutic use, Patient education as topic, Diabetes mellitus type 1, Child, Infant, Adolescent and keywords, without any time limit. Primary studies on insulin therapy teaching were included, while research on insulin pumps was excluded. Results: 243 studies were identified, 13 of which were included. The results present educational strategies focused on children, adolescents and young people of up to 24 years of age, applied individually or in groups; by telephone contact or text messages by mobile phone; dramatization and educational camps; by a single professional or a multidisciplinary team. The strategies described in the analyzed studies addressed the adjustment of insulin dosages in everyday situations and education for insulin management, associated with the nutritional strategy of carbohydrate counting, diabetes education with a specific module on insulin therapy and intensive insulin use. The studies analyzed the effect of the educational intervention on several clinical and behavioral outcomes, such as glycated hemoglobin and self-efficacy. Conclusion: this review could not identify a single educational strategy able to improve metabolic and psychosocial outcomes. In most cases, nurses are the professionals responsible for the development of educational strategies focused on insulin therapy in children and adolescents with diabetes, regardless of the context in which they will be deployed. This confirms their role as educators.

Self-care in People with Type 2 Diabetes Mellitus Research Protocol of a Multicenter Mixed Methods Study (SCUDO)

About 11% of the adult global populations is estimated to be living with type 2 diabetes mellitus (T2DM) by 2040. T2DM requires people to make decisions regarding complex therapeutic regimes, to maintain their well-being and quality of life, to manage symptoms and to reduce disease complications. All these behaviours, requiring knowledge, motivation, experience, and skills, have been referred to the concept of self-care. The intricacy and multidimensionality of T2DM self-care requires a complex approach to its overall comprehension. This Embedded Mixed Method study aims to investigate the experience of self-care in Type 2 Diabetes Mellitus adult patients. It comprises a prospective observational design, and an interpretive description. Quantitative data will be collected with validated questionnaires from 300 patients at baseline and once a year for two years on: diabetes self-care, quality of life, diabetes related distress, and sleep quality. Socio-demographic and clinical data will be collected from medical records. Qualitative data will be collected using semi-structured interviews on circa 10-20 patients, at baseline and once a year for two years, analysed according to interpretive description. Quantitative and qualitative data will be analysed separately and then merged and interpreted. This study will expand our understanding of self-care in people with T2DM. The expected outcome will be a better understanding of the effect of self-care on glycaemic control and therefore clinical outcomes and costs.

Psychometric Evaluation of the Farsi Version of the Self-Care of Diabetes Inventory in Iranian Patients with Diabetes

BACKGROUND

Lifelong self-care is important in particular for patients with diabetes, because preventing diabetes complications can help maintain the quality of life and independence of diabetic patients. Currently, there are 16 self-care tools, the majority of which focus on one part of self-care. Therefore, the aim of this study was to evaluate the psychometric properties of the Farsi Self-Care of Diabetes Inventory (F-SCODI) in Iran.

METHODS

A cross-sectional study was performed on 400 diabetic patients who were selected by convenience sampling to complete the F-SCODI. In this regard, construct validity was assessed using exploratory factor analysis. Additionally, the internal consistency of the F-SCODI was evaluated by McDonald's omega coefficient and Cronbach's alpha; whereas its stability was assessed by a test re-test approach.

RESULTS

In total, four factors were extracted (activity-nutritional behavior, smoking avoidance behavior, illness-related behaviors, and health-promoting behaviors) in the dimension of self-care maintenance, three factors (symptom monitoring, symptom assessment, and symptom recognition) in the dimension of self-care monitoring, two factors (autonomous self-care and consultative self-care) in the self-care management dimension, and two factors (task-specific self-care confidence and persistence self-care) in the dimension of confidence. In this regard, the overall consistencies of the four dimensions were 0.809, 0.767, 0.590, and 0.886, respectively.

CONCLUSION

This study indicated that the Farsi version of SCODI had acceptable internal consistency and reliability as well as content and construct validity. Given the acceptable psychometric properties, this tool can be used in future studies in Iranian patients with diabetes.

Patient-reported outcome measures for diabetes self-care: A systematic review of measurement properties

OBJECTIVES

The aims of the present systematic review were to identify currently available patient-reported outcome measures for diabetes self-care that have been psychometrically evaluated and to evaluate their measurement properties.

DESIGN

A systematic literature review with a meta-analysis.

DATA SOURCES

A systematic literature search was conducted of the MEDLINE, EMBASE, and CINAHL databases.

REVIEW METHODS

The updated COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) was applied using the following steps to evaluate the measurement properties of the diabetes self-care measures: (1) evaluating the methodological quality, (2) evaluating either quantitatively summarized or quantitatively pooled data against criteria for good measurement properties, and (3) the evaluating the quality of evidence by applying the modified Grading of Recommendations Assessment, Development, and Evaluation approach.

RESULTS

Among 8434 articles yielded by the database search, 27 full-text articles that reported 34 studies of 13 different patient-reported outcome measures were included in this systematic review. The Diabetes Self-Management Instrument demonstrated the best content validity, with sufficient moderate-quality evidence for relevance, comprehensiveness, and comprehensibility. The Diabetes Self-Management Instrument exhibited sufficient moderate-quality evidence for structural validity and internal consistency, and sufficient high-quality evidence for convergent validity of hypothesis testing and sufficient low-quality evidence for reliability. The eight-item Summary of Diabetes Self-Care Activities-Revised was the most frequently investigated and shortest instrument with sufficient high-quality evidence for structural validity and internal consistency. However, the sufficient but very-low-quality comprehensiveness and the inconsistent very-low-quality comprehensibility for content validity, and the insufficient low-quality evidence for reliability must be considered when selecting this instrument.

CONCLUSIONS

None of the identified diabetes self-care instruments appears to be universally superior to the others. The Diabetes Self-Management Instrument might be the best based on current evidence, but this requires further evaluation of the measurement of invariance across languages. The eight-item Summary of Diabetes Self-Care Activities-Revised is the shortest instrument, but current evidence with regards to its content validity and reliability needs to be considered before applying this instrument. Further studies are recommended to evaluate the reliability, measurement error, and responsiveness of the diabetes self-care measurements.

Optimizing Diabetes Self-management Using the Novel Skills, Confidence, and Preparedness Index (SCPI)

OBJECTIVE

The Skills, Confidence, and Preparedness Index (SCPI) is an electronic tool designed to assess three dimensions (knowledge, confidence, and preparedness) in a clinically relevant measure with immediate feedback to guide the individualization of patient education. This study sought to assess the validity and reliability of the final SCPI generation, its relevance to glycemia, and its responsiveness to patient education.

RESEARCH DESIGN AND METHODS

In Part 1, patients with type 1 and type 2 diabetes were recruited from specialist clinics over a 6-month period and completed the 23-item SCPI using a tablet. In Part 2, participants also underwent a diabetes self-management education (DSME) program. Baseline SCPI score was used to guide the DSME, and SCPI and glycemia were assessed at completion.

RESULTS

In total, 423 patients met inclusion criteria and 405 had evaluable data. SCPI scores were found to have a high degree of validity, internal consistency, and test-retest reliability, with no floor or ceiling effects. Scoring was negatively correlated with HbA_1c (type 1 diabetes: r = -0.26, P = 0.001; type 2 diabetes: r = -0.20, P = 0.004). In 51 participants who underwent a DSME intervention (6.4 ± 0.6 visits over a mean ± SD 3.4 ± 0.8 months), mean HbA_1c improvement was 1.2 ± 0.2% (13.1 ± 2.2 mmol/mol, P < 0.0001). Total SCPI score and each subscore improved in parallel.

CONCLUSIONS

The SCPI tool is a quick and easy-to-use measurement of three domains: skills, confidence, and preparedness. The instant scoring and feedback and its relationship to glycemic control should improve the efficiency and quality of individualizing care in the diabetes clinic.

Development and Psychometric Validation of an Instrument to Identify Barriers to Self-Care Among Spanish Patients With Type 2 Diabetes on the Basis of Theory of Planned Behavior

BACKGROUND

Several instruments are available to evaluate barriers to self-care in people with type 2 diabetes, but with significant psychometric weaknesses and poor theoretical background.

OBJECTIVES

To develop and psychometrically validate a questionnaire to identify barriers to self-care in this population on the basis of the theory of planned behavior.

METHODS

The study was carried out in 15 primary healthcare centers belonging to the Public Health Care System in Andalusia (Spain). After content validity was confirmed, an initial pilot study was undertaken (n = 54) and the model was evaluated in 2 samples of 205 subjects each to test its configural and metric invariance by confirmatory factor analysis. Internal consistency, test-retest reliability, criterion validity, and interpretability were carried out following COSMIN standards.

RESULTS

A 4-factor instrument (intention, subjective norms, perceived control, and attitudes) with 15 items was obtained with a good fit: goodness-of-fit index = 0.92, comparative fit index = 0.93, and root mean square error of approximation = 0.043 (90% confidence interval 0.034-0.052). Cronbach α was 0.78, and test-retest reliability was adequate (intraclass correlation coefficient 0.73; P < .0001). The instrument revealed an adequate criterion validity depending on the treatment complexity and level of metabolic control. Thus, participants with poor self-care scores were more likely to suffer from diabetes-related complications (odds ratio 1.91; 95% confidence interval 1.15-3.1).

CONCLUSIONS

A theory-driven instrument is suitable for its use with Spanish people with type 2 diabetes to assess their self-care needs and make tailored recommendations for lifestyle modifications on the basis of their behavioral determinants.

Generalizability of the Self-Care of Diabetes Inventory Across Cultures and Languages: Italy and the United States

Measuring self-care behaviors is crucial in diabetes research worldwide. Having a common measure of self-care represents an unmet need limiting the development of the science. The Self-Care of Diabetes Inventory was developed to address limitations of previous tools that were not theoretically grounded, strong in psychometrics, and clinically validated. However, the generalizability and comparability of the Self-Care of Diabetes Inventory has not been tested across cultures and languages. The aim of this study was to test the invariance of the Self-Care of Diabetes Inventory measurement model between Italy and the United States. Data from two multicenter cross-sectional studies were used. Two diabetes clinics and two hospitals in Italy and the United States were involved. We enrolled 200 adults in Italy and 226 in the United States, all with a confirmed diagnosis of type 1 or type 2 diabetes. The Self-Care of Diabetes Inventory was used to measure self-care maintenance, monitoring, and management behaviors as described in the middle range theory of self-care of chronic illness. Configural, metric, scalar, and strict invariance were tested for each scale. Three of the four measurement equivalence levels were supported in the three Self-Care of Diabetes Inventory Scales, whereas strict invariance-the highest level-was reached only by the Self-Care Maintenance and Self-Care Monitoring Scales. Clear support for the use of the Self-Care of Diabetes Inventory in diabetes research was provided. Cross-national comparisons of self-care between groups of Italian and U.S. patients are supported, based on the invariance of the measurement model. Aggregation of research data obtained using the Self-Care of Diabetes Inventory across countries could support knowledge development in the field of diabetes self-care.

Clinical and socio-demographic determinants of inadequate self-care in adults with type 1 diabetes mellitus: the leading role of self-care confidence

AIMS

To describe self-care maintenance, monitoring, and management behaviors in adults with type 1 diabetes (T1DM), and to identify clinical and socio-demographic determinants of inadequate self-care.

METHODS

A cross-sectional study was conducted in two diabetes outpatient clinics in Italy. Clinical and socio-demographic characteristics were collected from the medical records of 181 consecutively enrolled T1DM patients. The Self-Care of Diabetes Inventory was used to measure self-care maintenance, self-care monitoring, self-care management and self-care confidence. A standardized 0-100 score was used for each self-care dimension. A score < 70 was considered inadequate self-care. Three multiple logistic regression models were run to find determinants of inadequate self-care maintenance, monitoring, and management.

RESULTS

The majority of patients had adequate self-care maintenance (74%; n = 134), self-care monitoring (68.5%; n = 124) and self-care confidence (87.3%; n = 158), while self-care management was adequate for only a minority (34.8%; n = 63). The odds of inadequate self-care maintenance increased by 4.5 times when self-care confidence was inadequate (OR adjusted 4.589; 95% CI 1.611-13.071; p = 0.004). The odds of inadequate self-care monitoring increased four times when patients had inadequate self-care confidence (OR adjusted 4.116; 95% CI 1.457-11.628; p = 0.008). Inadequate self-care confidence increased the odds of performing inadequate self-care management more than five times (OR adjusted 5.313; 95% CI 1.143-24.686; p = 0.033).

CONCLUSIONS

Self-care management is commonly inadequate in adults with T1DM. Self-care confidence is the most important determinant of self-care behaviors in this population. Educational interventions are recommended to improve self-care confidence in adults with T1DM.

Patient-Reported Outcome Measures for Patients with Diabetes Mellitus Associated with Foot and Ankle Pathologies: A Systematic Review

Background: Diabetes mellitus (DM) is a chronic and complex disease, which is a major cause of morbidity and mortality and affects all age groups. It commonly produces secondary effects on the foot, often making daily activities impossible. Patient-reported outcome measures (PROMs) provide a standardised method of obtaining patients’ outlooks on their functional status and wellbeing. Although many instruments have been proposed for obtaining data on persons with DM whose feet are affected by the disease, in many cases the psychometric properties of the instrument have yet to be established. The principal objective of our review was to identify PROMs specific for patients with DM affecting the foot and ankle and to evaluate the psychometric properties and methodological quality of these instruments. Methods: In this systematic review, we investigate studies (published in English or Spanish) based on the use of one or more PROMs specific to foot and ankle pathologies for patients with DM (type I or II). To do so, the databases PubMed, Scopus, CINAHL, PEDro and Google Scholar were searched for studies that analysed psychometric or clinimetric properties in this respect. These were assessed according to Terwee or COSMIN criteria. Results: Of the 1016 studies identified in the initial search, only 11 were finally included in the qualitative review. Analysis according to Terwee and COSMIN criteria showed that the Foot Health Status Questionnaire (FHSQ) presented the greatest number of positive values. Conclusions: The FHSQ is the highest-quality PROM currently available for the foot and ankle, for patients with DM.

Socio-demographic and clinical determinants of self-care in adults with type 2 diabetes: a multicentre observational study

AIMS

To describe self-care as defined by the Middle Range Theory of Self-Care of Chronic Illness and to identify clinical and socio-demographic determinants in a T2DM population.

METHODS

A multicentre observational cross-sectional study was conducted involving 540 adults with a confirmed diagnosis of T2DM from six outpatient diabetes services in Italy. Socio-demographic and clinical data were collected from medical records. The Self-Care of Diabetes Inventory (SCODI) was used to measure self-care maintenance, monitoring, management, and confidence dimensions. For each separate scale, scores were standardized 0-100 with higher SCODI scores indicating better self-care; a score ≥ 70 is adequate. Multiple quantile regression models were performed to identify determinants of each self-care dimension.

RESULTS

Self-care maintenance (median = 81.3) and self-care confidence (median = 79.5) were adequate in most of the subjects. Self-care monitoring was adequate in only half of the sample (median = 70.6). Self-care management was poor (median = 59.4). Lower self-care maintenance was associated with lower self-care confidence (p < 0.001). Lower self-care monitoring was associated with being male (p < 0.001), having lower self-care confidence (p < 001), and having diabetes for < 10 years (p < 0.001). Lower self-care management was associated with being male (p = 0.002), being older (p = 0.005), having a low income (p = 0.030), being employed (p = 0.008), having missed diabetes education in the last year (p = 0.002), and lower self-care confidence (p < 0.0001). Lower self-care confidence was associated with having diabetes for < 10 years (p = 0.008), and having at least one comorbid condition (p = 0.006).

CONCLUSIONS

Determinants of self-care maintenance, monitoring, management and confidence include both clinical and socio-demographic variables. Modifiable determinants such as self-care confidence and diabetes self-care management education could be used to tailor interventions to improve diabetes self-care.

What we know about the purpose, theoretical foundation, scope and dimensionality of existing self-management measurement tools: A scoping review

OBJECTIVES

To identify self-report, self-management measures for adults with chronic conditions, and describe their purpose, theoretical foundation, dimensionality (multi versus uni), and scope (generic versus condition specific).

METHODS

A search of four databases (8479 articles) resulted in a scoping review of 28 self-management measures.

RESULTS

Although authors identified tools as measures of self-management, wide variation in constructs measured, purpose, and theoretical foundations existed. Subscales on 13 multidimensional tools collectively measure domains of self-management relevant to clients, however no one tool's subscales cover all domains.

CONCLUSIONS

Viewing self-management as a complex, multidimensional whole, demonstrated that existing measures assess different, related aspects of self-management. Activities and social roles, though important to patients, are rarely measured. Measures with capacity to quantify and distinguish aspects of self-management may promote tailored patient care.

PRACTICE IMPLICATIONS

In selecting tools for research or assessment, the reason for development, definitions, and theories underpinning the measure should be scrutinized. Our ability to measure self-management must be rigorously mapped to provide comprehensive and system-wide care for clients with chronic conditions. Viewing self-management as a complex whole will help practitioners to understand the patient perspective and their contribution in supporting each individual patient.

Assessment of self-management in patients with diabetes using the novel LMC Skills, Confidence and Preparedness Index (SCPI)

AIMS

The LMC Skills, Confidence & Preparedness Index (SCPI) is an electronic tool designed to meet ISOQOL standards and (a) assess three dimensions: knowledge, confidence and preparedness; (b) provide a clinically meaningful measure; (c) provide immediate feedback to the healthcare provider. Internal consistency and external validity have been previously reported in a refractory diabetes cohort. This larger evaluation, broader in glycemic control, sought to assess clinical relevance to glycemia.

METHODS

Participants with type 1 and type 2 diabetes were recruited from LMC Diabetes and Endocrinology specialist clinics, from April to October 2016. Participants completed the SCPI using a tablet. Demographic and laboratory data were extracted from the LMC Diabetes Patient Registry.

RESULTS

In total, 529 patients met inclusion criteria and were included in psychometric analyses; 518 patients with established diabetes (>6 months) were assessed for SCPI - glycemia correlations. SCPI scores were found to have a high degree of validity, internal consistency, and test-retest reliability. Most importantly, the tool showed good external validity in its relation to glycemic control, both in tertile analysis, demonstrating a threshold effect consistent with a 'moderate' degree of poor control; and in overall correlation with HbA1c for the total SCPI score and two subscales (Skills and Confidence).

CONCLUSIONS

The SCPI tool is a quick (25 items), easy to use measure of three domains - knowledge, confidence and preparedness. The instant scoring and specific feedback, as well as the relationship to glycemic control should provide significant value in the patient assessment in the diabetes clinic.

Development and psychometric testing of a theory-based tool to measure self-care in diabetes patients: the Self-Care of Diabetes Inventory

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.

Instruments to assess self-care among healthy children: A systematic review of measurement properties

AIM

To identify, critically appraise and summarize the measurement properties of instruments to assess self-care in healthy children.

BACKGROUND

Assessing self-care is a proper consideration for nursing practice and nursing research. No systematic review summarizes instruments of measurement validated in healthy children.

DESIGN

Psychometric review in accordance with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) panel.

DATA SOURCES

MEDLINE, CINAHL, PsycINFO, Web of Science and Open Grey were searched from their inception to December 2016.

REVIEW METHODS

Validation studies with a healthy child population were included. Search was not restricted by language. Two reviewers independently assessed the methodological quality of included studies using the COSMIN checklist.

RESULTS

Eleven studies were included in the review assessing the measurement properties of ten instruments. There was a maximum of two studies per instrument. None of the studies evaluated the properties of test-retest reliability, measurement error, criterion validity and responsiveness. Internal consistency and structural validity were rated as "excellent" or "good" in four studies. Four studies were rated as "excellent" in content validity. Cross-cultural validity was rated as "poor" in the two studies (three instruments) which cultural adaptation was carried out.

CONCLUSION

The evidence available does not allow firm conclusions about the instruments identified in terms of reliability and validity. Future research should focus on generate evidence about a wider range of measurement properties of these instruments using a rigorous methodology, as well as instrument testing on different countries and child population.

Construction and validation of the Self-care Assessment Instrument for patients with type 2 diabetes mellitus

Objective:

to construct and validate the contents of the Self-care Assessment instrument for patients with type 2 diabetes mellitus.

Method:

methodological study, based on Orem's General Theory of Nursing. The empirical categories and the items of the instrument were elucidated through a focus group. The content validation process was performed by seven specialists and the semantic analysis by 14 patients. The Content Validity Indices of the items, ≥0.78, and of the scale, ≥0.90, were considered excellent.

Results:

the instrument contains 131 items in six dimensions corresponding to the health deviation self-care requisites. Regarding the maintenance, a Content Validity Index of 0.98 was obtained for the full set of items, and, regarding the relevance, Content Validity Indices ≥0.80 were obtained for the majority of the assessed psychometric criteria.

Conclusion:

the instrument showed evidence of content validity.

The association of minor and major depression with health problem-solving and diabetes self-care activities in a clinic-based population of adults with type 2 diabetes mellitus

AIMS

We examined whether problem-solving and diabetes self-management behaviors differ by depression diagnosis - major depressive disorder (MDD) and minor depressive disorder (MinDD) - in adults with Type 2 diabetes (T2DM).

METHODS

We screened a clinical sample of 702 adults with T2DM for depression, identified 52 positive and a sample of 51 negative individuals, and performed a structured diagnostic psychiatric interview. MDD (n=24), MinDD (n=17), and no depression (n=62) were diagnosed using Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) Text Revised criteria. Health Problem-Solving Scale (HPSS) and Summary of Diabetes Self-Care Activities (SDSCA) questionnaires determined problem-solving and T2DM self-management skills, respectively. We compared HPSS and SDSCA scores by depression diagnosis, adjusting for age, sex, race, and diabetes duration, using linear regression.

RESULTS

Total HPSS scores for MDD (β=-4.38; p<0.001) and MinDD (β=-2.77; p<0.01) were lower than no depression. Total SDSCA score for MDD (β=-10.1; p<0.01) was lower than for no depression, and was partially explained by total HPSS.

CONCLUSION

MinDD and MDD individuals with T2DM have impaired problem-solving ability. MDD individuals had impaired diabetes self-management, partially explained by impaired problem-solving. Future studies should assess problem-solving therapy to treat T2DM and MinDD and integrated problem-solving with diabetes self-management for those with T2DM and MDD.

Systematic review of measurement properties of self-reported instruments for evaluating self-care in adults

AIMS

The aims of this study were as follows: to identify instruments developed to assess self-care in healthy adults; to determine the theory on which they were based; their validity and reliability properties and to synthesize the evidence on their measurement properties.

BACKGROUND

Many instruments have been developed to assess self-care in many different populations and conditions. Clinicians and researchers should select the most appropriate self-care instrument based on the knowledge of their measurement properties.

DESIGN

Systematic review of measurement instruments according to the protocol recommended by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) panel.

DATA SOURCES

PubMed, Embase, PsycINFO, Scopus and CINAHL databases were searched from inception to December 2015.

REVIEW METHODS

Studies testing measurement properties of self-report instruments assessing self-care in healthy adults, published in the English language and in peer review journals were selected. Two reviewers independently appraised the methodological quality of the studies with the COSMIN checklist and the quality of results using specific quality criteria.

RESULTS

Twenty-six articles were included in the review testing the measurement properties of nine instruments. Seven instruments were based on Orem's Self-care theory. Not all the measurement properties were evaluated for the identified instruments. No self-care instrument showed strong evidence supporting the evaluated measurement properties.

CONCLUSION

Despite the development of several instruments to assess self-care in the adult population, no instrument can be fully recommended to clinical nurses and researchers. Further studies of high methodological quality are needed to confirm the measurement properties of these instruments.

Development of a scale to measure diabetes self-management behaviors among older Koreans with type 2 diabetes, based on the seven domains identified by the American Association of Diabetes Educators

AIM

The purpose of this study was to develop the Diabetes Self-Management Behavior for Older Koreans (DSMB-O). This scale is based on the seven relevant domains that have been identified by the American Association of Diabetes Educators (AADE) and is adjusted for sociocultural and age-related characteristics.

METHODS

Four phases were used to develop of the DSMB-O as a criterion-referenced measure. In phases 1 and 2, the DSMB-O adopted the AADE's seven domains and established a self-report questionnaire using a small number of items that are applicable to older Koreans. In phase 3, the DSMB-O was formulated with 16 preliminary items, including seven subitems. By assessing the content validity, 14 items (including five subitems) were selected. The final phase involved evaluating the DSMB-O's psychometric properties, including test-retest reliability, content validity, and criterion-related validity, using data from 150 older Koreans with type 2 diabetes.

RESULTS

The coefficients of agreement and Cohen's Kappa for the test-retest reliability test ranged from 0.32 to 1.0 and -0.07 to 1.0, respectively. For the content validity, the values of both the item- and scale-level content validity indices were 1.0. The scores from the DSMB-O were positively correlated with the scores from the Korean version of the Summary of Diabetes Self-Care Activities Questionnaire.

CONCLUSION

The DSMB-O is short and easy for older Koreans to use, as well as having acceptable levels of reliability and validity. Hence, the DSMB-O can be a useful tool to evaluate diabetes self-management behaviors in older Koreans with type 2 diabetes.

Psychometric Properties of the Modified Personal Diabetes Questionnaire Among Chinese Patients With Type 2 Diabetes

This study examined the psychometric properties of the Chinese version of the Personal Diabetes Questionnaire (C-PDQ). The PDQ was translated into Chinese using a forward and backward translation approach. After being reviewed by an expert panel, the C-PDQ was administered to a convenience sample of 346 adults with Type 2 diabetes. The Chinese version of the Summary of Diabetes Self-Care Activities (C-SDSCA) was also administered. The results of the exploratory factor analysis revealed a one-factor structure for the Diet Knowledge, Decision-Making, and Eating Problems subscales and a two-factor structure for the barriers-related subscales. The criterion and convergent validity were supported by significant correlations of the subscales of the C-PDQ with the glycated hemoglobin values and the parallel subscales in the C-SDSCA, respectively. The C-PDQ subscales also showed acceptable internal consistency (α = .61-.89) and excellent test-retest reliability (intraclass correlation coefficients: .73-.96). The results provide preliminary support for the reliability and validity of the C-PDQ. This comprehensive, patient-centered instrument could be useful to identify the needs, concerns, and priorities of Chinese patients with type 2 diabetes.

Structural model of self-care agency in patients with diabetes: A path analysis of the Instrument of Diabetes Self-Care Agency and body self-awareness

Aim

The aim of this study was to examine a causal model of self‐care agency by exploring the relationship between the structure of “body self‐awareness” and the structure of the Instrument of Diabetes Self‐Care Agency (IDSCA).

Methods

The participants were 353 patients with diabetes. The internal consistency of the six items for body self‐awareness was examined by calculating the factor structure using principal factor analysis and Cronbach's alpha. In order to examine the relationship between the seven factors in the IDSCA, a path analysis was conducted.

Results

With regard to the factor structure, the factor loading of these five items was 0.511–0.743 (α = 0.739). In the path analysis, “body self‐awareness” was influenced by the “ability to acquire knowledge” and had a direct effect (0.33) on the “motivation to self‐manage”, while “motivation to self‐manage” had an effect (−0.32) on the “ability to self‐manage”. The Goodness‐of‐Fit Index was 0.974.

Conclusion

“Body self‐awareness” plays a part in the self‐care operation process and serves as an intermediary factor to enable the performance of self‐care operations by making the most use of self‐care agency. Moreover, striking a proper balance between self‐management that is focused on the treatment of diabetes and a person's ability for self‐management of diabetes was found to be important.