Diabetes problem-solving scale development in an adult, African American sample

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.

Reductions in Management Distress Following a Randomized Distress Intervention Are Associated With Improved Diabetes Behavioral and Glycemic Outcomes Over Time

OBJECTIVE

To explore associations between reductions in diabetes distress (DD) and improvements in glycemic outcomes among adults with type 1 diabetes (T1D) in the context of a DD randomized clinical trial.

RESEARCH DESIGN AND METHODS

Adults with T1D (N = 301) participated in a two-arm trial aimed at reducing DD (DD-focused OnTrack group vs. education-oriented KnowIt group). Mean age was 45.1 years; mean baseline HbA_1c was 8.8% (73 mmol/mol). Individuals were assessed at baseline and 9 months later on DD, self-care, HbA_1c, and frequency of hypoglycemia. Structural equation models evaluated hypothesized pathways among changes in DD, self-care, and glycemic outcomes in the total sample and by intervention group.

RESULTS

Reductions in DD were significantly and independently associated with better self-care, including fewer missed insulin boluses, more frequent insulin adjustment, improved problem-solving skills, more blood glucose monitoring, and greater adoption of continuous glucose monitoring (all P < 0.05). In turn, better self-care was linked with better glycemic outcomes, including fewer episodes of hypoglycemia and improved HbA_1c over time. Fit indices indicated good fit of the model to the data (confirmatory fit index = 0.94, root mean square error of approximation = 0.05), with stronger and more meaningful associations for OnTrack than for KnowIt.

CONCLUSIONS

In the context of an intervention to reduce DD for adults with T1D, results indicate that reductions in DD do not affect glycemic outcomes directly but through improvements in self-care behavior. Findings support the importance of integrating disease management with DD interventions to maximize improvements in glycemic outcomes.

The valorization of non-patent intellectual property in academic medical centers

Turning university research output into useful products such as drugs, devices and diagnostics requires skills, knowledge, and resources traditionally attributed to private industry. When it comes to intangibles such as care delivery models, informatics and algorithms, and the software behind smart wearables, the commercialization challenges are even greater. With notable exceptions, Academic Medical Centers have typically not excelled in advancing commercialization of such non-patent intellectual property (IP). We believe that this is in part because the traditional closed form university IP policy, formulated since Bayh-Dole (1980), is ill-suited to non-patent IP. In this paper, we reflect on the evolving challenges that new forms of healthcare-related discoveries, specifically non-patent IP, are placing on the traditional university intellectual property and technology transfer regime, and to offer suggestions on how universities can begin to modernize their IP policies to support the valorization of non-patent IP.

Toward effective interventions to reduce diabetes distress among adults with type 1 diabetes: Enhancing Emotion regulation and cognitive skills

OBJECTIVE

We tested three models to determine how improvements in emotion regulation (ER) and cognitive skills (CS) as a result of intervention operate to affect reductions in diabetes distress DD.

METHODS

Change data were drawn from the baseline and 9-month T1-REDEEM trial. Adults with type 1 diabetes were recruited from several U.S. states and Toronto, Canada. A primary and two alternative structural equation models were tested to explore the directionality of effect: primary model - changes in ER and CS drive changes in DD; reverse model - changes in DD drive changes in ER and CS; and bidirectional model - changes in ER, CS and DD occur together with no directionality.

RESULTS

All three models displayed a good fit to the data. The primary model indicated 7 significant directional pathways: improvements in ER and CS operate together to drive reductions in DD. The reverse model only indicated that reductions in DD affected changes in one CS variable; and the bidirectional model indicated only that these results were bidirectional. Reductions in all tested domains of DD occurred together.

CONCLUSIONS

Improvements in ER and CS drive reductions in DD.

PRACTICE IMPLICATIONS

Interventions to reduce high DD should focus on improving ER and CS.

The Effectiveness of Self-Management Interventions for Individuals with Low Health Literacy and/or Low Income: A Descriptive Systematic Review

BACKGROUND

With the burden of chronic illness increasing globally, self-management is a crucial strategy in reducing healthcare costs and increasing patient quality of life. Low income and low health literacy are both associated with poorer health outcomes and higher rates of chronic disease. Thus, self-management represents an important healthcare strategy for these populations. The purpose of this study is to review self-management interventions in populations with low income or low health literacy and synthesize the efficacy of these interventions.

METHODS

A systematic review of trials evaluating the efficacy of self-management interventions in populations with low income or low health literacy diagnosed with a chronic illness was conducted. Electronic databases were primarily searched to identify eligible studies. Data were extracted and efficacy summarized by self-management skills, outcomes, and content tailoring.

RESULTS

23 studies were reviewed, with ten reporting an overall positive effect on at least one primary outcome. Effective interventions most often included problem-solving as well as taking action and/or resource utilization. A wide range of health-related outcomes were considered, were efficacious empowerment and disease-specific quality of life were found to be significant. The efficacy of interventions did not seem to vary by duration, format, or mode of delivery or whether these included individuals with low health literacy and/or low income. Tailoring did not seem to impact on efficacy.

DISCUSSION

Findings suggest that self-management interventions in populations with low income or low health literacy are most effective when three to four self-management skills are utilized, particularly when problem-solving is targeted. Healthcare providers and researchers can use these findings to develop education strategies and tools for populations with low income or low health literacy to improve chronic illness self-management.

Development and validation of the hypoglycaemia problem-solving scale for people with diabetes mellitus

OBJECTIVE

To develop and psychometrically test a new instrument, the hypoglycaemia problem-solving scale (HPSS), which was designed to measure how well people with diabetes mellitus manage their hypoglycaemia-related problems.

METHODS

A cross-sectional survey design approach was used to validate the performance assessment instrument. Patients who had a diagnosis of type 1 or type 2 diabetes mellitus for at least 1 year, who were being treated with insulin and who had experienced at least one hypoglycaemic episode within the previous 6 months were eligible for inclusion in the study.

RESULTS

A total of 313 patients were included in the study. The initial draft of the HPSS included 28 items. After exploratory factor analysis, the 24-item HPSS consisted of seven factors: problem-solving perception, detection control, identifying problem attributes, setting problem-solving goals, seeking preventive strategies, evaluating strategies, and immediate management. The Cronbach's α for the total HPSS was 0.83.

CONCLUSIONS

The HPSS was verified as being valid and reliable. Future studies should further test and improve the instrument to increase its effectiveness in helping people with diabetes manage their hypoglycaemia-related problems.

Development and validation of a diabetes self-management instrument for older African-Americans

The objective of this study was to develop and validate a new diabetes self-management instrument for older African-Americans 65 years of age and older. The Self-Care Utility Geriatric African-American Rating (SUGAAR) was developed using the American Diabetes Association's standards for the management of type 2 diabetes in older adults and cognitive interviews with older African-Americans. The instrument underwent extensive review by a panel of experts, two rounds of cognitive interviews, and a pilot test before it was administered in an interview format to 125 community-dwelling older African-Americans. The instrument demonstrated content validity and significant, but modest, convergent validity with items from an established diabetes self-management instrument. Social workers and health care professionals can use the SUGARR to assess diabetes self-management and to identify areas for education and support for older African-Americans with type 2 diabetes.

Development and validation of the diabetes adolescent problem solving questionnaire

OBJECTIVE

Problem solving is a critical diabetes self-management skill. Because of a lack of clinically feasible measures, our aim was to develop and validate a self-report self-management problem solving questionnaire for adolescents with type 1 diabetes (T1D).

METHODS

A multidisciplinary team of diabetes experts generated questionnaire items that addressed diabetes self-management problem solving. Iterative feedback from parents and adolescents resulted in 27 items. Adolescents from two studies (N=156) aged 13-17 were recruited through a pediatric diabetes clinic and completed measures through an online survey. Glycemic control was measured by HbA1c recorded in the medical record.

RESULTS

Empirical elimination of items using principal components analyses resulted in a 13-item unidimensional measure, the diabetes adolescent problem solving questionnaire (DAPSQ) that explained 56% of the variance. The DAPSQ demonstrated internal consistency (Cronbach's alpha=0.92) and was correlated with diabetes self-management (r=0.53, p<.001), self-efficacy (r=0.54, p<.001), and glycemic control (r=-0.24, p<.01).

CONCLUSION

The DAPSQ is a brief instrument for assessment of diabetes self-management problem solving in youth with T1D and is associated with better self-management behaviors and glycemic control.

PRACTICE IMPLICATIONS

The DAPSQ is a clinically feasible self-report measure that can provide valuable information regarding level of self-management problem solving and guide patient education.

Evaluation of the effectiveness of a problem-solving intervention addressing barriers to cardiovascular disease prevention behaviors in 3 underserved populations: Colorado, North Carolina, West Virginia, 2009

INTRODUCTION

In low-income and underserved populations, financial hardship and multiple competing roles and responsibilities lead to difficulties in lifestyle change for cardiovascular disease (CVD) prevention. To improve CVD prevention behaviors, we adapted, pilot-tested, and evaluated a problem-solving intervention designed to address barriers to lifestyle change.

METHODS

The sample consisted of 81 participants from 3 underserved populations, including 28 Hispanic or non-Hispanic white women in a western community (site 1), 31 African-American women in a semirural southern community (site 2), and 22 adults in an Appalachian community (site 3). Incorporating focus group findings, we assessed a standardized intervention involving 6-to-8 week group sessions devoted to problem-solving in the fall of 2009.

RESULTS

Most sessions were attended by 76.5% of participants, demonstrating participant adoption and engagement. The intervention resulted in significant improvement in problem-solving skills (P < .001) and perceived stress (P < .05). Diet, physical activity, and weight remained stable, although 72% of individuals reported maintenance or increase in daily fruit and vegetable intake, and 67% reported maintenance or increase in daily physical activity.

CONCLUSION

Study results suggest the intervention was acceptable to rural, underserved populations and effective in training them in problem-solving skills and stress management for CVD risk reduction.

Problem solving in diabetes self-management and control: a systematic review of the literature

PURPOSE

The purpose of this systematic review is to assess the published literature on problem solving and its associations with diabetes self-management and control, as the state of evidence exists.

DATA SOURCES

PubMed, PsychINFO, and ERIC electronic databases were searched for the years 1990 to the present and for English-language articles, and reference lists from included studies were reviewed to capture additional studies.

STUDY SELECTION

Quantitative and qualitative studies that addressed problem solving as a process or strategy for diabetes self-management were included. Fifty-two studies met the criteria for inclusion.

DATA EXTRACTION

Study design, sample characteristics, measures, and results were reviewed.

DATA SYNTHESIS

Thirty-six studies were quantitative; 16 were conceptual or qualitative. Studies were classified as addressing the problem-solving definition/framework, assessment, intervention, or health care professional issues.

CONCLUSIONS

Problem solving is a multidimensional construct encompassing verbal reasoning/rational problem solving, quantitative problem solving, and coping. Aspects of problem solving can be assessed using newly developed diabetes-specific problem-solving measures for children/adolescents and adults. Cross-sectional studies in adults, but not children/adolescents, provide consistent evidence of associations between problem solving and A1C level. Only 25% of problem-solving intervention studies with children/adolescents and 50% of interventions with adults reported improvement in A1C. Most intervention studies reported an improvement in behaviors, most commonly global adherence in children/adolescents and dietary behavior in adults. Methodological limitations (noninclusion of problem-solving measures, inadequate descriptions of problem-solving interventions, homogenous samples) need to be addressed in future research to clarify the effect of problem solving on diabetes outcomes, identify characteristics of effective interventions, and determine the utility across age and racial/ethnic groups.