Psychometric properties of the Spanish Version of the Diabetes Self-management Assessment Report Tool

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.

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.

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

OBJECTIVES

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

DESIGN

A systematic literature review with a meta-analysis.

DATA SOURCES

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

REVIEW METHODS

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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.

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.

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.

The Diabetes Self-management Assessment Report Tool (D-SMART): process evaluation and patient satisfaction

PURPOSE

The purpose of this article is to present the results of the process evaluation and patient experience in completing the Diabetes Self-management Assessment Report Tool (D-SMART), an instrument within the AADE Outcome System to assist diabetes educators to assess, facilitate, and track behavior change in the provision of diabetes self-management education (DSME).

METHODS

The D-SMART was integrated into computer and telephonic systems at 5 sites within the Pittsburgh Regional Initiative for Diabetes Education (PRIDE) network. Data were obtained from 290 patients with diabetes using the system at these programs via paper-and-pencil questionnaires following baseline D-SMART assessments and electronic system measurement of system performance. Process evaluation included time of completion, understanding content, usability of technology, and satisfaction with the system. Patients were 58% female and 85% Caucasian and had a mean age of 58 years. Fifty-six percent of patients had no more than a high school education, and 78% had Internet access at home.

RESULTS

Most patients reported completing the D-SMART at home (78%), in 1 attempt (86%) via the Internet (55%), and in less than 30 minutes. Seventy-six percent believed the questions were easy to understand, and 80% did not need assistance. Age was negatively associated with ease of use. Moreover, 76% of patients believed the D-SMART helped them think about their diabetes, with 67% indicating that it gave the diabetes educator good information about themselves and their diabetes. Most (94%) were satisfied with the D-SMART. Level of satisfaction was independent of the system being used.

CONCLUSIONS

The D-SMART was easily completed at home in 1 attempt, content was understandable, and patients were generally satisfied with the wording of questions and selection of answers. The D-SMART is easy to use and enhanced communication between the patient and clinician; however, elderly patients may need more assistance. Computer-based and telephonic D-SMARTs appear to be feasible and useful assessment methods for diabetes educators.