Measuring diabetes regimen adherence: A psychometric analysis of the self-care inventory

2.50
Hdl Handle:
http://hdl.handle.net/10755/163594
Category:
Abstract
Type:
Presentation
Title:
Measuring diabetes regimen adherence: A psychometric analysis of the self-care inventory
Author(s):
Butler, Heather; Weinger, Katie
Author Details:
Heather Butler, Joslin Diabetes Center, Hopkington, New Hampshire, USA, email: heather.butler@joslin.harvard.edu; Katie Weinger
Abstract:
Purpose: Measuring adherence to diabetes treatment recommendations remains a critical problem for both clinical care and research. Few easy to use instruments with well studied psychometric properties exist. In order to address this issue, we investigated the psychometric properties of the updated Self-Care Inventory (SCI), a 15-item self-report measure of adherence to diabetes treatment recommendations. Responses are rated on a 5-point Likert scale ranging from 1= "I never do this" to 5= "I always do this as recommended without fail". The original SCI had 14 items and rendered a total score and four subscales: (1) blood glucose regulation, (2) insulin and food regulation, (3) exercise, and (4) other precautions. We modified the SCI by updating the language, combining two items, and deleting two items from the original. The specific aim of this study was to determine the reliability and validity of the updated SCI when measuring diabetes regimen adherence for a broad range of adults with diabetes, including older adults (> 60years). Framework: The Theory of Reasoned Action (Aijzen & Fishbein, 1980), which assumes that individuals are rational beings who use information available to them to make informed and rational decisions, provided the theoretical framework for this investigation. Methods & Sample: Subjects who attended regularly scheduled education appointments at the Joslin Diabetes Clinic (n=94; mean age 51 + 15 yrs, range=19-83yrs; 53% female; duration of diabetes = 13 +12.11; HgbA1c = 8.5 + 1.65) with both type 1 (n=46, 56% female) and type 2 (n=48, 50% female) diabetes completed two measures of adherence: the SCI and the Summary of Diabetes Self-Care Activities (SDSCA). The SDSCA also provides a total score and four subscale scores: diet, exercise, glucose monitoring and medication administration. In addition, subjects also completed: the Problem Areas in Diabetes (PAID), a measure of diabetes related emotional distress; Benefits and Barriers scale; and a written assessment of patients' knowledge and understanding of their treatment prescriptions. Results: The updated SCI had high internal consistency (alpha = 0.87); the SDSCA demonstrated a moderate internal consistency (alpha = 0.62). For both the SCI and the SDSCA, education was associated with greater self-reported adherence (SCI r=0.21, p< 0.04; SDSCA r=0.2, p< 0.05). A one-way ANOVA found that gender, age and duration of diabetes were not associated with self-reported adherence on either the SCI (F=0.03, p> 0.7, df=2) or the SDSCA (F=0.67; p> 0.51; df=2). For purposes of comparison, individual items on the SCI were standardized using t-scores and grouped according to the four SDSCA sub-scales: diet, exercise, glucose monitoring and medication administration. The SCI and the SDSCA were correlated on the total scores (r=0.639; p< 0.0001) and each of the four subcategories (diet r=0.25, p< 0.02; exercise r=0.60, p< 0.0001; glucose monitoring r=0.68, p< 0.0001; medication administration r=0.38, p< 0.0003). Adherence using the SCI was associated with glycemic control (HgbA1c) (r=-0.439 (type 1), r=-0.409 (type 2); p< 0.0005) suggesting that subjects in poor glycemic control reported lower adherence to treatment recommendations. Subjects who reported having barriers to adherence and diabetes related emotional distress also reported lower treatment adherence (barriers r= -0.34; p< 0.0015; PAID r= -0.37; p< 0.0004) on the SCI. In this sample, the total score on the SDSCA was associated with barriers to diabetes care requirements (r= -0.33; p< 0.03), but was not associated with glycemic control (r= -0.16; p=0.29) or diabetes related emotional distress (r= -0.21; p=0.19). Responses to the SCI were subjected to an exploratory factor analysis. The principal components method was used to extract the components, and this was followed by Varimax (orthogonal) rotation. Kaiser's criterion (Eigen value of 1 or greater) and scree test suggested two meaningful factors to extract and rotate. The two-factor solution supported the most meaningful factor pattern and accounted for 71% of the total variance. One item ("wearing a medic alert id") did not load on either factor but was retained based on clinical judgment for further investigation. Conclusions & Implications: This study found the updated SCI to be a reliable, valid and useful adjunct to clinical practice and research. The SCI and the SDSCA were correlated suggesting that they are measuring a similar construct [adherence]. However, only the SCI was correlated with glycemic control and diabetes-related distress, suggesting that the SCI is a more clinically relevant indicator of diabetes-related adherence than the SDSCA. Factor analysis of the SCI revealed a two-factor solution, which captured most of the important aspects of diabetes self-management requirements. Two important aspects were missing from the updated SCI: daily foot care and attending yearly ophthalmologic appointments, and should be added in the future. The updated SCI is easy to administer, score and interpret and may be valuable to diabetes educators and other health care clinicians in measuring adherence to diabetes treatment recommendations.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2002
Conference Name:
14th Annual Scientific Sessions
Conference Host:
Eastern Nursing Research Society
Conference Location:
University Park, Pennsylvania, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleMeasuring diabetes regimen adherence: A psychometric analysis of the self-care inventoryen_GB
dc.contributor.authorButler, Heatheren_US
dc.contributor.authorWeinger, Katieen_US
dc.author.detailsHeather Butler, Joslin Diabetes Center, Hopkington, New Hampshire, USA, email: heather.butler@joslin.harvard.edu; Katie Weingeren_US
dc.identifier.urihttp://hdl.handle.net/10755/163594-
dc.description.abstractPurpose: Measuring adherence to diabetes treatment recommendations remains a critical problem for both clinical care and research. Few easy to use instruments with well studied psychometric properties exist. In order to address this issue, we investigated the psychometric properties of the updated Self-Care Inventory (SCI), a 15-item self-report measure of adherence to diabetes treatment recommendations. Responses are rated on a 5-point Likert scale ranging from 1= "I never do this" to 5= "I always do this as recommended without fail". The original SCI had 14 items and rendered a total score and four subscales: (1) blood glucose regulation, (2) insulin and food regulation, (3) exercise, and (4) other precautions. We modified the SCI by updating the language, combining two items, and deleting two items from the original. The specific aim of this study was to determine the reliability and validity of the updated SCI when measuring diabetes regimen adherence for a broad range of adults with diabetes, including older adults (> 60years). Framework: The Theory of Reasoned Action (Aijzen & Fishbein, 1980), which assumes that individuals are rational beings who use information available to them to make informed and rational decisions, provided the theoretical framework for this investigation. Methods & Sample: Subjects who attended regularly scheduled education appointments at the Joslin Diabetes Clinic (n=94; mean age 51 + 15 yrs, range=19-83yrs; 53% female; duration of diabetes = 13 +12.11; HgbA1c = 8.5 + 1.65) with both type 1 (n=46, 56% female) and type 2 (n=48, 50% female) diabetes completed two measures of adherence: the SCI and the Summary of Diabetes Self-Care Activities (SDSCA). The SDSCA also provides a total score and four subscale scores: diet, exercise, glucose monitoring and medication administration. In addition, subjects also completed: the Problem Areas in Diabetes (PAID), a measure of diabetes related emotional distress; Benefits and Barriers scale; and a written assessment of patients' knowledge and understanding of their treatment prescriptions. Results: The updated SCI had high internal consistency (alpha = 0.87); the SDSCA demonstrated a moderate internal consistency (alpha = 0.62). For both the SCI and the SDSCA, education was associated with greater self-reported adherence (SCI r=0.21, p< 0.04; SDSCA r=0.2, p< 0.05). A one-way ANOVA found that gender, age and duration of diabetes were not associated with self-reported adherence on either the SCI (F=0.03, p> 0.7, df=2) or the SDSCA (F=0.67; p> 0.51; df=2). For purposes of comparison, individual items on the SCI were standardized using t-scores and grouped according to the four SDSCA sub-scales: diet, exercise, glucose monitoring and medication administration. The SCI and the SDSCA were correlated on the total scores (r=0.639; p< 0.0001) and each of the four subcategories (diet r=0.25, p< 0.02; exercise r=0.60, p< 0.0001; glucose monitoring r=0.68, p< 0.0001; medication administration r=0.38, p< 0.0003). Adherence using the SCI was associated with glycemic control (HgbA1c) (r=-0.439 (type 1), r=-0.409 (type 2); p< 0.0005) suggesting that subjects in poor glycemic control reported lower adherence to treatment recommendations. Subjects who reported having barriers to adherence and diabetes related emotional distress also reported lower treatment adherence (barriers r= -0.34; p< 0.0015; PAID r= -0.37; p< 0.0004) on the SCI. In this sample, the total score on the SDSCA was associated with barriers to diabetes care requirements (r= -0.33; p< 0.03), but was not associated with glycemic control (r= -0.16; p=0.29) or diabetes related emotional distress (r= -0.21; p=0.19). Responses to the SCI were subjected to an exploratory factor analysis. The principal components method was used to extract the components, and this was followed by Varimax (orthogonal) rotation. Kaiser's criterion (Eigen value of 1 or greater) and scree test suggested two meaningful factors to extract and rotate. The two-factor solution supported the most meaningful factor pattern and accounted for 71% of the total variance. One item ("wearing a medic alert id") did not load on either factor but was retained based on clinical judgment for further investigation. Conclusions & Implications: This study found the updated SCI to be a reliable, valid and useful adjunct to clinical practice and research. The SCI and the SDSCA were correlated suggesting that they are measuring a similar construct [adherence]. However, only the SCI was correlated with glycemic control and diabetes-related distress, suggesting that the SCI is a more clinically relevant indicator of diabetes-related adherence than the SDSCA. Factor analysis of the SCI revealed a two-factor solution, which captured most of the important aspects of diabetes self-management requirements. Two important aspects were missing from the updated SCI: daily foot care and attending yearly ophthalmologic appointments, and should be added in the future. The updated SCI is easy to administer, score and interpret and may be valuable to diabetes educators and other health care clinicians in measuring adherence to diabetes treatment recommendations.en_GB
dc.date.available2011-10-27T11:10:18Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:10:18Z-
dc.conference.date2002en_US
dc.conference.name14th Annual Scientific Sessionsen_US
dc.conference.hostEastern Nursing Research Societyen_US
dc.conference.locationUniversity Park, Pennsylvania, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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