New measures of diabetes self-care agency, diabetes self-efficacy, and diabetes self-management for insulin-treated individuals with type 2 diabetes

Psychometric properties of the arabic version of PHEEM applied on a sample of medical residents in Syria

BACKGROUND

The clinical learning environment (CLE) plays a crucial role in shaping the learning experiences and professional development of medical professionals. Understanding and optimising this environment is essential for improving doctors' knowledge acquisition, clinical skills, and overall well-being. The development of the Postgraduate Hospital Educational Environment Measure (PHEEM) and its translation to numerous languages has been a milestone in clinical education. Even though PHEEM was recently translated into Arabic, its psychometric properties in this form remain unevaluated. Therefore, this study aims to conduct a comprehensive psychometric analysis of the Arabic version of the PHEEM questionnaire.

METHODS

This is a cross-sectional questionnaire survey validation study. The defined population were medical residents in Damascus, Syria. A paper-based survey as well as an online-based one were conducted using several non-probability sampling methods namely, convenience, river and, snowball sampling between June 15, 2023, and June 21, 2023. Both exploratory (EFA) and confirmatory (CFA) factor analyses were conducted. Several psychometric criteria were applied including scree plot, eigenvalue > 1.5 and the 'proportion of variance accounted for' criterion.

RESULTS

A total of 543 participants completed the questionnaire (56.9% female). Kaiser-Meyer-Olkin measure for sample adequacy was high (0.937) and the P-value for Bartlett's test was < 0.001. EFA revealed five meaningful factors which were labelled: perception of teachers, learner's engagement and social participation, external regulation, work culture, and living conditions. These factors had the following eigenvalues: 12.6, 2.18, 2.03, 1.86, and 1.41 respectively, with a total explained variance of 43.45%. Cronbach's Alpha was 0.938. CFA confirmed the model structure of EFA (SRMR = 0.067 and RMSEA = 0.066). The Average Variance Explained (AVE) value of any given factor was > 0.7.

DISCUSSION

The Arabic PHEEM inventory demonstrated satisfactory psychometric properties. The extracted domains are of theoretical relevance to the psychosocial-material conceptual framework for learning environment. Nonetheless, this validation was performed in the Syrian context; therefore, future studies in other Arabic countries are recommended to support the applicability of Arabic PHEEM in the wide Arab World.

Translation, cultural adaptation and linguistic validation of the postgraduate hospital educational environment measure into Arabic

BACKGROUND

Assessment of the clinical learning environment (CLE) is an essential step that teaching hospitals routinely undertake to ensure the environment is conducive, learning-oriented and supportive of junior doctors' education. The Postgraduate Hospital Educational Environment Measure (PHEEM) is an internationally recognized tool for assessing the CLE with evidence of high reliability and validity. Translation of PHEEM into other languages such as Spanish, Japanese and Persian enabled wider adoption of the instrument in the world. However, in Syria and other Arabic countries, a validated Arabic translation of PHEEM is still not available, making it difficult to adopt it and use it in Arabic contexts. This study aims to translate and culturally adapt the PHEEM from English into Arabic.

METHODS

This study followed the structured translation and validation process guideline proposed by Sousa & Rojjanasrirat 2010. First, the PHEEM went through forward translation by three translators, then reconciled with the aid of a fourth translator. Afterwards, two professional bicultural and bilingual translators conducted back translation into English and compared it with the original version. This formed the Pre-final Version (PFV) which was then pretested for clarity on a sample of medical residents in Damascus, Syria. Following appropriate modifications, the PFV was sent to a panel of experts for a comprehensive review of language clarity and to assess content validity.

RESULTS

A total of thirty-five medical residents were recruited. Ten items with language clarity issues were identified and modified according to the elicited suggestions. Thereafter, the modified PFV was presented to ten subject experts who identified three items in need of revision. The item-content Validity Index (CVI) was over 0.78 for all of the 40 items; the calculated scale-CVI was 0.945.

DISCUSSION

This study provided the first linguistically valid Arabic translation of the widely used PHEEM inventory. The next step is to conduct a full psychometric analysis of the Arabic PHEEM to provide further evidence of validity and reliability.

The Effect of a Diabetes Self-Management Mobile Application on Self-Efficacy, Self-Care Agency, and Self-Care Management Among Patients With Type 1 Diabetes Mellitus

Background: Diabetes mellitus is a chronic disease that needs long-term management. Mobile health is an emerging field that is being used for diabetes self-management. Aim: Evaluate the effect of a diabetes self-management mobile application on self-efficacy, self-care agency, and self-care management among 128 Jordanian patients with Type 1 Diabetes Mellitus. Methods: The study utilized a non-equivalent controlled groups quasi-experimental design, with 64 patients in the control and in the intervention groups. Results: There was significant improvement in mean self-efficacy in the intervention group, improved self-care agency between the groups, and improved self-care management both within the intervention group and between the groups, after controlling for self-efficacy and self-care agency. Conclusion: Using a diabetes self-management mobile application may help improve patients' confidence in managing diabetes, and better commitment to and performance of self-care activities.

Cultural adaptation and validation of the Malay Chronic Kidney Disease Self-management instrument (MCKD-SM)

BACKGROUND

There is growing evidence that self-management behaviour can improve outcomes for patients with chronic kidney disease (CKD). However, no measures are available in Malay to effectively assess the self-management of CKD. The aim of this study was to translate, culturally adapt and validate the Malay Chronic Kidney Disease Self-Management (MCKD-SM) instrument for Malay-speaking health professionals and patients.

METHODS

This study was carried out in two phases: the translation and cultural adaptation phase and the validation phase. The instrument was translated from English to Malay and then adapted and validated in a sample of 337 patients with CKD stages 3-4 attending a nephrology clinic in a tertiary hospital in Malaysia. Structural validity was evaluated by exploratory factor analysis. The instrument's reliability was assessed by internal consistency and test-retest reliability. The correlations between the MCKD-SM and kidney disease knowledge and the MCKD-SM and self-efficacy were hypothesised a priori and investigated.

RESULTS

The MCKD-SM instrument has 29 items grouped into three factors: 'Understanding and Managing My CKD', 'Seeking Support' and 'Adherence to Recommended Regimen'. The three factors accounted for 56.3% of the total variance. Each factor showed acceptable internal reliability, with Cronbach's α from 0.885 to 0.960. The two-week intra-rater test-retest reliability intraclass correlation coefficient values for all items ranged between 0.938 and 1.000. The MCKD-SM scores significantly correlated with kidney disease knowledge (r = 0.366, p < 0.01) and self-efficacy (r = 0.212, p < 0.01).

CONCLUSION

The MCKD-SM was found to be a valid and reliable patient-reported outcome measure of pre-dialysis CKD self-management behaviour in the Malay-speaking population.

A Social Media-Based Diabetes Intervention for Low-Income Mandarin-Speaking Chinese Immigrants in the United States: Feasibility Study

BACKGROUND

Chinese immigrants bear a high diabetes burden and face significant barriers to accessing diabetes self-management education (DSME) and counseling programs.

OBJECTIVE

The goal of this study was to examine the feasibility and acceptability and to pilot test the potential efficacy of a social media-based DSME intervention among low-income Chinese immigrants with type 2 diabetes (T2D) in New York City.

METHODS

This was a single group pretest and posttest study in 30 Chinese immigrants with T2D. The intervention included 24 culturally and linguistically tailored DSME videos, focusing on diabetes education and behavioral counseling techniques. Over 12 weeks, participants received 2 brief videos each week via WeChat, a free social media app popular among Chinese immigrants. Primary outcomes included the feasibility and acceptability of the intervention. Feasibility was evaluated by recruitment processes, retention rates, and the video watch rate. Acceptability was assessed via a satisfaction survey at 3 months. Secondary outcomes, that is, hemoglobin A_1c (HbA_1c), self-efficacy, dietary intake, and physical activity, were measured at baseline, 3 months, and 6 months. Descriptive statistics and paired 2-sided t tests were used to summarize the baseline characteristics and changes before and after the intervention.

RESULTS

The sample population (N=30) consisted of mostly females (21/30, 70%) who were married (19/30, 63%), with limited English proficiency (30/30, 100%), and the mean age was 61 (SD 7) years. Most reported an annual household income of <US $25,000 (24/30, 80%) and a high school education or less (19/30, 63%). Thirty participants were recruited within 2 months (January and February 2020), and 97% (29/30) of the participants were retained at 6 months. A video watch rate of 92% (28/30) was achieved. The mean baseline HbA_1c level was 7.3% (SD 1.3%), and this level declined by 0.5% (95% CI -0.8% to -0.2%; P=.003) at 6 months. The mean satisfaction score was 9.9 (SD 0.6) out of 10, indicating a high level of satisfaction with the program. All strongly agreed or agreed that they preferred this video-based DSME over face-to-face visits. Compared to baseline, there were significant improvements in self-efficacy, dietary, and physical activity behaviors at 6 months.

CONCLUSIONS

This pilot study demonstrated that a social media-based DSME intervention is feasible, acceptable, and potentially efficacious in a low-income Chinese immigrant population with T2D. Future studies need to examine the efficacy in an adequately powered clinical trial.

Development and psychometric evaluation of self‐management scale for pregnant woman with gestational diabetes mellitus in China

Aim

To develop a self‐management scale and evaluate its validity for pregnant woman with GDM in China.

Design

A cross‐sectional survey design.

Methods

This study was conducted through three phases. The item pools of the scale were developed through literature review and expert interview. Content validity was assessed by an expert panel. Structure validity was evaluated through exploratory factor analysis. In the end, internal consistency reliability was tested.

Results

The self‐management scale includes four dimensions, including self‐management consciousness, pregnancy management, blood glucose management and resource utilization, with a total of 35 items. In the scale, the Cronbach's α was 0.95. The split‐half reliability of the overall scale is 0.79. And the test‐retest reliability was 0.91. The content validity was 0.94.

Conclusions

The scale is significantly valid and reliable, and it can be used to evaluate the self‐management ability of pregnant woman with GDM in China.

Adherence to diabetes self-care management and associated factors among people with diabetes in Gamo Gofa Zone public health hospitals

Introduction:

Adherence to diabetes self-care management is a lifestyle modification for people with diabetes which includes; medication, dietary practice and regular physical activity. The objective of this study was to assess the adherence to diabetes self-care management and associated factors among people with diabetes in Gamo Gofa Zone, Southern, Ethiopia, 2018.

Methods:

Institutional-based cross-sectional study design with a systematic random sampling technique was conducted. A total 635 diabetic participants were involved in this study. Data were collected using structured interviewer administered questionnaire. Data were analyzed using SPSS version 21. Descriptive statistics were employed to describe the study population in relation to the relevant variables. Binary and multivariable logistic regression was conducted to identify factors associated with the outcome variables. P-value < 0.05 with 95% confidence interval was used to declare statistical significance.

Results:

The prevalence of good adherence toward diabetes self-care management was 341 (53.7%), (95% confidence interval = 46.09, 61.31). Regarding diabetes self-care practices, poor adherence had been detected in blood sugar measurement practice, dietary feeding practice, physical exercise and eye examination practice. The multivariable analysis indicated that government workers [adjusted odds ratio = 2.74 (1.03, 7.30)], training on diabetes self-care practice [adjusted odds ratio = 3.13 (1.89, 5.16)], diabetes’ association membership [adjusted odds ratio = 1.59 (1.01, 2.50)], having personal glucometer at home [adjusted odds ratio = 2.70 (1.37, 5.33)], duration of diabetic illness >10 years [adjusted odds ratio = 9.59 (3.99, 23.05)] and people with diabetes who were not developing complication [adjusted odds ratio = 1.54 (1.01, 2.33)] were significantly associated with good adherence to diabetes self-care management practice.

Conclusion:

Significant number of diabetes patients had poor adherence to diabetes self-care practice. Special focus should be given to farmers with diabetes, those with diabetic complication and for those with duration of diabetes less than 10 years. Periodical training should be given for people with diabetes on dietary feeding, physical exercise and eye examination practice.

EQ-5D-5L-based quality of life normative data for patients with self-reported diabetes in Poland

INTRODUCTION

The new, five-level EQ-5D generic questionnaire (EQ-5D-5L) has never been used among diabetes patients in Poland.

OBJECTIVES

To develop health-related quality of life (HRQoL) norms for patients with self-reported diabetes, based on a large representative sample of the general Polish population, using the EQ-5D-5L.

MATERIALS AND METHODS

Members of the general public, selected via multistage stratified sampling, filled in the EQ-5D-5L questionnaire and answered a question about the presence of diabetes. We estimated three types of EQ-5D-5L outcomes: limitations within domains, EQ VAS and EQ-5D-5L index. Multiple linear regression was used to examine the relationship between sociodemographic characteristics and HRQoL, both in patients with diabetes and the general population sample.

RESULTS

Among 2,973 respondents having complete EQ-5D-5L data, 255 subjects (8.6%) self-reported diabetes. Treatment with insulin, other drugs, combination therapy or lack of drug treatment was declared by 22.0%, 48.6%, 5.1% and 24.3% of patients, respectively. Respondents with diabetes had a lower EQ VAS score (18.5 points difference on a 100-points scale) and a lower EQ-5D-5L index score (0.135 difference; scale range: 1.59). The multivariate analysis showed that the factors independently improving the HRQoL in the general population were secondary or higher education, and factors reducing HRQoL were female sex, belonging to an older age group, being treated because of diabetes with insulin, other drugs or combination treatment. Respondents diagnosed with diabetes but not treated with drugs showed a decrease in EQ VAS scores, but not in the EQ-5D-5L index.

CONCLUSIONS

Diabetes leads to HRQoL deterioration in all age groups when compared to matched general population respondents without diabetes. The most significant HRQoL reduction experience older patients with a basic level of education. Obtained EQ-5D-5L normative data may be used in the clinical care of patients with diabetes and health technology assessment of new anti-diabetic drugs.

Measurement Properties of Patient-Reported Outcome Measures for Diabetes: Systematic Review

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.

Continuous Glucose Monitoring as a Matter of Justice

Type 1 diabetes (T1D) is a chronic illness that requires intensive lifelong management of blood glucose concentrations by means of external insulin administration. There have been substantial developments in the ways of measuring glucose levels, which is crucial to T1D self-management. Recently, continuous glucose monitoring (CGM) has allowed people with T1D to keep track of their blood glucose levels in near real-time. These devices have alarms that warn users about potentially dangerous blood glucose trends, which can often be shared with ther people. CGM is consistently associated with improved glycemic control and reduced hypoglycemia and is currently recommended by doctors. However, due to the costs of CGM, only those who qualify for hospital provision or those who can personally afford it are able to use it, which excludes many people. In this paper, I argue that unequal access to CGM results in: (1) unjust health inequalities, (2) relational injustice, (3) injustice with regard to agency and autonomy, and (4) epistemic injustice. These considerations provide prima facie moral reasons why all people with T1D should have access to CGM technology. I discuss the specific case of CGM policy in the Netherlands, which currently only provides coverage for a small group of people with T1D, and argue that, especially with additional considerations of cost-effectiveness, the Dutch government ought to include CGM in basic health care insurance for all people with T1D.

Continuous Glucose Monitoring as a Matter of Justice

Type 1 diabetes (T1D) is a chronic illness that requires intensive lifelong management of blood glucose concentrations by means of external insulin administration. There have been substantial developments in the ways of measuring glucose levels, which is crucial to T1D self-management. Recently, continuous glucose monitoring (CGM) has allowed people with T1D to keep track of their blood glucose levels in near real-time. These devices have alarms that warn users about potentially dangerous blood glucose trends, which can often be shared with ther people. CGM is consistently associated with improved glycemic control and reduced hypoglycemia and is currently recommended by doctors. However, due to the costs of CGM, only those who qualify for hospital provision or those who can personally afford it are able to use it, which excludes many people. In this paper, I argue that unequal access to CGM results in: (1) unjust health inequalities, (2) relational injustice, (3) injustice with regard to agency and autonomy, and (4) epistemic injustice. These considerations provide prima facie moral reasons why all people with T1D should have access to CGM technology. I discuss the specific case of CGM policy in the Netherlands, which currently only provides coverage for a small group of people with T1D, and argue that, especially with additional considerations of cost-effectiveness, the Dutch government ought to include CGM in basic health care insurance for all people with T1D.

Prevalence of Depression and Its Influence on the Quality of Life of Jordanians Living in Residential Care Facilities

BACKGROUND

As a third-world country experiencing a rise in the elderly population and changes to traditional family structures, improving psychological health is critical to improving quality of life (QoL) in the older adults living in residential care facilities in Jordan.

PURPOSE

This study aimed to (a) estimate the prevalence of depression among nursing home (NH) residents in Jordan; (b) measure perceived QoL in these NH residents in the dimensions of mobility, self-care, usual activity, pain and discomfort, and anxiety/depression; and (c) assess the influence of depression on each of these QoL dimensions.

METHODS

This cross-sectional study recruited a convenience sample of 155 participants living in a residential care facility in Jordan. The instruments used included a sociodemographic and clinical questionnaire, the Mini-Mental State Examination, a Geriatric Depression Scale (GDS), and the EuroQol, which is a five-dimension, five-level questionnaire. The data were presented as means, standard deviations, and percentages as well as adjusted odds ratios (AORs) with 95% confidence intervals (CIs).

RESULTS

A high prevalence of depression was found in the study population, with 72.3% having a score between 6 and 9 on the GDS, which is suggestive of depression. Moreover, 18.1% scored ≥ 10 on the GDS, which is indicative of a nearly continual state of depression. With regard to the QoL dimensions, 84.5% of the participants reported experiencing pain, 81.9% reported anxiety/depression, 80.6% reported problems performing usual activities, 75.5% reported problems with self-care, and 63.2% reported mobility difficulties. Pain, anxiety, and depression were found to be significantly associated with level of depression (AOR = 2.78 and 95% CI [1.18, 6.57], AOR = 5.81 and 95% CI [2.14, 15.78], and AOR = 4.75 and 95% CI [1.87, 12.07], respectively).

CONCLUSIONS

Depression is common among NH residents in Jordan and is associated significantly with poor QoL. This study yielded empirical data that may be used to develop strategies to enhance or promote the mental health status and QoL of NH residents in Jordan.

Self-efficacy instruments for type 2 diabetes self-care: A systematic review of measurement properties

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.

Comparison of Diabetes-Dependent Quality of Life (ADDQoL) in Patients with T2DM in Poland, The Czech Republic, and Slovakia

INTRODUCTION

The purpose of the paper was to perform a comparative analysis of the impact of T2DM on QoL, including specific ADDQoL domains and associations between QoL, selected socio-demographic factors (including gender, age, education, residence, marital status, professional activity) or clinical parameters (HbA1c levels, fasting blood glucose, BMI, duration of DM, complications, treatment used), in adult diabetic patients from Poland, the Czech Republic and Slovakia. The study group included 608 patients diagnosed with T2DM. There were 214 patients from Poland, 196 from the Czech Republic and 198 from Slovakia.

RESULTS

Overall, respondents from all three countries rated their QoL as good or very good. The mean scores for the item "If I did not have diabetes, my quality of life would be" were slightly higher for Poles than for Slovaks and Czechs. In the ADDQoL results, the weighted impact scores were negative for all domains. The lowest scores in all three countries were found for "freedom to eat" for all patients; the highest for "living conditions". For Polish patients, the linear regression model demonstrated the following significant AWI predictors: pre-university education and past smoking. For Czech patients, the linear regression model demonstrated that none of the characteristics analyzed were significant independent predictors of AWI. In the For Slovak patients, the linear regression model demonstrated the following significant AWI predictors: higher education and concurrent heart failure.

CONCLUSION

In summary, our findings demonstrate that T2DM has a negative impact on all aspects of patients' QoL, which is the strongest in terms of the freedom to eat and dietary habits, regardless of the country. Education, past smoking, and concurrent heart failure were the only independent predictors of QoL in our study. This suggests a need for further research that would include more variables and a larger number of patients.

Development and psychometric properties of the female adolescents' sexual reproductive self-care scale

INTRODUCTION

The aim of this study was to design and evaluate the psychometric properties of an instrument for understanding female adolescents' reproductive and sexual self-care behaviors.

METHODS

A methodological study was conducted. In the qualitative phase, individual in-depth interviews were performed to develop the initial questionnaire. In the quantitative part, the psychometric properties of the questionnaire were evaluated.

FINDINGS

The initial questionnaire with 128 items was reviewed by the research team and taking into account the cut-off point 1.5 for the item impact and 0.62 for the content validity ratio (CVR), the number of questions fell to 82 items. S-CVR and S-content validity index (CVI) rations were 0.83 and 0.91, respectively. Exploratory factor analysis led to 74 items in seven dimensions. The alpha Cronbach's coefficient for the whole questionnaire was 0.895 and the intra-cluster correlation coefficient was 0.91.

CONCLUSION

The questionnaire developed in this study is reliable and valid for assessing female adolescents' sexual and reproductive self-care.

Diabetes self-care management practices among insulin-taking patients

Background

Diabetes self-care management (DSCM) is complex because various factors and relationships influence its processes.

Aims

This study aimed to identify the level of DSCM, compare the levels of self care between patients with type 1 and patients with type 2 diabetes, and identify significant predictors of self-care among Jordanian patients with type 1 and type 2 diabetes who were taking insulin.

Methods

A descriptive cross-sectional design was employed using a convenience sample of 310 Jordanian patients. The Arabic translated version of the 40-item Diabetes Self-Management Scale was used to collect data.

Results

The type of diabetes (t(310) = 4.81; p < .001) and the type of medications (insulin, or insulin and tablets) (t(310) = 4.75; p < .001) significantly affected the level of self-care. Age (t(296) = - 3.41; p = 0.001), gender (t(296) = -4.78; p < 0.001) training in self-care (t(296) = 4.30; p < .001), educational level (t(296) = 2.81, P = .005) and using traditional treatment (herbal therapy) (t(296) = -4.64, p < .001) significantly predicted self-care and explained around 58% of the variance in self-care.

Conclusions

Various factors were found to influence self-care. Further research is needed to explore the complex nature of DSCM.

Psychometric properties and characteristics of the Diabetes Self Management Scale

Objective

Assessing diabetes self care management is essential for nursing care for diabetes. There is a need to have valid and reliable scales that assess the actual performance of diabetes self management. The purpose of this study was to revise and conduct psychometric testing and analysis of the Diabetes Self Management Scale (DSMS).

Methods

A cross-sectional methodological design was used. A convenience sample was used and 78 adults with diabetes and taking insulin from five sites in the Midwest area of the U.S participated in the study. Reliability analysis was done using Ferketich techniques to make decisions about whether any given item should be retained or deleted.

Results

A descriptive analysis for the 60 items of the scale was conducted; several items had low variability compared to the other items on the scale. The correlation matrices showed that a total of 20 items had poor item characteristics. These 20 items were deleted resulting in developing 40- item version of the scale. The 40 - item scale had high level of internal consistency (Cronbach's α = 0.947). The validity testing of the 40 - item scale was guided by the Research Model for Diabetes Self Care Management; results were congruent with the model and showed strong correlation with self efficacy, moderate correlation with self care agency, and weak correlation with diabetes knowledge.

Conclusion

The items and the scale (DSMS) have undergone careful psychometric testing. The 40-item DSMS is a reliable and valid instrument to measure diabetes self care management among people with diabetes.

Confirmatory factor analysis of the Appraisal of Self-Care Agency Scale - Revised

Objective

to analyze the factor structure of the Appraisal of Self-Care Agency Scale-Revised (ASAS-R), adapted for Brazil.

Method

methodological study conducted with 150 individuals with diabetes mellitus cared for by the Family Health Strategy, most of whom are elderly with low educational levels. The test of the hypothesis concerning the confirmatory factor composition of the ASAS-R was performed using latent variables structural equations.

Results

the model's goodness-of-fit indexes were satisfactory (χ2 = 259.19; χ2/g.l = 2.97, p < 0.001; GFI = 0.85; RMR = 0.07; RMSEA = 0.09); the factor loads were greater than 0.40; and most item-to-factor-correlations presented moderate to strong magnitude (0.34 to 0.58); total alpha value was 0.74, while the alpha of the three factors were 0.69, 0.38 and 0.69, respectively.

Conclusion

the scale's factor structure presented satisfactory validity and reliability results, with the exception of one factor. Application of this scale to samples of the general population is desirable in order to strengthen analyses of internal consistency and the dimensionality of the factor structure. This study is expected to contribute to further studies addressing the self-care agency construct and the development of the ASAS-R.

A Randomized Controlled Trial of a Mobile Health Intervention to Promote Self-Management After Lung Transplantation

Lung transplant recipients are encouraged to perform self-management behaviors, including (i) monitoring health indicators, (ii) adhering to their regimen, and (iii) reporting abnormal health indicators to the transplant coordinator, yet performance is suboptimal. When hospital discharge was imminent, this two-group trial randomized 201 recipients to use either the mobile health (mHealth) intervention (n = 99) or usual care (n = 102), to compare efficacy for promoting self-management behaviors (primary outcomes) and self-care agency, rehospitalization, and mortality (secondary outcomes) at home during the first year after transplantation. The mHealth intervention group performed self-monitoring (odds ratio [OR] 5.11, 95% confidence interval [CI] 2.95-8.87, p < 0.001), adhered to medical regimen (OR 1.64, 95% CI 1.01-2.66, p = 0.046), and reported abnormal health indicators (OR 8.9, 95% CI 3.60-21.99, p < 0.001) more frequently than the usual care group. However, the two groups did not differ in rehospitalization (OR 0.78, 95% CI 0.36-1.66, p = 0.51) or mortality (hazard ratio 1.71, 0.68-4.28, p = 0.25). The positive impact of the mHealth intervention on self-management behaviors suggests that the intervention holds promise and warrants further testing.

The relationships among depression, self-care agency, self-efficacy and diabetes self-care management

At the time the study was conducted, Besher Gharaibeh, Byron Gajewski, and Diane Boyle were affiliated with School of Nursing University of Kansas, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; Ahmed Al-smadi was affiliated with University of Ulster, Belfast, Newtownabbey Co. Antrim BT37 0QB, Jordandtown road, UK. The coexistence of diabetes and depression is associated with negative outcomes such as poor diabetes self-care management (DSCM). Complex relationships exist among diabetes knowledge, self-efficacy, self-care agency, depression and DSCM. No study has examined the relationships among all these factors at the same time. We aimed to examine relationships among depression, diabetes knowledge, self-care agency, self-efficacy and DSCM in insulin- treated people based on a modification of the DSCM model. A cross-sectional, correlational model testing design was used. Participants with type 1 ( n = 35) and type 2 ( n = 43) diabetes were recruited from both outpatient and community sites. Participants mean age was 46.6 years (standard deviation 13.7) and the majority were men (56.4%). Multiple regression analyses tested the hypothesised relationships. Depression was found to have a direct negative relationship with self-care agency and self-efficacy. The relationship between depression and DSCM was not direct. Self-care agency and self-efficacy completely mediated the effect of depression on DSCM. Self-efficacy completely mediated the effect of self-care agency on DSCM. We conclude that effective treatment programmes for persons managed with insulin should probably include not only screening and treatment of depression, but also skills training to enhance patient self-care agency and self-efficacy alongside DSCM.

Predictors of diabetes self-management in older adults receiving chemotherapy

BACKGROUND

Cancer patients with diabetes have higher mortality rates and are more likely to develop infections, and be hospitalized during treatment. Hyperglycemia has been hypothesized as one of the factors associated with this increased risk. Diabetes self-management is one of the essential elements used by patients to maintain glucose levels.

OBJECTIVE

This exploratory study seeks to develop an understanding of the impact cancer treatment can have on overall diabetes self-management and how individual, clinical, and behavioral characteristics may influence or predict the level of diabetes self-management in adults who are undergoing chemotherapy for a solid tumor cancer.

METHODS

This study was conducted at 8 community-based cancer centers in Michigan and Ohio and used a written, self-administered survey at baseline and a phone survey 8 weeks later.

RESULTS

Diabetes self-management significantly decreased (P < .001), and the level of symptom severity significantly increased (P < .001) after patients were on chemotherapy for a minimum of 8 weeks. The level of symptom severity and diabetes self-efficacy were significantly predictive of the performance of diabetes self-management activities.

CONCLUSIONS

Chemotherapy and associated symptoms can have a negative impact on the performance of diabetes self-management activities in adults with both diabetes and cancer, increasing the risk for hyperglycemia and development of complications.

IMPLICATIONS FOR PRACTICE

Oncology nurses need to be aware of the impact cancer treatment can have on the performance of diabetes self-management activities in adults. Future research needs to test interventions that may assist patients with diabetes and cancer in managing both diseases.

Measuring Self-Care in Persons With Type 2 Diabetes: A Systematic Review

This systematic review examines the characteristics and psychometric properties of the instruments used to assess self-care behaviors among persons with type 2 diabetes. Electronic databases were searched for relevant studies published in English within the past 20 years. Thirty different instruments were identified in 75 articles: 18 original instruments on type 2 diabetes mellitus self-care, 8 translated or revised version, and 4 not specific but relevant to diabetes. Twenty-one instruments were multidimensional and addressed multiple dimensions of self-care behavior. Nine were unidimensional: three focusing exclusively on medication taking, three on diet, one on physical activity, one on self-monitoring of blood glucose, and one on oral care. Most instruments (22 of 30) were developed during the last decade. Only 10 were repeated more than once. Nineteen of the 30 instruments reported both reliability and validity information but with varying degrees of rigor. In conclusion, most instruments used to measure self-care were relatively new and had been applied to only a limited number of studies with incomplete psychometric profiles. Rigorous psychometric testing, operational definition of self-care, and sufficient explanation of scoring need to be considered for further instrument development.

Tradução, adaptação e validação de uma escala para o autocuidado de portadores de diabetes mellitus tipo 2 em uso de insulina

Objetivo Traduzir, adaptar e validar a escala Appraisal of Self Care Agency Scale-Revised (ASAS-R) para o Brasil.Métodos Utilizou-se o método descritivo de adaptação de instrumentos de medidas, em 150 portadores de diabetes mellitus. As etapas foram: tradução, síntese das traduções independentes, avaliação pelo Comitê de Juízes, retrotradução, submissão das versões retrotraduzidas aos autores da versão original, validação semântica, submissão da versão adaptada aos autores da versão original e pré-teste.Resultados ASAS-R manteve as equivalências semântica, cultural e conceitual. O alfa de Cronbach foi de 0,74, e o coeficiente de correlação intraclasse, no teste e reteste, foi de 0,81, e na análise interobservadores, de 0,84.Conclusão A versão manteve as equivalências conceitual, semântica e cultural. Confirmou-se a correlação entre os construtos capacidade de autocuidado, depressão e percepção do estado de saúde, exceto apoio social. Na validade discriminante, observaram-se diferenças significantes entre grupos, quanto à idade, escolaridade e autoaplicação de insulina.

Factors influencing self-management in patients with type 2 diabetes: a quantitative systematic review protocol

AIM

To describe a protocol for a quantitative systematic review, to identify critique and summarize factors that influence self-management education.

BACKGROUND

Self-management education enables patients to manage their condition successfully and it is associated with better self-care, good control over lifestyle and leading the best possible quality of life, notwithstanding the presence of a chronic disease. Type II Diabetes is a chronic disease that requires lifestyle adjustments and disease management to keep glycaemia and long-term complications under control. Education has to be customized and based on an assessment that includes factors influencing self-management, such as personal characteristics that can optimize the educational intervention.

DESIGN

The protocol for the systematic review was conducted according to the guidelines of the Centre for Reviews and Dissemination, York (UK).

METHOD

The review question was defined in terms of population, interventions, comparators, outcomes and study designs. The protocol included decisions about the review question, inclusion criteria, search strategy, study selection, data extraction, quality assessment, data synthesis and plans for dissemination. Funding for the review was confirmed on January 2011 by the Centre of Excellence for Nursing Scholarship in Rome.

DISCUSSION

An initial summary will be made by tabulating the data; the review will be reported in a narrative style and be developed according to the PRISMA guidelines. The protocol for the systematic review will allow us to identify, among the factors influencing self-management in people with Type II diabetes, the personal characteristics most relevant to the factors of motivation and empowerment. In addition, the systematic review will also identify an appropriate self-management model.

Quality of recipient-caregiver relationship and psychological distress are correlates of self-care agency after lung transplantation

Self-care behaviors are crucial for following the complex regimen after lung transplantation, yet little is known about recipients' levels of self-care agency (the capability and willingness to engage in self-care behaviors) and its correlates. We examined levels of self-care agency and recipient characteristics (socio-demographics, psychological distress, quality of relationship with primary lay caregiver, and health locus of control) in 111 recipients. Based on Perceived Self-Care Agency scores, recipients were assigned to either the low- or high-self-care agency comparison group. Characteristics were compared between groups to identify characteristics likely to be associated with lower-self-care agency. Mean (SD) score for self-care agency (scale range, 53-265) was 223.02 (22.46). Recipients with lowest-self-care agency scores reported significantly poorer quality of caregiver relationships (p < 0.001) and greater psychological distress (p < 0.001). After controlling for psychological distress, the quality of the recipient-caregiver relationship remained significantly associated with self-care agency. Every one-point decrease in the quality of caregiver relationship increased the risk of low-self-care agency by 12%. Recipients with poorer caregiver relationships and greater psychological distress may need additional support to perform the self-care behaviors expected after lung transplantation.

From silence to storm--patient illness trajectory from diabetes diagnosis to haemodialysis in Taiwan: a qualitative study of patients' perceptions

AIMS

This article is a report of a study that explored the perceptions of patients as they experienced their diabetes illness trajectory, and their initial decisions to undergo dialysis, in an effort to provide further complementary guidance for nurses and healthcare practitioners.

BACKGROUND

Diabetes leads to higher morbidity and mortality when patients develop renal failure resulting from diabetic nephropathy. An effective self-care regimen and multidisciplinary team approach are required to avoid or delay the serious chronic complications of the disease. Patients and healthcare practitioners must be aware therefore of psycho-physiological adjustment when seeking to delay the onset of complications.

DESIGN

A qualitative design was used for data collection through semi-structured interviews.

METHOD

Data were analysed using content analysis. Participants were 25 diabetes patients undergoing initial haemodialysis who were recruited from diabetes and nephrology wards at a medical centre in northern Taiwan. Data were collected from December 2010-August 2011.

FINDINGS

The core theme describing the illness trajectory derived from face-to-face interviews with people undergoing hemodialysis was 'from silence to storm'. There emerged also five phases of patient experience that resulted from the development of diabetic nephropathy: (1) diabetes onset stage; (2) stable stage; (3) burden stage; (4) shock stage; and (5) coping stage.

CONCLUSIONS

Patients suffer with diabetic nephropathy for a long-term period. Our findings may enhance the understanding of nurses regarding the experiences of patients with diabetic nephropathy, and will help them provide diabetes care that promotes healthy life for those individuals.

Perceived impact of cancer treatment on diabetes self-management

PURPOSE

The purpose of this study was to identify the impact that cancer and its treatment had on diabetes self-management and to identify common issues that individuals with diabetes encounter while undergoing chemotherapy.

METHODS

This exploratory study utilized a baseline self-administered written survey and an 8-week telephone follow-up survey that included 2 open-ended questions. Forty-three adults aged 50 or older with diabetes and a solid tumor cancer receiving chemotherapy were recruited from 8 community outpatient cancer centers in Michigan and Ohio. Descriptives, t tests, and correlations were utilized to analyze the data. Content analysis was used to analyze the data from the open-ended questions.

RESULTS

After a minimum of 8 weeks of chemotherapy, patients performed significantly fewer diabetes self-management behaviors. The majority of individuals experienced a moderate to high impact on their ability to perform diabetes self-management activities while receiving chemotherapy. Exercise, ability to eat and drink, and monitoring blood sugars were most affected. Three themes identifying patient issues were noted: self-management issues, health issues, and prioritization.

CONCLUSIONS

Cancer treatment and cancer-related symptoms can have a negative impact on diabetes self-management behaviors in adults with diabetes who are undergoing chemotherapy. Diabetes self-management education is targeted to improve health outcomes in patients with diabetes and cancer and addresses the "cause" not just the "source" of the problem needs to be developed. Further research needs to be done to address issues related to glycemic control and health-related outcomes in this population.

Self-efficacy and self-care behavior of Malaysian patients with type 2 diabetes: a cross sectional survey

This study investigated the association between self-efficacy and self-care behavior to determine the degree of self-efficacy and to examine differences in self-efficacy according to patient variables, including state of health, of Malaysian patients with type 2 diabetes. The sample comprised 388 patients (respondents). We collected the data from December 2010 to February 2011. We found a significant positive relationship between self-efficacy and self-care behavior (r(s) = 0.481, P < 0.001). The degree of self-efficacy was moderately high (mean = 7.570). We found significant differences between self-efficacy and education level (Wilk's Lambda = 0.918, F[12, 1008] = 2.779, P < 0.05), duration of diabetes (Wilk's Lambda = 0.954, F[8, 736] = 2.264, P < 0.05), other chronic conditions (Wilk's Lambda = 0.967, F[4, 383] = 3.304, P < 0.05) and diabetic complications (Wilk's Lambda = 0.963, F[4, 383] = 3.653, P < 0.05). Self-efficacy can be used as a model to understand self-care behavior. Individualized nursing interventions based on self-efficacy theory should be utilized in high risk diabetic patients so as to assist and improve self-care behavior.

Diabetes Disease Management in a Home Care Setting

The purpose of this Orem’s Self-Care Deficit Theory of Nursing guided project was to extend a program evaluation project to examine the effects of three different approaches to home health care diabetes care on patient self-care behaviors. Group 1 (n = 64) received an experimental Diabetes Disease Management Program, group 2 (n = 167) received a Diabetes Learning Collaborative program, and group 3 (n = 132) received standard diabetes home care. No statistically significant group differences were found for self-care behaviors. Statistically significant associations in group 2 between emergent care and patients who met American Diabetes Association criteria for glucose control regarding discharge management of injectable medication management were found. A significant clinical finding was that 46% of patients (n = 117) did not meet the glucose criteria.

Delineation of self-care and associated concepts

PURPOSE

The purpose of this paper is to delineate five concepts that are often used synonymously in the nursing and related literature: self-care, self-management, self-monitoring, symptom management, and self-efficacy for self-care.

METHOD

Concepts were delineated based on a review of literature, identification of relationships, and examination of commonalities and differences.

FINDINGS

More commonalities than differences exist among self-care, self-management, and self-monitoring. Symptom management extends beyond the self-care concepts to include healthcare provider activities. Self-efficacy can mediate or moderate the four other concepts. Relationships among the concepts are depicted in a model.

CONCLUSIONS

A clearer understanding of the overlap, differences, and relationships among the five concepts can provide clarity, direction and specificity to nurse researchers, policy makers, and clinicians in addressing their goals for health delivery.

CLINICAL RELEVANCE

Concept clarity enables nurses to use evidence that targets specific interventions to individualize care toward achieving the most relevant goals.

Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline

RATIONALE, AIMS AND OBJECTIVES

The diversity of the population worldwide suggests a great need for cross-culturally validated research instruments or scales. Researchers and clinicians must have access to reliable and valid measures of concepts of interest in their own cultures and languages to conduct cross-cultural research and/or provide quality patient care. Although there are well-established methodological approaches for translating, adapting and validating instruments or scales for use in cross-cultural health care research, a great variation in the use of these approaches continues to prevail in the health care literature. Therefore, the objectives of this scholarly paper were to review published recommendations of cross-cultural validation of instruments and scales, and to propose and present a clear and user-friendly guideline for the translation, adaptation and validation of instruments or scales for cross-cultural health care research.

METHODS

A review of highly recommended methodological approaches to translation, adaptation and cross-cultural validation of research instruments or scales was performed. Recommendations were summarized and incorporated into a seven-step guideline. Each one of the steps was described and key points were highlighted. Example of a project using the proposed steps of the guideline was fully described.

CONCLUSIONS

Translation, adaptation and validation of instruments or scales for cross-cultural research is very time-consuming and requires careful planning and the adoption of rigorous methodological approaches to derive a reliable and valid measure of the concept of interest in the target population.

Reliability, validity and factor structure of the Appraisal of Self-Care Agency Scale-Revised (ASAS-R)

RATIONALE, AIMS AND OBJECTIVES

Self-care agency is a fundamental concept in nursing and health care research. Having self-care agency enhances an individual's health-promoting behaviours and/or specific capabilities for chronic disease self-management. The purpose of this study was to continue the development and psychometric testing of the Appraisal of Self-Care Agency - Revised (ASAS-R).

METHODS

A cross-sectional methodological design was used to examine the reliability, validity and factor structure of the ASAS-R among individuals from the general population. The sample consisted of 629 adults who were randomly selected to conduct an exploratory factor analysis (EFA; n=240) and a confirmatory factor analysis (CFA; n=389) of the scale. A demographic questionnaire, the ASAS-R and the Health-Promoting Lifestyle Profile (HPLP-II) were the measures used to collect the data.

RESULTS

The final 15-item three-factor ASAS-R had an overall Cronbach's alpha (α) of 0.89. The three factors extracted, rotated and scored in this study were labelled: having power for self-care, developing power for self-care and lacking power for self-care. All inter-items and item-to-total correlations met recommended criteria of r=0.30 to r=0.70, except for one of the items that had an item-to-total correlation of 0.71, slightly exceeding the maximum recommended item-to-total correlation. The three factors had Cronbach's alphas of 0.86, 0.83 and 0.79, respectively. The three factors together explained 61.7% of the scale items variance. Each item of the scale had a strong factor loading ranging from 0.52 to 0.81. All measures of model fit exceeded the recommended criteria, indicating that the 15-item ASAS-R had a very good fit (χ(2) /d.f.=1.97, GFI=0.94, AGFI=0.92, CFI=0.96, TLI=0.95, RMSEA=0.05, RMR=0.05 and the PCLOSE=0.48).

CONCLUSIONS

The 15-item three-factor ASAS-R is a short, reliable and valid instrument to measure self-care agency among individuals from the general population, but further psychometric evaluation is needed among individuals with chronic diseases, especially those with diabetes mellitus.