Table 1.
Self-Report Instruments Used to Measure Self-Care Behaviors of Persons With Type 2 Diabetes Mellitus (T2DM).
| Name | Content areas | # Items | Response Format | Validity | Reliability | Studies, Authors, (Publication Year) |
|---|---|---|---|---|---|---|
| Adherence and Self-Management Monitoring Tool (ASMMT) | Medication and SMBG | 16 | — | Face and content validites | — | Yusuff, Obe, and Joseph (2008) |
| Adherence to Therapeutic Regimen | Medication, exercise, diet, foot care, and SMBG | 68 | 5-point Likert-type | Content validity | Test–retest reliability: .90 | Nesari, Zakerimoghadam, Rajab, Bassampour, and Faghihzadeh (2010) |
| A scale for patients’ assessment of their diabetes self-management | Taking medications, exercising, following an eating plan, SMBG, and foot care | 20 | 5-point Likert-type | Criterion validity: p < .05 (HbA1c), concurrent validity: p < .05 (receipt of necessary diabetes services) | Internal consistency: Cronbach’s α = .68 | Heisler, Smith, Hayward, Krein, and Kerr (2003) |
| Diabetes Care Profile (DCP) | Self-care adherence and diet adherence | 8 | 5-point Likert-type | Criterion validity: r = .28/0.15 (GHb), concurrent validity: r = −.35 (CES-D), r = .23 (social provisions scale), r = .23 (happiness and satisfaction scale) | Internal consistency: Cronbach’s α = .70–.87 (community), .70–.89 (medical center) | Fitzgerald, Davis, et al. (1996) |
| — | Internal consistency: Cronbach’s α = .74–.85 | Fitzgerald, Anderson, et al. (1998) | ||||
| Criterion validity: r = .24/.17 (HbA1c), convergent validity: r = −.43/.13 (Beck Depression Inventory, BDI) r = .19/.29 (Diabetes Family Behavior Checklist, DFBC) | Internal consistency: Cronbach’s α = .58–.76 | Cunningham et al. (2005) | ||||
| — | Internal consistency: Cronbach’s α = .68–.86 | Chasens, Korytkowski, Sereika, and Burke (2013) | ||||
| Diabetes Health Promotion Self-Care Scale (DHPSC) | Interpersonal relationships, diet, SMBG, personal health responsibility, exercise, adherence to the recommended regimens, and foot care | 26 | 5-point Likert-type | Content validity: reviewed by experts, CVI = .94, construct validity: 7 factors accounted for 69.31% of the total variance, concurrent validity: r = .14–.39 (satisfaction subscales of Diabetes Quality of Life), r = .23–.49 (Diabetes Empowerment Scale), r =.10 (HbA1c) | Internal consistency: Cronbach’s α = .78–.94, Item-total correlations: .30–.70 (except for 3 items from the adherence to recommended regimens subscale and 1 item from the foot care subscale), test–retest reliability: ICC = .76–.95 | Wang (2012) |
| Diabetes Self-Care Ability Questionnaire (DSCAQ) | Diet, exercise and activity, SMBG, information and follow-up, hygiene and foot care, and medication-taking routine | 36 | 4-point Likert-type | — | Internal consistency: Cronbach’s α = .83 | Partiprajak, Hanucharurnkul, Piaseu, Brooten, and Nityasuddhi (2011) |
| — | Internal consistency: Cronbach’s α = .87 | Mekwiwatanawong, Hanucharurnkul, Piaseu, and Nityasuddhi (2013) | ||||
| Diabetes Self-management Assessment Report Tool (D-SMART) | Exercise, eating, medication, SMBG, problem solving, barriers to diabetes self-management and living with diabetes | 49 | 4–5-point Likert-type | — | Internal consistency: Cronbach’s α = .65–.80, test–retest reliability: ICC = .83–.89 | Fain (2007) |
| Diabetes Self-Management Instrument (DSMI) | SMBG, self-integration, self-regulation, interaction with providers, and adherence | 35 | 4-point Likert-type | CVI = .90, construct validity: 5 factors accounted for 46% of the total variance | Internal consistency: Cronbach’s α = .94, interitem correlation: .30–.70, test–retest reliability: .73 | Lin, Anderson, Chang, Hagerty, and Loveland-Cherry (2008) |
| Diabetes Self-Management Scale (DSMS) | SMBG, exercise, diet, glucose monitoring, problem solving, and reducing risks | 60 | 5-point Likert-type | CVI = 0.70–1.00 | — | Sousa, Hartman, Miller, and Carroll (2009) |
| Diabetes Self-Care Scale (DSCS) | — | 35 | 6-point Likert-type | Construct validity: 3 factors accounted for 67.2% of the total variance; the meaningfulness of the item endorsability order and the consistency of that order across respondent supported construct validity | Internal consistency: respondent separation reliability = .80, item separation reliability = .99 | N. Lee and Fisher (2005) |
| DSCS(Turkey) | 4-point Likert-type | — | Internal consistency: Cronbach’s α = 0.70 | Karakurt and Kasikci (2012) | ||
| Modified Insulin Management Diabetes, Self-Care Scale (M-IMDSCS) | Medication, exercise, diet, and general management | 30 | 6-point Likert-type | Divergent validity: r = −.37 (HbA1c), r = .83 (self-efficacy) | Internal consistency: Cronbach’s α = .73–.90 | Ludlow and Gein (1995) |
| Diabetes Self-Care Scale (DSC) (Chinese) | Medication, exercise, diet, SMBG, foot care, and prevention of unstable blood sugar | 27 | 5-point Likert-type | — | Internal consistency: Cronbach’s α = .88, test–retest reliability: .91 | Bai, Chiou, and Chang (2009) |
| — | Internal consistency: Cronbach’s α = .90 | Kang et al. (2010) | ||||
| Content validity, construct validity: 6 factors accounted for 74% of the total variance; criterion validity: r = .11 (HbA1c) | Internal consistency: Cronbach’s α = .81, test–retest reliability: ICC = .83 | Wang, Wu, and Hsu (2011) | ||||
| — | Internal consistency: Cronbach’s α = .94 | Huang, Hung, Stocker, and Lin (2013) | ||||
| Disease-Specific Adherence Scale for Diabetes | Following a low-fat or weight loss diet, following a diabetic diet, taking prescribed medications, checking blood for sugar, exercising regularly, checking feet for minor injuries, carrying something with sugar in it, carrying medical supplies for self-care | 8 | 6-point Likert-type | Criterion validity: r = −.33 (blood glucose level), r = −.25 (HbA1c) | Internal consistency: Cronbach’s α = .69 | Kravitz et al. (1993) |
| — | Internal consistency: Cronbach’s α = .61 | Y. Y. Lee and Lin (2009) | ||||
| Revised Adherence in Diabetes Questionnaire (RADQ) | Diet, exercise, medicine, SMBG, and frequency of reexaminations | 10 | 4-point Likert-type | — | Internal consistency: Cronbach’s α = .87 | Zhang et al. (2013) |
| Self-Care Activity Questionnaire | Medication, exercise, diet, and SMBG | 45 | 5–7 point Likert-type, Yes/No | Content validity | Internal consistency: Cronbach’s α = .69–.76 | Tan and Magarey (2008) |
| Self-Care Behavior Scale | Exercise, diet, medication and SMBG, self-care of feet, and prevention of high, and low blood glucose | 26 | 5-point Likert-type | — | Internal consistency: Cronbach’s α = .92 | Huang and Hung (2007) |
| Self-Care Inventory (SCI) | Internal consistency: Cronbach’s α = .53–.81 | Polonsky et al. (1995) | ||||
| SCI-R | Diet, SMBG, medication administration, exercise, low glucose levels, preventive/routine aspects of self-care | 15 | 5-point Likert-type | Content validity, concurrent validity: r = .63 (SDSCA), convergent validity: r = −.37 (HbA1c), r = −.37 (PAID) r = −.30 (perceived barriers to diabetes subscale) r = .25 (self-esteem), r = .47 (self-efficacy), r = −.36 (diabetes-related emotional distress), Construct validity: a large general factor | Internal consistency: Cronbach’s α = 0.87, item-to-total correlations: .34–.67 | Weinger, Welch, Butler, and La Greca (2005) |
| Internal consistency: Cronbach’s α = .85 | Ogbera and Adeyemi-Doro (2011) | |||||
| Adherence to Self-Care Behaviors Questionnaire | Regular clinic attendance, blood tests, medication and/or insulin use, sticking to the recommended diet, and regular physical activity | 10 | 5-point Likert-type | Construct validity: 1 factor model | Internal consistency: Cronbach’s α = .75 | Cohen and Kanter (2004) |
| Summary of Diabetes Self-Care Activities (SDSCA) | Medication, exercise, diet, and SMBG | 12 | 4–7 point Likert-type | construct validity: three-factor explained 67.6% of the variance | Internal consistency: Cronbach’s α = .74 (diet), .85 (exercise), and .75 (SMBG) | Talbot, Nouwen, Gingras, Gosselin, and Audet (1997) |
| Internal consistency: Cronbach’s α = .71 | Gallegos, Ovalle-Berumen, and Vinicio Gomez-Meza (2006) | |||||
| Internal consistency: Cronbach’s α = .71 (diet) and .84(exercise) | Bean, Cundy, and Petrie (2007) | |||||
| Diet | Internal consistency: Cronbach’s α = .68, test–retest reliability: ICC = .73 | Nouwen et al. (2011) | ||||
| SDSCA-revised | Medication, exercise, diet, SMBG, foot care, and smoking | 11 core and 14 optional items | 7-point Likert-type | Internal consistency: Cronbach’s α = .62, item-to-total correlations: .11–.63 | Weinger et al. (2005) | |
| Internal consistency: Cronbach’s α = .80 | Sacco et al. (2007) | |||||
| Internal consistency: Cronbach’s α = .62 | Costa, Pereira, and Pedras (2012) | |||||
| Internal consistency: Cronbach’s α = .61 | Kroese, Adriaanse, and De Ridder (2012) | |||||
| Internal consistency: Cronbach’s α = .65 | Kroese, Adriaanse, Vinkers, van de Schoot, and de Ridder (2014) | |||||
| Diet and exercise | Internal consistency: Cronbach’s α = .67–.89 | Janzen Claude, Hadjistavropoulos, and Friesen, (2014) | ||||
| Diet and exercise | Construct validity: factor analysis yielding two factors | Internal consistency: Cronbach’s α = .65 (exercise)/.75 (diet) | Oftedal, Bru, and Karlsen (2011) | |||
| Diet, exercise, and SMBG | Inter-item correlations: >.56 | Sultan, Attali, Gilberg, Zenasni, and Hartemann (2011) | ||||
| Diet, exercise, and SMBG | Internal consistency: Cronbach’s α = .70–.72 | Trouilloud and Regnier (2013) | ||||
| SDSCA (Chinese Mainland) | 8–25 | 7-point Likert-type | Construct validity: five factors accounted for 91% | Internal consistency: Cronbach’s α = .68, inter-item correlation: .69–.77 | Xu, Savage, Toobert, Wei, and Whitmer (2008) | |
| CVI = .91 | Internal consistency: Cronbach’s α = .83 | Shi, Ostwald, and Wang (2010) | ||||
| — | Internal consistency: Cronbach’s α = .82 | Gao et al. (2013) | ||||
| SDSCA (Chinese Hong Kong) | CVI = .80; Construct validity: eight-factor model | Internal consistency: Cronbach’s α = .62–.98 | Tang, Pang, Chan, Yeung, and Yeung (2008) | |||
| SDSCA (Chinese Taiwan) | — | Internal consistency: Cronbach’s α = .70–.86 | Vivienne Wu et al. (2008), Wu, Courtney, et al. (2007), and Wu, Huang, et al. (2011) | |||
| SDSCA (Korean) | 9 | 7-point Likert-type | Construct validity: four factors explained 64% of total variance. Concurrent validity: r = −.43 (Diabetes Management Self-Efficacy Scale) | Internal consistency: Cronbach’s α = .69 | Choi et al. (2011) | |
| SDSCA (Turkish) | 12 | 7-point Likert-type | Construct validity: factor analysis yielding six factors | Internal consistency: Cronbach’s α = .46–.93 | Kav et al. (2010) | |
| Content validity: CVI = .97 | Internal consistency: Cronbach’s α = .59–.94 | Cosansu and Erdogan (2014) | ||||
| SDSCA (Thailand) | Content validity | Item-total correlation = .43, test–retest reliability: .89 | Keeratiyutawong, Hanucharurnkul, Eramo Melkus, Panpakdee, and Vorapongsathorn (2006) | |||
| — | Internal consistency: Cronbach’s α = .57 (diet)/.94 (medication) | Sowattanangoon, Kochabhakdi, and Petrie (2008) | ||||
| — | Internal consistency: Cronbach’s α = .73 | Nyunt, Howteerakul, Suwannapong, and Rajatanun (2010) | ||||
| — | Internal consistency: Cronbach’s α = .73 | Navicharem (2012) | ||||
| SDSCA (Arabic) | Content validity | — | Jarab, Alqudah, Mukattash, Shattat, and Al-Qirim (2012) | |||
| SDSCA (Maltese) | — | Internal consistency: Cronbach’s α = .50 | Gatt & Sammut (2008) | |||
| SDSCA (Portuguese) | Content validity | Internal consistency: Cronbach’s α = .57 (diet) | Gucciardi, Demelo, Lee, and Grace (2007) | |||
| Diabetes Self-Care Activity Questionnaire (Greek) | Sociodemographic, risk factors, physical and mental health, physician–patient communication, self-care activities, self-care recommendations, and compliance with medical orders | 38 | Content validity, convergent validity: r = .768–.876 (Habit, Attitudes and Knowledge questionnaire); Discriminant validity | Internal consistency: Cronbach’s α = .83, test–retest reliability: ICC = .90 | Intas et al. (2012) | |
| The Diabetes Activities Questionnaire (TDAQ) | Lifestyle, monitoring, and treatment | 13 | Visual analogue scale | Content validity, construct validity: two-factor model | Internal consistency: Cronbach’s α = .82, test–retest reliability: .78, item-total correlation: >.30 (except for 2 items) | Hernandez (1997) |
| Cronbach’s α = .84 | Chlebowy and Garvin (2006) | |||||
| DSBQ | Diet | 89 | 5-point Likert-type | — | Internal consistency: Cronbach’s α = .55–.81 | Taru, Tsutou, Nakawatase, Usami, and Miyawaki (2008) |
| Kristal Food Habits Questionnaire | Diet | 20 | — | — | Internal consistency: Cronbach’s α = .67 | Kroese, Adriaanse, Vinkers, et al. (2014) |
| Modified version of Dobson’s 17-item Short Fat Questionnaire | Diet | — | — | — | Internal consistency: Cronbach’s α = .82 | Clarke (2009) |
| Evaluation Scale for Self-Management, Behavior related to Physical Activity of T2DM (ES-SMBPA-2D) | Physical activity | 38 | 5-point Likert-type | Content validity, construct validity: Factor analysis, criterion validity: r = .14–.16 (IPAQ) | Internal consistency: Cronbach’s α = .56–.90, test–retest reliability: .60–.88 | Nakawatase et al. (2007) |
| Medication Adherence Report Scale (MARS) | Medication | 5 | 5-point Likert-type | — | Internal consistency: Cronbach’s α = .79 | Barnes, Moss-Morris, and Kaufusi (2004) |
| — | Internal consistency: Cronbach’s α = .97 | Clarke (2009) | ||||
| — | Internal consistency: Cronbach’s α = .79 | Aflakseir (2012) | ||||
| — | Internal consistency: Cronbach’s α = .65–.75 | Kroese, Adriaanse, et al. (2012) | ||||
| — | Internal consistency: Cronbach’s α = .83 | Kroese, Adriaanse, Vinkers, et al. (2014) | ||||
| Measurement of Adherence to Treatment (MAT) | Oral Antidiabetics (MAT OADs), Insulin Therapy (MAT insulin) | 14 | 6-point Likert-type | Content validity, criterion-related validity: ROC curves: .83 (MAT OADs), .77 (MAT insulin), sensitivity: .84 (MAT OADs), .60 (MAT insulin), specificity: .35 (MAT OADs), .21 (MAT insulin) | Internal consistency: Cronbach’s α = .84 (MAT OADs), .68 (MAT insulin), item-total correlation: .38–.77(MAT OADs), .20–.53(MAT insulin) | Boas, Lima, & Pace (2014) |
| Morisky Medication Adherence Scale (MMAS-4 item) | 4 | Yes/no | — | Internal consistency: Cronbach’s α = .54 | Parada, Horton, Cherrington, Ibarra, and Ayala (2012) | |
| MMAS-4 item (Chinese) | Content validity, construct validity: one-factor model, convergent validity: association with HbA1c and adherence to diet and physical exercise | Internal consistency: Cronbach’s α = .62 | Wang (2012) | |||
| MMAS-4 item (Arabic) | Content and face validity | — | Jarab et al. (2012) | |||
| MMAS-8 item (Malaysian) | Medication adherence | 8 | Yes/No 5-point Likert-type | Convergent validity: r = .79 (original MMAS), r = −.43 (HbA1c), sensitivity: 78%, specificity: 45% | Internal consistency: Cronbach’s α = .68, test–retest reliability: .82 | Al-Qazaz et al. (2010) |
| MMAS-8 item (Korean) | Medication adherence | 8 | Yes/No 5-point Likert-type | Convergent validity: r = .88 (original MMAS), construct validity: three-factor model explaining 62.4% of the total variance, OR = 2(1.21–3.36; HbA1c), sensitivity (74.1%), specificity (38.3%) | Internal consistency: Cronbach’s α = .66, item-total correlation: .23–.66, test–retest reliability: ICC = .79 | W. Y. Lee et al. (2013) |
| MMAS-8 item (Thai) | Medication adherence | 8 | Yes/No 5-point Likert-type | Convergent validity: r = .77 (3-item MMAS), r = .57 (medication adherence visual analog scale), OR = 1.84 (HbA1c), construct validity: factor analysis, sensitivity (51%), specificity (64%) | Internal consistency: Cronbach’s α = .61, test–retest reliability: .83 | Sakthong, Chabunthom, and Charoenvisuthiwongs (2009) |
| MMAS-8 item (Iran/Persian) | Medication adherence | 8 | Yes/No, 5-point Likert-type | Content validity | Internal consistency: Cronbach’s α: > .70, test–retest reliability: ICC = .8 | Negarandeh, Mahmoodi, Noktehdan, Heshmat, and Shakibazadeh (2013) |
| A scale to measure adherence to self-monitoring of blood glucose | SMBG | 15 | 9-point Likert-type | Content validity, Construct validity: two factors accounted for 43.2% of variance | Internal consistency: Cronbach’s α = .84 | Wagner, Schnoll, and Gipson (1998) |
| The UISESS-B scale | Oral care | 35 | 3-point Likert-type | Content validity, construct validity: 68.85% of variance (habits subscale), 62.29% of variance (self-perception subscale), convergent validity: r = .70 (CPO: a worldwide oral health scale) | Internal consistency: Cronbach’s α = .78–.84, test–retest reliability: ICC = .64–.73 | Salcedo-Rocha, Garcia-de-Alba-Garcia, Velasquez-Herrera, and Barba-Gonzalez (2011) |
Note. OR = odds ratio; SMBG = self-monitoring of blood glucose; ICC = Intraclass correlation coefficient; PAID = Problem Areas in Diabetes Scale; IPAQ = International Physical Activity Questionnaire; ROC = Receiver Operating Characteristics.