Abstract
ObjectivesTo develop and evaluate the psychometric properties of a Chinese questionnaire which assesses the barriers and enablers to commencing insulin in primary care patients with poorly controlled Type 2 diabetes.Research Design and MethodQuestionnaire items were identified using literature review. Content validation was performed and items were further refined using an expert panel. Following translation, back translation and cognitive debriefing, the translated Chinese questionnaire was piloted on target patients. Exploratory factor analysis and item-scale correlations were performed to test the construct validity of the subscales and items. Internal reliability was tested by Cronbach’s alpha.ResultsTwenty-seven identified items underwent content validation, translation and cognitive debriefing. The translated questionnaire was piloted on 303 insulin naïve (never taken insulin) Type 2 diabetes patients recruited from 10 government-funded primary care clinics across Hong Kong. Sufficient variability in the dataset for factor analysis was confirmed by Bartlett’s Test of Sphericity (P<0.001). Using exploratory factor analysis with varimax rotation, 10 factors were generated onto which 26 items loaded with loading scores > 0.4 and Eigenvalues >1. Total variance for the 10 factors was 66.22%. Kaiser-Meyer-Olkin measure was 0.725. Cronbach’s alpha coefficients for the first four factors were ≥0.6 identifying four sub-scales to which 13 items correlated. Remaining sub-scales and items with poor internal reliability were deleted. The final 13-item instrument had a four scale structure addressing: ‘Self-image and stigmatization’; ‘Factors promoting self-efficacy; ‘Fear of pain or needles’; and ‘Time and family support’.ConclusionThe Chinese Attitudes to Starting Insulin Questionnaire (Ch-ASIQ) appears to be a reliable and valid measure for assessing barriers to starting insulin. This short instrument is easy to administer and may be used by healthcare providers and researchers as an assessment tool for Chinese diabetic primary care patients, including the elderly, who are unwilling to start insulin.
Highlights
The global burden of diabetes mellitus is rapidly increasing and it is estimated that worldwide, over 285 million adults suffer from Type 2 diabetes mellitus (T2DM) [1]
The translated questionnaire was piloted on 303 insulin naıve Type 2 diabetes patients recruited from 10 governmentfunded primary care clinics across Hong Kong
Using exploratory factor analysis with varimax rotation, 10 factors were generated onto which 26 items loaded with loading scores . 0.4 and Eigenvalues
Summary
The global burden of diabetes mellitus is rapidly increasing and it is estimated that worldwide, over 285 million adults suffer from Type 2 diabetes mellitus (T2DM) [1]. T2DM is a metabolic condition characterised by insulin resistance causing reduced responsiveness to the effect of insulin on peripheral tissues, resulting in high blood sugar levels. T2DM has become a major public health problem in the Chinese, with prevalence rates in China rising sharply in the past decade to approximately 9.7% (accounting for approximately 92.4 million adults) [2]. Located on the Pearl River Delta, Hong Kong is a Special Administrative Region of the People’s Republic of China, with a population which is over 95% ethnically Chinese. Prevalence estimates for T2DM in Hong Kong adults range from 2% in people aged , 35 years to over 20% in those . Prevalence estimates for T2DM in Hong Kong adults range from 2% in people aged , 35 years to over 20% in those . 65 years [3,4]
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