Table 2.

Description of measurements

Outcome and description of measurements
Primary outcome—self-efficacy
Psychosocial Self-efficacy	The Diabetes Empowerment Scale (DES-SF) is an eight-item self-administered measurement that assesses the perceived ability to manage psychosocial issues such as managing stress, coping with emotional distress, engaging with family and friends for support and discussion with healthcare providers.43 Participants rate items on a 4-point Likert scale ranging from 0 (strongly disagree) to 4 (strongly agree). The sum of all items ranged from 0 to 32. Previous research reported the DES-SF Chronbach’s alpha is at 0.84.26
Diabetes management self-efficacy	The Diabetes Management Self-efficacy Scale (DMSES) is a 20-item self-administered measurement that assess self-efficacy in managing specific diabetes self-care behaviours such as glucose monitoring, general and specific diet, medication adherence, exercise and foot care.27 Participants rate items on a 10-point Likert scale ranging from 0 (not at all confident) to 10 (totally confident). The Malay validated DMSES has a Chronbach’s α estimate of 0.951.17
Secondary outcomes
Depression	Patient Health Questionnaire –PHQ-9 is a nine-item self-administered measurement that assseses the presentation of depression symptoms and the impairments related to the symptoms. Participants rate items on a 4-point Likert scale ranging from 0 to 3. The sum of all items range between 0 and 27. The Malay validated PHQ-9 has a Chronbach’s α estimate of 0.70, sensitivity of 87% and specificity of 82%.28
Anxiety	General Anxiety Disorder-7—GAD-7 is a seven-item self-administered measurement that assesses the presentation of anxiety symptoms and the impairments related to the symptoms. Participants rate items on a 4-point Likert scale ranging from 0 to 3. The sum of all items range between 0 and 21. The Malay validated GAD-7 has a Chronbach’s α estimate of 0.74, sensitivity of 76% and specificity of 94%.29
Diabetes-related distress	Problem Areas in Diabetes (PAID)—20 is a 20 item self-administered measurement that assesses emotional problems in patients with diabetes. Participants rate items on a 5-point Likert scale ranging between 0 (not a problem) and 4 (serious problem). The sum of all items range from 0 to 80. The Malay validated PAID-MY 20 has a Chronbach’s α estimate of 0.921.30
Well-being	WHO-5 Well-Being Index (WHO-5) is a five-item self-administered measurement that assesses emotional well-being and mental health.31 Participants rate items on a 5-point Likert scale ranging between 0 (none of the time) and 5 (all of the time). The raw score that ranges from a minimum of 0 (absence of well-being) to a maximum of 25 (maximum well-being) are then multiplied by four to obtain the percentage scale. The recommended cut-off score of ≤50 is an indication of poor well-being.
Self-management behaviours	Summary of Diabetes Self-Care Activities (SDSCA) is an 11 item self-administered measurement that assess aspects of diabetes regimen including general diet, specific diet, exercise, blood glucose testing, foot care and smoking.44 Participants responds based on engagement to self-management behaviours related to diabetes in the last 7 days. The Malay validated SDSCA Chronbach’s α estimate for the main domains ranged between 0.651 and 0.905.33
Glycaemic control	Glycaemic control will be reported in SI units (mmol A1c/mol Hb) that will be collected from patient records. Based on the guideline, the target that needs to be achieved for control of T2DM is a HbA1c level of not more than 6.5%.

Hb, haemoglobin; HbA1c, haemoglobin A1c; T2DM, type 2 diabetes mellitus.