Abstract
Objective The aim of this study was to cross-culturally adapt and validate the Brazilian Portuguese version of SCI-R to adults with type 2 diabetes. Materials and methods The SCI-R is a 15-question survey that reflects how well patients with diabetes have adhered to treatment recommendations. A pretest (n = 40) was first performed to improve comprehension of the survey items. A final version was then self-administered in another 75 adults with type 2 diabetes to determine the survey's reliability and validity according to its association with HbA1c. Finally, we conducted a test-retest reliability analysis over three weeks to stabilize the sample and determine intra-observer variability. Results After the pretest phase, the final sample's (N = 75) mean age was 59.9 ± 7.5 years and mean HbA1c level was 8.6 ± 1.5% (70 ± 16.4 mmol/mol). The initial Cronbach's alpha was 0.61; however, further analysis showed that four items had low item correlation and were excluded from the final version, which increased the Cronbach's alpha to 0.63. In predictive validity analysis, HbA1c levels correlated significantly with total survey scores (r = -0.38, P = 0.001). The intra-class correlation coefficient between baseline and three-week scores was 0.93, which indicates high reproducibility. Conclusions The Brazilian Portuguese version of the SCI-R is a valid tool for measuring treatment adherence in adults with type 2 diabetes.
Highlights
It is estimated that diabetes affects 14.3 million adults in Brazil, which represents 10.2% of the Brazilian population aged 20-79 years [1], ranking high among the health problems in this country [2]
We found no significant differences in age, sex or diabetes duration between participants and decliners, or between the pretest and final samples
We conducted a complementary adjustment process of the Self-Care Inventory – Revised (SCI-R) survey, which had been previously cross-culturally adapted to Brazilian Portuguese and validated for type 1 diabetes [12]
Summary
It is estimated that diabetes affects 14.3 million adults in Brazil, which represents 10.2% of the Brazilian population aged 20-79 years [1], ranking high among the health problems in this country [2]. Despite all the evidence that glycemic control can be optimized and microvascular and macrovascular complications can be prevented [3,4], adherence to diabetes treatment has still been a challenge [5]. In Brazil, most type 2 diabetes patients present poor glycemic control, which is strongly associated with poor adherence to diabetes treatment [6]. Among those treated in the public healthcare system, the hemoglobin A1c (HbA1c) levels of less than 30% were within the American Diabetes Association target [6,7]. Considering that improved treatment adherence could optimize glycemic control [5,9,10], instruments that assess patient compliance are essential. Cultural barriers have limited the available tools for Brazilian adults with type 2 diabetes
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