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Panagiotidis P, Kalokairinou A, Tzavara C, Michailidou A, Velonaki VS. Health Literacy, Self-Efficacy and Glycemic Control in Patients With Diabetes Type 2 in a Greek Population. Cureus 2024; 16:e55691. [PMID: 38586620 PMCID: PMC10997967 DOI: 10.7759/cureus.55691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Aim To investigate the relationship between health literacy (HL), self-efficacy (SE), and achievement of treatment goals in patients with type 2 diabetes mellitus (T2DM). Method The cross-sectional study was conducted with a random sample of patients with T2DM attending the diabetology clinic and the Home Care department of the General Hospital of Drama, Greece. They completed two questionnaires: the short form of the European Health Literacy Survey Questionnaire (HLS-EU-Q16) to measure HL and the Diabetes Management Self-Efficacy Scale (DMSES) for people with T2DM to measure SE. Medical history, demographic characteristics, and values related to glycemic control were also recorded. Linear regression analysis was used to search for the dependence of glycosylated hemoglobin (A1C) values with HL and SE and the dependence between them. Result About 120 patients with T2DM (response rate of 92.3%) were enrolled in the study. The mean age of the participants was 62.5 years [standard deviation (SD) = 10.6 years] and most of them were female (53.3%). A1C was found to be significantly negatively associated with diet, physical activity, and SE score. Also, a statistically significant positive correlation was found between HL and SE. HL was correlated with age, gender, education level, and A1C, with women and older people having lower HL, while conversely higher education level was significantly associated with higher HL. Higher A1C was significantly associated with lower HL. Also, SE partially mediates the relationship between HL and A1C, in a significant way. Conclusion The results of the study confirm the important role of HL and SE in the successful management of T2DM. Multi-level educational interventions for diabetic patients could improve HL and SE and promote diabetes self-management.
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Affiliation(s)
- Panagiotis Panagiotidis
- Nursing, National and Kapodistrian University of Athens, Athens, GRC
- Outpatient Diabetes Clinic, General Hospital of Drama, Drama, GRC
| | | | - Chara Tzavara
- Biostatistician, School of Medicine, National and Kapodistrian University of Athens, Athens, GRC
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Al Hashmi I, Al Yazidi B, Al Omari O. Translation and psychometric validation of the Arabic Gestational Diabetes Management Self-Efficacy Scale (GDMSES). J Healthc Qual Res 2022; 37:231-238. [PMID: 35042678 DOI: 10.1016/j.jhqr.2021.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 11/11/2021] [Accepted: 12/07/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The assessment of self-efficacy for adherence to healthy behaviours among women with gestational diabetes (GDM) is undermined by the unavailability of validated tools. Therefore, this study aimed at translating, culturally adapting and assessing the psychometric properties of the Arabic version of Gestational Diabetes Management Self-Efficacy Scale (GDMSES). MATERIALS AND METHODS This methodological study was conducted in the Antenatal Clinic at Sultan Qaboos University Hospital in Oman between October 2016 and January 2017. A total of 90 forms of the Arabic GDMSES tool were completed by Omani pregnant women with gestational diabetes. The study has a multiphase design: (1) cultural and linguistic validation; (2) content and face validity; (3) construct validity; (4) internal validity. RESULTS The Arabic GDMSES showed satisfactory content validity (CVI between .8 and 1), acceptable overall scale internal consistency reliability (Cronbach's alpha=0.85) and stability overtime (Pearson correlation coefficient>.6). Four factors emerged for construct validity using exploratory factor analysis: nutrition and body weight, adaptation to healthy eating, physical activity and treatment and blood sugar. Our sample size of 90 was considered adequate in determining these factors (Kaiser-Meyer-Olkin=.78). CONCLUSIONS GDMSES is a valid and reliable tool, thus providing a quick and easy self-efficacy assessment tool for antenatal nurses dealing with pregnant women with GDM.
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Affiliation(s)
- I Al Hashmi
- College of Nursing, Sultan Qaboos University, Al Khoudh 66, Muscat 123, Oman.
| | - B Al Yazidi
- College of Nursing, Sultan Qaboos University, Al Khoudh 66, Muscat 123, Oman
| | - O Al Omari
- College of Nursing, Sultan Qaboos University, Al Khoudh 66, Muscat 123, Oman
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Wee PJL, Kwan YH, Loh DHF, Phang JK, Puar TH, Østbye T, Thumboo J, Yoon S, Low LL. Measurement Properties of Patient-Reported Outcome Measures for Diabetes: Systematic Review. J Med Internet Res 2021; 23:e25002. [PMID: 34397387 PMCID: PMC8398743 DOI: 10.2196/25002] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/18/2020] [Accepted: 06/14/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The management of diabetes is complex. There is growing recognition of the use of patient-reported outcome measures (PROMs) as a standardized method of obtaining an outlook on patients' functional status and well-being. However, no systematic reviews have summarized the studies that investigate the measurement properties of diabetes PROMs. OBJECTIVE Our aims were to conduct a systematic review of studies investigating the measurement properties of diabetes PROMs by evaluating the methodological quality and overall level of evidence of these PROMs and to categorize them based on the outcome measures assessed. METHODS This study was guided by the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Relevant articles were retrieved from the Embase, PubMed, and PsychINFO databases. The PROMs were evaluated with the COSMIN (COnsensus-based Standards for the selection of health Measurement Instruments) guidelines. RESULTS A total of 363 articles evaluating the measurement properties of PROMs for diabetes in the adult population were identified, of which 238 unique PROMs from 248 studies reported in 209 articles were validated in the type 2 diabetes population. PROMs with at least a moderate level of evidence for ≥5 of 9 measurement properties include the Chinese version of the Personal Diabetes Questionnaire (C-PDQ), Diabetes Self-Management Instrument Short Form (DSMI-20), and Insulin Treatment Appraisal Scale in Hong Kong primary care patients (C-ITAS-HK), of which the C-PDQ has a "sufficient (+)" rating for >4 measurement properties. A total of 43 PROMs meet the COSMIN guidelines for recommendation for use. CONCLUSIONS This study identified and synthesized evidence for the measurement properties of 238 unique PROMs for patients with type 2 diabetes and categorized the PROMs according to their outcome measures. These findings may assist clinicians and researchers in selecting appropriate high-quality PROMs for clinical practice and research. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020180978; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020180978.
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Affiliation(s)
| | - Yu Heng Kwan
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | | | - Jie Kie Phang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Troy H Puar
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Truls Østbye
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Julian Thumboo
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sungwon Yoon
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Lian Leng Low
- SingHealth Office of Regional Health, Singapore, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
- Post Acute and Continuing Care, Outram Community Hospital, SingHealth Community Hospitals, Singapore, Singapore
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Troncone A, Chianese A, Cascella C, Zanfardino A, Iafusco D. Psychological Outcomes in Children and Early Adolescents With Type 1 Diabetes Following Pediatric Diabetes Summer Camp: A 3-Month Follow-Up Study. Front Pediatr 2021; 9:650201. [PMID: 33777869 PMCID: PMC7987815 DOI: 10.3389/fped.2021.650201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/05/2021] [Indexed: 01/09/2023] Open
Abstract
Objective: The aim of this study was to assess general psychosocial adjustment to diabetes and perceived disease management among patients with type 1 diabetes (T1D) and their parents before and after patients' participation in a diabetes summer camp. Methods: In this follow-up study, 20 children and adolescents with T1D (eight boys; mean age = 11.01 ± 0.94 years; mean diabetes duration = 3.02 ± 2.27) attending a southern Italian diabetic center, along with their parents, were assessed prior to and 3 months after the youths participated in a 1 week camp-based intervention involving didactic and interactive child-centered education and recreational activities. Patients and their parents completed measures assessing patients' quality of life and strategies employed by patients to cope with pain. Patients also completed measures evaluating their diabetes psychosocial adjustment, diabetes self-efficacy management, and illness perception; also, their parents completed measures of caregivers' perceived diabetes burden and treatment satisfaction. Youths' glycated hemoglobin (HbA1c) and standardized body mass index (z-BMI) values were also assessed. Within-subjects repeated-measures analyses of variance evaluated pre- and post-camp changes. Results: Camp attendance showed no beneficial effects on glycemic control, as indicated by HbA1c values both before (7.02%) and after (7.28%) camp being lower than 7.5%. HbA1c values were found to have increased after camp (pre-camp = 7.02%, post-camp = 7.28%; p = 0.010), but since they still fell within an acceptable range, they did not reveal clinically relevant changes in glycemic control. No substantial significant improvement in psychosocial measures was observed in children or parents (all p > 0.05). According to the parents' evaluation, social support-seeking as a patient pain-coping strategy was slightly increased (p = 0.044) after attending the camp. Conclusions: This study does not provide empirical evidence of benefits of participating in a diabetes camp for either patients or their parents. These findings suggest that healthcare providers rethink such camps as an experience for youths with T1D that actively involves parents and that includes both youth- and parent-focused psychological interventions.
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Affiliation(s)
- Alda Troncone
- Department of Psychology, University of Campania "L. Vanvitelli", Caserta, Italy
| | - Antonietta Chianese
- Department of Psychology, University of Campania "L. Vanvitelli", Caserta, Italy
| | - Crescenzo Cascella
- Department of Psychology, University of Campania "L. Vanvitelli", Caserta, Italy
| | - Angela Zanfardino
- Department of the Woman, Child and General and Specialized Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - Dario Iafusco
- Department of the Woman, Child and General and Specialized Surgery, University of Campania "L. Vanvitelli", Naples, Italy
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Lee J, Lee EH, Chae D. Self-efficacy instruments for type 2 diabetes self-care: A systematic review of measurement properties. J Adv Nurs 2020. [PMID: 32400902 DOI: 10.1111/jan.14411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/25/2020] [Accepted: 04/21/2020] [Indexed: 11/29/2022]
Abstract
AIMS To identify currently available self-efficacy instruments for type 2 diabetes self-care and to evaluate the evidence for their measurement properties. DESIGN Systematic review of measurement properties. DATA SOURCES The PubMed, Embase and CINAHL databases were searched from their inception to 27 May 2019. REVIEW METHODS The updated COnsensus-based Standards for the selection of health Measurement INstruments methodology were applied. RESULTS Twelve instruments were identified from 3,665 records. Eight instruments were related to self-efficacy in performing a comprehensive set of the tasks/behaviours for diabetes self-care and the other four addressed specific behaviours related to diabetes self-care, such as insulin management. Most of the 12 instruments were developed based on Bandura's self-efficacy theory as their theoretical background. Overall, sufficient high-quality evidence for measurement properties was seldom identified. The Diabetes Management Self-Efficacy Scale is currently the best instrument, with particularly the 4-factor, 16-item version being demonstrated to have sufficient high-quality evidence for structural and internal consistency and sufficient moderate-quality evidence for reliability and convergent validity. CONCLUSIONS None of the instruments evaluated all of the relevant measurement properties. The Diabetes Management Self-Efficacy Scale is currently the most suitable instrument for potential use in practice and research. The measurement invariance across languages, measurement error and responsiveness of this instrument still need be evaluated. IMPACT This systematic review provides clinicians and researchers with a comprehensive list of available instruments for measuring self-efficacy in diabetes self-care, as well as evidence for helping them to select the most appropriate instrument. Using a psychometrically sound instrument will accurately inform practitioners about the levels of self-efficacy in self-care among patients with type 2 diabetes in practice and avoid threatening the credibility of research studies on self-efficacy in diabetes self-care.
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Affiliation(s)
- Jiyeon Lee
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Eun-Hyun Lee
- Graduate School of Public Health, Ajou University, Suwon, Republic of Korea
| | - Duckhee Chae
- College of Nursing, Chonnam National University, Gwangju, Republic of Korea
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Lindkvist EB, Kristensen LJ, Sildorf SM, Kreiner S, Svensson J, Mose AH, Birkebaek N, Thastum M. A Danish version of self-efficacy in diabetes self-management: A valid and reliable questionnaire affected by age and sex. Pediatr Diabetes 2018; 19:544-552. [PMID: 29094452 DOI: 10.1111/pedi.12601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/18/2017] [Accepted: 09/29/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Managing the chronic illness type 1 diabetes (T1D) is extremely demanding, especially during adolescence. Self-efficacy is belief in one's own capabilities and this is crucial for diabetes management. Having a valid method for measuring self-efficacy is important. OBJECTIVE Our aims were to psychometrically validate a Danish version of the self-efficacy in diabetes management (SEDM) questionnaire, and to examine the relationship between background variables and self-efficacy. METHODS All Danish adolescents with T1D (n = 1075) were invited to participate in our study. In total, 689 agreed to participate and 602 completed the study. Data were collected using a web-based survey. All participants were asked to provide a blood sample for HbA1c measurement. Graphical log-linear Rasch modeling (GLLRM) was used to validate the questionnaire and its reliability was assessed using Monte Carlo simulation. RESULTS We found the questionnaire to be valid and reliable, but it had a dual structure that suggested a need for 2 separate subscales. One subscale related to practical (SEDM1) and the other to emotional (SEDM2) aspects of diabetes management. Both subscales were targeted toward adolescents with lower self-efficacy and were associated with HbA1c. SEDM1 was influenced by treatment modality and age. In SEDM2 we found an interaction between age and sex. CONCLUSION The Danish version of the SEDM questionnaire should be divided into two parts, each with a valid and reliable subscale for self-efficacy measurement. The relationship between self-efficacy and age seems to differ between boys and girls.
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Affiliation(s)
- Emilie Bundgaard Lindkvist
- Department of Paediatrics, Copenhagen Diabetes Research Center (CPH-DIRECT), Herlev University Hospital, Herlev, Denmark
| | - Lene Juel Kristensen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Stine Møller Sildorf
- Department of Paediatrics, Copenhagen Diabetes Research Center (CPH-DIRECT), Herlev University Hospital, Herlev, Denmark
| | - Svend Kreiner
- Section of Biostatistics, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jannet Svensson
- Department of Paediatrics, Copenhagen Diabetes Research Center (CPH-DIRECT), Herlev University Hospital, Herlev, Denmark
| | | | - Niels Birkebaek
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Mikael Thastum
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
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Messina R, Rucci P, Sturt J, Mancini T, Fantini MP. Assessing self-efficacy in type 2 diabetes management: validation of the Italian version of the Diabetes Management Self-Efficacy Scale (IT-DMSES). Health Qual Life Outcomes 2018; 16:71. [PMID: 29685153 PMCID: PMC5914030 DOI: 10.1186/s12955-018-0901-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 04/16/2018] [Indexed: 11/24/2022] Open
Abstract
Background Being highly self-efficacious is a key factor in successful chronic disease self-management. In the context of measuring self-efficacy in type 2 diabetes management, the Diabetes Management Self-Efficacy Scale (DMSES) is the most widely used scale. The aim of this study was to adapt the English version of the scale to Italian and to evaluate the psychometric properties of the Italian version of DMSES in type 2 diabetes (IT-DMSES). Methods We conducted a cross-sectional study of people with type 2 diabetes attending the Endocrine-Metabolic Disease Care Unit of the Internal Medicine Department of San Marino State Hospital between October 2016 and February 2017. Patients completed a socio-demographic and clinical data form, the IT-DMSES and 3 self-report questionnaires measuring diabetes distress (PAID-5), psychological well-being (WHO-5) and depression (PHQ-9). Psychometric testing included construct validity (principal component analysis), internal consistency (Cronbach’s α coefficient) and convergent/discriminant validity (Spearman’s correlation coefficient). Decision tree analysis was performed to classify patients into homogeneous subgroups of self-efficacy based on their demographic and clinical characteristics. Results Participants were 110 males and 55 females, mean age of 65.2 years (SD ± 9), 56.9% had been diagnosed for 1–15 years, 63% had HbA1c level > 53 mmol/mol. Two main factors underlain the construct of self-efficacy in diabetes management: ‘Disease Management’ and “Lifestyles Management”. Disease Management had a good reliability (α = .849) and Lifestyle Management had an excellent reliability (α = .902) indicating that the instrument is internally consistent. A negative and weak correlation was found between Lifestyle management, PAID-5 (r = − 0.258, p = < 0.01) and PHQ-9 (r = − 0.274, p = < 0.01) and a positive one with WHO-5 (r = 0.325, p < 0.01) supporting convergent validity. Disease management was uncorrelated with PAID-5 (r = − 0.142, p = 0.083), PHQ-9 (r = − 0.145, p = 0.076) and weekly correlated with WHO-5 (r = 0.170, p = 0.037) confirming discriminant validity. Higher levels of self-efficacy in lifestyle management were found in patients diagnosed for at least 1 year up to 15 years and aged > 65 years and the poorest self-efficacy was found in males < 65 years. Conclusions Results support the validity and reliability of IT-DMSES. The scale can be used in research and clinical practice to monitor type 2 diabetes self-management over time. Electronic supplementary material The online version of this article (10.1186/s12955-018-0901-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rossella Messina
- Department of Biomedical and Neuromotor Sciences, Section of Hygiene and Biostatistics, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Section of Hygiene and Biostatistics, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK
| | - Tatiana Mancini
- Endocrine-Metabolic Disease Care Unit, Department of Internal Medicine, Istituto Sicurezza Sociale, Cailungo, San Marino
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Section of Hygiene and Biostatistics, Alma Mater Studiorum-University of Bologna, Bologna, Italy
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Sangruangake M, Jirapornkul C, Hurst C. Psychometric Properties of Diabetes Management Self-Efficacy in Thai Type 2 Diabetes Mellitus Patients: A Multicenter Study. Int J Endocrinol 2017; 2017:2503156. [PMID: 29201051 PMCID: PMC5671723 DOI: 10.1155/2017/2503156] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/23/2017] [Accepted: 10/03/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aims of this study were to translate and psychometrically evaluate the Thai version of diabetes management self-efficacy scale (T-DMSES) and to examine its association with HbA1c control in diabetic individuals. METHODS This study recruited patients from outpatient diabetes clinics of both community and university hospitals. The first phases of this study involved translation of the existing DMSES into Thai, and in the second phase, we evaluated its psychometric properties. The construct validity was evaluated using confirmatory factor analysis. Criterion validity of DMSES was subsequently evaluated by examining DMSES's association with HbA1c control. RESULTS The T-DMSES contains 20 items across four factors. Confirmatory factor analysis demonstrated the construct validity of T-DMSES (χ2 = 645.142, df = 164, p < 0.001, CFI = 0.98, RMSEA = 0.065, TLI = 0.977, and AGFI = 0.981). The T-DMSES was also shown to be criterion valid with most subscales highly associated with HbA1c control. CONCLUSION The T-DMSES was shown to have good psychometric properties. It is likely to provide valuable insights into the epidemiology of diabetes management self-efficacy and may also prove useful in evaluating interventions for raising diabetes management self-efficacy, which in turn, improve both patient self-management and blood sugar control.
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Affiliation(s)
- Monthida Sangruangake
- Public Health Program, Khon Kaen University, Khon Kaen, Thailand
- Faculty of Nursing, Ratchathani University, Udonthani, Thailand
| | - Chananya Jirapornkul
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Cameron Hurst
- Center of Excellence in Biostatistics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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