Development and validation of the Diabetes Obstacles Questionnaire (DOQ) to assess obstacles in living with Type 2 diabetes

Health Related Quality of Life Measurements for Diabetes: A Systematic Review

Health-related quality of life (HRQOL) is an essential measure that is used to assess the effect of chronic disease management on the health status of an individual. Previous studies have identified various instruments used in the measuring of diabetes-specific health-related quality of life (HRQOL). The aim of this paper is to provide a systematic review of the various instruments used for the diabetes-specific measure of HRQOL, and place emphasis on its content and measurement properties. Methods Preferred Reporting Items for Systematic Reviews and Meta analyses (PRISMA) guidelines was used. A systematic search strategy was used to identify publications reporting diabetes HRQOL measures. The search terms used were: “diabetes quality of life”, “measurements”, and “instruments”. The database that was searched includes PubMed, Science Direct, CINAHL, and Medline. Articles written in the English language and published from January 1990 to December 2020 were included. Those articles that did not measure HRQOL for diabetic patients were excluded. Results: A total of seventeen instruments met the inclusion criteria and included in the review. The appraisal of diabetes scale (ADS), Audit of Diabetes-Dependent QOL measure (ADDQOL), Diabetes Health Profile (DHP), and Problem Areas in Diabetes (PAID) are more suitable for single-scale questionnaires when investigating one or more specific aspects of diabetes-specific quality of life (QOL). The ADDQOL, ADS, Diabetes Impact Measurement Scales (DIMS), Diabetes Quality of Life Clinical Trial Questionnaire (DQLCTQ-R), Malay Version of Diabetes Quality of Life (DQOL), Iranian Diabetes Quality of Life (IRDQOL), Brief Clinical Inventory, and PAID are relevant measures of HRQOL for insulin dependent diabetes mellitus (IDDM) and non-insulin dependent diabetes mellitus (NIDDM) patients. The Asian Diabetes Quality of Life AsianDQOL, The Chinese Short Version of DQOL, Elderly Diabetes Burden Scale (EDBS), Malay Version of Diabetes Quality of Life (DQOL), are relevant measures of HRQOL for NIDDM patients. Only two instruments assess for responsiveness, namely PAID and DQLCTQ-R. In PAID, the effect sizes ranged from 0.32 to 0.65 for interventions. The DQLCTQ-R four domains were responsive to clinical change in metabolic control. Based on this review ADDQOL, DSQOLS, and EDBS psychometric properties are sufficient. Conclusion: Most studies did not check for responsiveness, and future studies should prioritize responsiveness to change, which was not included in the psychometric finding of the reviewed instruments.

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.

Diabetes-related quality of life in six European countries measured with the DOQ-30

Background

The quantification of diabetes-related quality of life (DR-QoL) is an essential step in making Type 2 Diabetes (T2DM) self-management arrangements. The European General Practitioners Research Network (EGPRN) initiated the EUROBSTACLE study to develop a broadly conceptualised DR-QoL instrument for diverse cultural and ethnic groups; high and low-income countries. In 2016 the Diabetes Obstacles Questionnaire-30 (DOQ-30) was introduced.

Objectives

The research aimed to study obstacles a patient with diabetes (PWD) may face in everyday life. First, we assessed how descriptive and clinical characteristics and the residential country were associated with the obstacles. Secondly, we calculated the proportion of respondents who expressed obstacles.

Methods

Data were collected in 2009 in a cross-sectional survey in Belgium, France, Estonia, Serbia, Slovenia, and Turkey. Multiple linear regressions were computed to detect associations between descriptive and clinical characteristics, residential country, and obstacles. Percentages of respondents who perceived obstacles were calculated.

Results

We found that although descriptive and clinical characteristics varied to quite a great extent, they were weakly associated with the perception of obstacles. The residential country was most often associated with the existence of some obstacle. The highest percent (48%) of all respondents perceived ‘Uncertainty about Insulin Use’ as an obstacle.

Conclusion

Descriptive and clinical characteristics were weakly associated with perceived obstacles. However, the residential country plays an essential role in the decline of the QoL of PWDs. Education of both PWDs and healthcare professionals (HCPs) plays an essential role in countering the fear of insulin.

Psychometric evaluation of the Persian version of the diabetic foot self-care questionnaire in Iranian patients with diabetes

BACKGROUND

Diabetic foot self-care refers to a group of self-management behaviors that can reduce the incidence of foot ulcers and amputations. It is necessary to have a valid and reliable standard tool to measure foot self-care in diabetic patients. This study aimed to evaluate the psychometric properties of the Persian version of the Diabetic Foot Self-Care Questionnaire of the University of Malaga, Spain (DFSQ-UMA) in Iran.

METHODS

This cross-sectional study was conducted with 407 diabetic patients who were selected using a convenient sampling method. Construct validity was assessed by exploratory (with 207 patients) and confirmatory (with 200 patients) factor analyses. Internal consistency was calculated using Cronbach's alpha and McDonald's omega coefficients.

RESULTS

In the exploratory factor analysis, three factors with eigenvalues of 3.84, 2.41, and 2.26 were extracted that together explained 56.74% of the total variance of diabetic foot self-care. A Cronbach's alpha of 0.865 was found for the total instrument.

CONCLUSIONS

The Persian version of the DFSQ-UMA has good validity and reliability, and given its good psychometric properties, it can be used in future studies.

Psychometric evaluation of the Farsi version of the diabetes foot self-care bahavior scale

BACKGROUND

Diabetes foot self-care is one of the self-management behaviors of diabetic patients leading to a reduction in the incidence of pressure ulcers and amputation. Having a valid, reliable, simple and comprehensive tool is essential in measuring the self-care behavior of diabetic patients. The aim of this study was to evaluate the psychometric properties of the Farsi version of the diabetes foot self-care bahavior scale (DFSBS) in Iran.

METHODS

In this cross-sectional and methodological study, 500 patients with type 2 diabetes were recruited by convenience sampling. Construct validity was assessed by exploratory factor analysis (over 300 patients) and confirmatory factor analysis (over 200 patients). Internal consistency was calculated by Cronbach's alpha coefficient and its stability was calculated by intraclass correlation coefficient (ICC).

RESULTS

In the exploratory factor analysis, two self-care factors related to feet and shoes were extracted which had specific values of 38.49 and 1.24, respectively, and were able to account for 56.22% of the total self-care variance of diabetes foot. Confirmatory factor analysis had excellent fit model. The internal consistency and ICC of the whole instrument were 0.83 and 0.791 (95% CI: 0.575-0.925; P < 0.001), respectively.

CONCLUSIONS

The Farsi version of DFSBS (F-DFSBS) has good validity and reliability, and due to its appropriate psychometric properties, this tool can be used in future studies.

Patients With Type 2 Diabetes Mellitus: Obstacles in Coping

BACKGROUND

Diabetes mellitus is a major global threat to public health. Reducing the daily obstacles of coping with the disease for patients with diabetes may improve management.

PURPOSE

The aim of this study was to investigate daily obstacles to coping with Type 2 diabetes mellitus (T2DM) and related factors.

METHODS

A descriptive and cross-sectional design was used. Data were collected from 186 patients with T2DM who were hospitalized in an endocrinology clinic in Turkey. The Hospital Anxiety and Depression Scale and the Diabetes Obstacles Questionnaire were used to collect data. Multiple linear regression analysis was performed to explore the predictors of obstacles to coping in patients with T2DM.

RESULTS

The highest mean score was achieved on the obstacles to coping with diabetes (2.57 ± 3.78) among the subscales of the Diabetes Obstacles Questionnaire. After regression analysis, level of treatment compliance was identified as the most significant predictor (β = .289, p < .001). Anxiety, depression, smoking status, and highest level of education were also identified as significant predictors.

CONCLUSIONS

On the basis of these results, nurses should plan and implement interventions to improve treatment compliance and assist patients to overcome obstacles to disease management. Moreover, patient anxiety, depression, and lifestyle behaviors should be addressed.

Diabetes-Specific Questionnaires Validated in Brazilian Portuguese: A Systematic Review

Two researchers conducted independent searches on five different electronic databases: PubMed/MEDLINE, Embase, SciELO, LiLACS and Web of Science. Studies were selected that covered cross-cultural adaptation methodology and validation in Brazil with type 1 and type 2 diabetes patients of any age. After reading the full-text articles, data related to psychometric characteristics were extracted from each study selected. Reliability was assessed with Cronbach's α (Cα). The initial searches identified 2,211 studies. After exclusions, 26 were included, covering a total of 31 questionnaires. Questionnaires were grouped into 11 domains based on their main focus of interest: adherence (n = 8), quality of life (n = 7), diabetes knowledge (n = 3), hypoglycemia (n = 3), self-efficacy (n = 3), satisfaction with pharmaceutical services (n = 1), emotional stress (n = 2), hope (n = 1), attitude towards diabetes (n = 1), perception of disease severity (n=1), and risk of developing diabetes (n = 1). This study identified and reviewed all of the diabetes-specific questionnaires that have been validated for Brazilian Portuguese, which should facilitate selection of the most appropriate instrument for each domain of interest in future research and clinical settings.

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.

Assessing quality of life in diabetes: II - Deconstructing measures into a simple framework

A growing number of instruments measuring diabetes-specific health-related quality of life (HRQOL) have been identified in previous systematic reviews, the most recent being published in 2008. The purpose of this paper is report on an updated systematic review of diabetes-specific HRQOL measures highlighting the time period 2006-2016; to deconstruct existing diabetes-specific HRQOL measures into a simple framework for evaluating the goodness-of-fit between specific research needs and instrument characteristics; and to present core characteristics of measures not yet reported in other reviews to further facilitate scale selection. Using the databases Medline, Pubmed, CINAHL, OVID Embase, and PsycINFO, we identified 20 diabetes-specific HRQOL measures that met our inclusion criteria. For each measure, we extracted eight core characteristics for our measurement selection framework. These characteristics include target population (type 1 vs. type 2), number and type of HRQOL dimensions measured and scored, type of score and calculation algorithm, sensitivity to change data reported in subsequent studies, number of survey items, approximate time length to complete, number of studies using the instrument in the past 10years, and specific languages instruments is translated. This report provides a way to compare and contrast existing diabetes-specific HRQOL measures to aid in appropriate scale selection and utilization.

Development and Evaluation of a Computer-Based, Self-Management Tool for People Recently Diagnosed with Type 2 Diabetes

Aim. The purpose of this study was to develop and evaluate a computer-based, dietary, and physical activity self-management program for people recently diagnosed with type 2 diabetes. Methods. The computer-based program was developed in conjunction with the target group and evaluated in a 12-week randomised controlled trial (RCT). Participants were randomised to the intervention (computer-program) or control group (usual care). Primary outcomes were diabetes knowledge and goal setting (ADKnowl questionnaire, Diabetes Obstacles Questionnaire (DOQ)) measured at baseline and week 12. User feedback on the program was obtained via a questionnaire and focus groups. Results. Seventy participants completed the 12-week RCT (32 intervention, 38 control, mean age 59 (SD) years). After completion there was a significant between-group difference in the "knowledge and beliefs scale" of the DOQ. Two-thirds of the intervention group rated the program as either good or very good, 92% would recommend the program to others, and 96% agreed that the information within the program was clear and easy to understand. Conclusions. The computer-program resulted in a small but statistically significant improvement in diet-related knowledge and user satisfaction was high. With some further development, this computer-based educational tool may be a useful adjunct to diabetes self-management. This trial is registered with clinicaltrials.gov NCT number NCT00877851.

Development and validation of the short version of the diabetes obstacles questionnaire (DOQ-30) in six European countries

BACKGROUND

Patients with type 2 diabetes reveal different obstacles in living with the disease. The EGPRN initiated a qualitative research EUROBSTACLE to create a broadly conceptualized diabetes-related quality of life (DR-QoL) instrument. It led to the development of the diabetes obstacle questionnaire (DOQ), a five-point Likert-scaled measure, consisting of 78 items in eight scales.

OBJECTIVES

To develop and validate a short, easy-to-use version of the DOQ.

METHODS

A cross-sectional study with the DOQ was carried out. Participants answered the DOQ and GPs added some clinical data from their medical records. Data of 853 patients from Belgium, France, Estonia, Serbia, Slovenia, and Turkey were included in the analysis. The selection of items for the short version of the DOQ was achieved with exploratory factor analysis (EFA). Construct validity was proved with EFA and Pearson correlations between the DOQ and the new DOQ-30. Internal reliability was established with Cronbach's alpha.

RESULTS

DOQ-30 resulted in 30 items in nine subscales. It explained 49.8% of items' variance. It shows a considerable good internal reliability and construct validity.

CONCLUSION

The DOQ-30 is a five-point Likert-scaled broadly conceptualized measure of DR-QoL. It addresses a variety of obstacles, such as social, psychological, cognitive and behavioural. The DOQ-30 is ready for implementation in general practice and research in Europe as a valuable instrument to assess DR-QoL.

Facilitators, barriers and expectations in the self-management of type 2 diabetes--a qualitative study from Portugal

BACKGROUND

Patients with type 2 diabetes mellitus (DM) have a central role in managing their disease, but the effective adoption of self-management behaviours is often challenging.

OBJECTIVES

The main objective of this study was to assess the facilitators, barriers and expectations in the self-management of type 2 DM, as perceived by patients.

METHODS

Patients with type 2 DM were recruited at the Portuguese Diabetes Association outpatient clinic, using a convenient sampling technique. Qualitative data was obtained using video-recorded focus groups. Each session had a moderator and an observer, and followed a pre-tested questioning route. Two independent researchers transcribed and analysed the focus groups.

RESULTS

Three major themes were identified: diet, physical exercise, and glycaemic control. Difficulties in changing dietary habits were grouped in four main categories: decisional, food quality, food quantity, and dietary schedule. Barriers related to physical exercise also included decisional aspects, as well as fatigue, muscle and joint pain, and other co-morbidities. Information and knowledge translation, as well as family and social ties, were commonly explored aspects across the three themes and were regarded as facilitators in some situations and as barriers in others.

CONCLUSION

This study provided new insight on the barriers, facilitators and expectations in type 2 DM self-management, pointing out the importance of tailored guidance. Future research should explore interventions designed to promote and facilitate behaviour change in this population.

Development and Validation of the Perception of Self-Monitoring of Blood Glucose Scale in Insulin-Treated Patients With Diabetes

Background and Purpose: The Perception of Self-Monitoring of Blood Glucose (P-SMBG) scale was developed and validated to assess perceptions of self-monitoring of blood glucose (SMBG) in insulin-treated patients with diabetes. Method: An initial 68-item version of the P-SMBG has been evaluated by a panel of professionals and patients. A sample of 375 patients tested the revised scale. Results: Factor analysis suggested a 19-item scale and a 2-factor structure, separating negatively and positively worded items. Cronbach’s alpha was .84 and .72, and the intraclass correlation coefficient was .66 and .57, respectively for both factors. Item–total correlations were in the range of .23–.66. Convergent/divergent validity was confirmed for the negatively worded items. Conclusions: The final P-SMBG scale (21 items) can be used to assess positive and negative perceptions of SMBG in insulin-treated patients with diabetes.

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

AIM

To determine the psychometric properties and theoretical grounding of instruments that evaluate self-care behaviour or barriers in people with type 2 diabetes.

BACKGROUND

There are many instruments designed to evaluate self-care behaviour or barriers in this population, but knowledge about their psychometric validation processes is lacking.

DESIGN

Systematic review.

DATA SOURCES

We conducted a search for psychometric or validation studies published between January 1990-December 2012. We carried out searches in Pubmed, CINAHL, PsycINFO, ProQuolid, BibliPRO and Google SCHOLAR to identify instruments that evaluated self-care behaviours or barriers to diabetes self-care.

REVIEW METHODS

We conducted a systematic review with the following inclusion criteria: Psychometric or clinimetric validation studies that included patients with type 2 diabetes (exclusively or partially) and which analysed self-care behaviour or barriers to self-care and proxies like self-efficacy or empowerment, from a multidimensional approach. Language: Spanish or English. Two authors independently assessed the quality of the studies and extracted data using Terwee's proposed criteria: psychometrics properties, dimensionality, theoretical ground and population used for validation through each included instrument.

RESULTS

Sixteen instruments achieved the inclusion criteria for the review. We detected important methodological flaws in many of the selected instruments. Only the Self-management Profile for Type 2 Diabetes and Problem Areas in Diabetes Scale met half of Terwee's quality criteria.

CONCLUSION

There are no instruments for identifying self-care behaviours or barriers elaborated with a strong validation process. Further research should be carried out to provide patients, clinicians and researchers with valid and reliable instruments that are methodologically solid and theoretically grounded.

A systematic review of patient-reported and economic outcomes: value to stakeholders in the decision-making process in patients with type 2 diabetes mellitus

BACKGROUND

The need for an approach to measuring health results that incorporates patients' and payers' perspectives has generated a wide range of health care outcomes (HCOs), but it is yet unknown whether these HCOs are appropriate or valid for the health care decision-making process.

OBJECTIVE

The goal of this study was to assess HCOs, patient-reported outcomes (PROs), and economic outcomes in terms of validity and appropriateness to health care decision making in type 2 diabetes mellitus (T2DM).

METHODS

This systematic review of studies published between January 1, 1996, and November 1, 2010, comprised an electronic literature search of MEDLINE and Centre for Reviews and Dissemination databases. Studies included were clinical trials, observational studies, economic analyses, and studies on the development and validation of HCOs in T2DM in the adult population. HCOs were assessed and classified according to their relevance for decision makers in terms of feasibility for routine use, validity, sensitivity, reliability, understanding, and scope.

RESULTS

Two independent reviewers screened 4497 citations. Of these, 281 potentially eligible full articles were retrieved, and 185 met the inclusion criteria. A total of 121 HCOs in T2DM were identified: 80 (66.1%) PROs and 41 (33.9%) economic outcomes. Only 44.6% of the outcomes assessed were appropriate and valid for health care decision making. Greater deficiencies in evidence were found for PROs (61.3%), followed by economic outcomes (43.9%).

CONCLUSIONS

A large number of HCOs are being used in the health care decision-making process, but a significant proportion of these new outcomes have not been properly validated. Despite the fact that appropriate measures will depend on the specific needs of the decision makers, researchers need to use HCOs for which evidence of quality and appropriateness is available.

Prevalent obstacles and predictors for people living with type 2 diabetes

Background. Type 2 diabetes (T2DM) is a chronic, progressive disease with serious micro- and macrovascular complications. A person affected by T2DM should learn to accept the new restricted lifestyle. Aims. The aim of the study was to identify the prevalence of obstacles in coping with daily life for people with T2DM and the magnitude of the relationships of the obstacles with various patient characteristics. Methods. Participants were recruited from randomly selected GPs' lists in Estonia. Respondents completed the Estonian version of the Diabetes Obstacles Questionnaire (DOQ). The statements were assessed on a 5-point scale. Biomedical and clinical variables were measured. The central tendency statistics and skewness and kurtosis for all statements were computed to find out those that reflect obstacles. Then obstacles of the DOQ were stratified. Multinomial logistic regression (MLR) was computed to estimate the influences of descriptive variables on the statements. Results and Conclusions. Altogether, 138 diabetic patients were enrolled in the study. Fourteen statements were identified as obstacles. Variables such as age, type of diabetes treatment, and BMI had significant effects on five of them. Younger age, BMI, and insulin nonuse were revealed as the strongest predictive characteristics for perceiving obstacles more often in coping with daily life.

An instrument to assess the needs of patients with type 2 diabetes mellitus for health-promotion activities

BACKGROUND

Health promotion has become an integral part of primary healthcare for patients with chronic illness. A practical instrument to identify patient needs in health promotion will support patient-centered health counseling.

OBJECTIVE

The objective of the study was to develop and pilot test the 'Health Promotion Diabetes' (HEPRODIA) instrument, which aims to identify the needs of patients with diabetes mellitus for health-promoting activities with regard to their preferred lifestyle behavior change.

METHODS

Scale development of the instrument was guided by existing insights and expert opinion. Questionnaire data were collected in a sample of patients (n = 221) from eight primary care practices in the southern part of the Netherlands. The resulting instrument comprised a fixed set of 14 items to elicit patients' preferred lifestyle change, plus a variable set of 4-20 items concerning specific barriers and support needs regarding the chosen change. The instrument provides a starting point for discussion with a practice nurse about healthy lifestyle changes. Internal consistency (Cronbach's α) and feasibility of the instrument, as well as experiences of the practice nurses using the instrument, were evaluated.

RESULTS

Cronbach's α of the different scales ranged from 0.46 to 0.74. The practice nurses perceived the instrument as useful in daily practice and that it may be improved by further adjustment of patient segments.

CONCLUSION

The HEPRODIA instrument is an aid to assess patient needs concerning health-promoting activities and to facilitate health counseling. Patients and practice nurses can benefit from using the instrument for patient-orientated health-promotion counseling. The psychometric properties of the instrument can be further improved.

Validation of the Diabetes Obstacles Questionnaire (DOQ) to assess obstacles in living with type 2 diabetes in a Belgian population

AIMS

The aim of this study was to validate the Dutch version of the Diabetes Obstacles Questionnaire (DOQ) [H. Hearnshaw, K. Wright, J. Dale, J. Sturt, E. Vermeire, P. Van Royen, Development and validation of the Diabetes Obstacles Questionnaire (DOQ) to assess obstacles in living with Type 2 diabetes, Diabetic Med. 24 (2007) 878-882] assessing people living with type 2 diabetes' obstacles to adhere to treatment recommendations. The goal is to have at one's disposal an instrument to identify obstacles to adhering to treatment recommendations for people living with type 2 diabetes in a Dutch speaking population.

METHODS

Participants were recruited from a pragmatic sample of general practices in Flanders (Belgium). In accordance with the validation procedure in the UK [H. Hearnshaw, K. Wright, J. Dale, J. Sturt, E. Vermeire, P. Van Royen, Development and validation of the Diabetes Obstacles Questionnaire (DOQ) to assess obstacles in living with Type 2 diabetes, Diabetic Med. 24 (2007) 878-882], responders also completed the Dutch version of a quality of life questionnaire (ADDQoL) [C. Bradley, C. Todd, T. Gorton, E. Symonds, A. Martin, R. Plowright, The development of an individualised questionnaire measure of perceived impact of diabetes on quality of life: the ADDQoL. Qual. Life Res. 8 (1999) 79-91] and the Problem Areas in Diabetes (PAID) scale as golden standard [G. Welch, A.M. Jacobson, W.H. Polowsky, The Problem Areas in Diabetes (PAID) scale. An evaluation of its utility. Diabetes Care 20 (1997) 760-766]. Some biomedical variables such as HbA1c were collected also.

RESULTS

Each scale showed sufficient reliability with Cronbach's alpha (>0.76). Each subscale had a factor structure of no more than 4, and a Kaiser-Meyer-Olkin measure of 0.75. Criterion validity was shown by significant correlation with the PAID and construct validity by a correlation with HbA1c. Construct validity has also been shown by significant correlations between ADDQoL and the DOQ Obstacles of Lifestyle changes scale.

CONCLUSIONS

The Dutch version of the DOQ is a feasible and valid instrument for the assessment of obstacles to adherence to treatment recommendations in people living with type 2 diabetes.