Self-Care Inventory Research Articles

A new self-report measure of self-management of type 1 diabetes for adolescents.

The development of instruments to measure self-management in youth with type 1 diabetes has not kept up with current understanding of the concept. This study aimed to report the development and the testing of a new self-report measure to assess the Self-Management of Type 1 Diabetes in Adolescents (SMOD-A). Following a qualitative study, items were identified and reviewed by experts for content validity. A total of 515 adolescents, 13 to 21 years old, participated in a field study by completing the SMOD-A (either once or twice) and additional measures of diabetes-related self-efficacy (Self-Efficacy for Diabetes Scale), quality of life (Diabetes Quality of Life for Youth Questionnaire), self-management (Diabetes Self-Management Profile), and adherence (Self-Care Inventory). Data were collected also on metabolic control (glycosylated hemoglobin [HbA1c]). The content validity index was .93. Exploratory alpha factor analyses revealed five subscales: Collaboration With Parents, Diabetes Care Activities, Diabetes Problem Solving, Diabetes Communication, and Goals (alpha = .71 to .85). The stability of the SMOD-A ranged from .60 to .88 at 2 weeks (test-retest) to .59 to .85 at 3 months. Correlations of SMOD-A subscales with Self-Efficacy for Diabetes Scale-Diabetes; Diabetes Quality of Life for Youth Questionnaire satisfaction, impact, and worry; Diabetes Self-Management Profile; and Self-Care Inventory were generally significant and in the expected direction. Collaboration with parents and HbA1c values were related significantly and positively (r = .11); all other SMOD-A subscales were related significantly and negatively to HbA1c (r = -.10 to -.26), demonstrating that better self-management is associated somewhat with better metabolic control and supporting construct validity of the new measure. The SMOD-A has been found to be a reliable, stable, and valid measure of SMOD-A.

Validity and Reliability of an Adolescent and Parent Rating Scale of Type 1 Diabetes Adherence Behaviors: The Self-Care Inventory (SCI)

Accurate assessment of diabetes regimen adherence behaviors in youth is a challenging endeavor and is limited by a paucity of empirically supported measures. The purpose of this research is to further demonstrate the validity and reliability of the Self-Care Inventory (SCI), a youth and parent report measure of adherence with diabetes self-care behaviors. The SCI was chosen given its ease of implementation, applicability to multiple diabetes regimens, and dual parent/youth formats. Participants were 164 youth with type 1 diabetes and a parent. Measures were administered at regular office visits to a tertiary care diabetes clinic. The SCI has strong psychometric properties, including adequate internal consistency, parent-youth agreement, and test-retest agreement. Relations between the SCI and a structured interview of diabetes adherence (the Diabetes Self-Management Profile; DSMP) and hemoglobin A1c (HbA1c) were strong. In addition to demonstrating strong psychometrics, this research provides independent support for the SCI. Thus, the SCI is consistent with recent criteria proposed by Quittner et al. (Journal of Pediatric Psychology, 33, 916-936) for an empirically supported measure of regimen adherence. Although other methods of accessing adherence may provide more comprehensive assessments, the brevity, ease-of-implementation, and robustness for multiple regimens makes the SCI an ideal tool for clinicians and researchers.

The fit between stress appraisal and dyadic coping in understanding perceived coping effectiveness for adolescents with type 1 diabetes.

This study examined whether perceived coping effectiveness (PCE) was associated with better diabetes management and was higher when adolescents' dyadic coping was matched to shared stress appraisals. There were 252 adolescents with Type 1 diabetes who completed stress and coping interviews where they appraised mothers' and fathers' involvement in stress ownership (mine, indirectly shared, directly shared with parent), in coping (uninvolved, supportive, collaborative, or controlling), and rated their effectiveness in coping. Adolescents completed assessments of depressive symptoms (Children's Depression Inventory), self-care behaviors (Self-Care Inventory), and efficacy of disease management (Diabetes Self-Efficacy). Glycosylated hemoglobin levels were obtained from medical records. Higher PCE was associated with fewer depressive symptoms, self-care behaviors, and efficacy across age and, more strongly for older adolescents' metabolic control. Appraisals of support or collaboration from parents were more frequent when stressors were appraised as shared. PCE was enhanced when dyadic coping with mothers (but not fathers) was consistent with stress appraisals (e.g., shared stressors together with collaborative coping). Stress and coping is embedded within a relational context and this context is useful in understanding the coping effectiveness of adolescents.

Instrumente zur Messung der Selbstpflege bei Patienten mit Herzinsuffizienz. Ergebnisse einer Literaturanalyse

Heart Failure is a frequent disease that is accompanied by much suffering for the patients and high costs for the health care system. An improvement of the health-related self-care is supposed to improve the outcomes of patients with heart failure. In order to evaluate the efficiency of interventions valid and reliable instruments measuring the health-related self-care are needed in practice and research. The aim of the systematic literature review is to create a synopsis of the present nursing assessment instruments for the measurement of the health-related self-care of patients with heart failure and to evaluate these instruments' reliability and validity. With a systematic literature search in three electronic databases and hand-search studies using instruments that measure the health-related self-care of patients with heart failure have been identified. The instruments are described and their reliability and validity are discussed. Five Instruments were identified: European Heart Failure Self-care Behaviour Scale (EHFScBS); Revised Heart Failure Self-care Behaviour Scale (rHFScBS); Heart Failure Self-Care Inventory (HFS-CI), Self-Management of Heart Failure Scale (SMHF); Self-Care of Heart Failure Index (SCHFI). As far as the psychometric properties are concerned, each of these scales has its strengths and weaknesses. The EHFScBS, the HFS-CI, and the SCHFI can be recommended with restriction for use in practice and research. However, further testing in order to evaluate reliability and validity is necessary for all instruments.

Depressive Symptoms and Diabetes Control in African Americans

This study of African Americans with diabetes investigated: (1) the relationship between depressive symptoms and glycemic control; (2) the relationship between depressive symptoms and long-term diabetes complications; (3) the relationship between depressive symptoms and medication usage; and (4) the effects of demographic and diabetes variables on these relationships. One-hundred twenty five African American diabetic adults who were attending health fairs reported demographic and medical history and provided blood samples for A1c assessment of glycemic control. They also completed the Centers for Epidemiological Studies Depression questionnaire, and the Diabetes Self-Care Inventory. After controlling for confounders, higher depressive symptoms were associated with higher A1c, more long-term diabetes complications, and more diabetes medications. Diabetes self-care did not fully account for these relationships. The relationship between depression and poor diabetes control exists in African Americans as it does in Whites. Providers are encouraged to attend to depression in their African American patients with diabetes.

Clinical and Life Quality Differences Between Mexican American Diabetic Patients at a Free Clinic and a Hospital‐Affiliated Clinic in Texas

This paper explores the contribution of personal, cultural, and disease characteristics, diabetes knowledge, number of symptoms, and 2 specific clinics to the explained variance in glycosylated hemoglobin (A1c) and quality of life among Mexican Americans with type 2 diabetes. This descriptive correlational study used hierarchical multiple regression analysis. 87 Mexican American patients with type 2 diabetes were recruited from 2 clinics, 1 hospital-affiliated and 1 free clinic, that served a primarily minority and indigent population. A language-based acculturation scale, the Diabetes Knowledge Questionnaire-24, Diabetes Symptom Self-Care Inventory, and Self-Anchoring Striving Scale were administered in one-on-one interviews. Medical records were reviewed for recent A1c and health history. The participants' clinic explained an additional 13% of the variance in A1c and 6% of the variance in quality of life after controlling for gender, acculturation, time since diagnosis, number of diabetes medications, diabetes knowledge, and number of symptoms. Clinics differed in patient characteristics, beyond the variables entered in the regression model, and in their care delivery. Clinic characteristics and their influence on diabetes outcomes should be explored to maximize patients' abilities to steer the course of their diabetes away from complications.

Brief report: The relationship of parental support and conflict to physical activity in preadolescents with type 1 diabetes.

To use structural equation modeling to provide a preliminary examination of the relationship between parental support and conflict regarding physical activity behaviors in preadolescents with type 1 diabetes. Parent-child dyads (n = 85, M child age = 10.8) completed physical activity items from the Diabetes Family Behavior Scale, Diabetes Related Conflict Scale, and Self-Care Inventory. Children completed physical activity items from the Center for Disease Control's Youth Risk Behavior Surveillance System, and activity was further measured via 24 hr recall interviews assessing physical activity behavior on a typical day. Parental conflict was related to less frequent physical activity, whereas parental support was related to more frequent physical activity. In this exploratory study, parental conflict and support for physical activity were related to physical activity in preadolescents with type 1 diabetes. Further research and development of interventions aimed at improving parental support and decreasing conflict around physical activity are warranted.

Role of Parental Monitoring in Understanding the Benefits of Parental Acceptance on Adolescent Adherence and Metabolic Control of Type 1 Diabetes

This study examined 1) whether the benefits of mothers' and fathers' accepting relationships with their adolescents regarding diabetes control were due to parental monitoring and 2) how parents together may provide sufficient acceptance and monitoring for diabetes management. Adolescents aged 10-14 years with type 1 diabetes (n = 185) and their mothers (n = 185) and fathers (n = 145) completed assessments of parental acceptance and monitoring of diabetes tasks. Adolescents completed a modified version of the Self-Care Inventory (1) to measure adherence. A1C scores were used as a marker of glycemic control. Mediational analyses revealed that the benefits of adolescents' reports of fathers' acceptance on A1C and mothers' and fathers' acceptance on better adherence were partially mediated by monitoring. Both mothers' and fathers' monitoring and fathers' acceptance had independent effects in predicting adherence. However, only fathers' monitoring had an independent effect on A1C. The effect of fathers' monitoring on A1C occurred as fathers were monitoring at a lower level than mothers. Mothers' and fathers' reports of their own acceptance and monitoring were not associated with A1C or adherence. Results reveal the importance of fathers' acceptance and monitoring in diabetes management, a role that should be encouraged, despite the little attention it has received.

The impact of apathy on glycemic control in diabetes: A cross-sectional study

Objective Diabetes mellitus is a major public health problem with a prevalence of 6–7%. Self-care behaviors play a major role in the control of diabetes. Apathy is characterized by loss of initiative and motivation. Apathy may interfere with self-care behavior and glycemic control. The primary objective was to determine the prevalence of apathy in patients with diabetes. The secondary objective was to determine if there was an association between clinically significant apathy and factors that affect glycemic control. Research design and methods We conducted a cross-sectional study of 100 patients with diabetes who were assessed with the Apathy Evaluation Scale-Clinician version (AES-C), the Hamilton Depression Scale (HAM-D), and the Self-Care Inventory (SCI). For this study we defined clinically significant apathy as AES-C score of >30. We excluded patients with a HAM-D score of >14 ( n = 19) to avoid confounding from depression. T-tests were used to compare clinical characteristics between subjects with and without apathy. Multiple linear regression modeling was used to investigate the association between clinically significant apathy and factors that affect glycemic control. Results Fifty (61.7% of 81) patients had clinically significant apathy. Compared to the non-apathetic patients, those with apathy had a higher mean BMI (30.5 kg/m 2 versus 34.1 kg/m 2 ( p = 0.03)) and were less likely to adhere to an exercise plan ( p = 0.01) or insulin regimen ( p = 0.003). After adjustment for age, BMI, cholesterol, mild depression and the average Self-Care Index score, the mean HbA1C level was 0.66% greater for apathetic compared to non-apathetic subjects ( P = 0.08). Conclusion Apathy is highly prevalent in patients with diabetes without depression. Apathy may have a negative impact on self-care behaviors and diabetes control.

Symptom Prevalence and Treatments Among Mexican Americans With Type 2 Diabetes

The purpose of this study was to examine the prevalence of diabetes-related symptoms among Mexican Americans with type 2 diabetes, their perceptions of symptom seriousness, treatments used to self-manage the symptoms, and ratings of treatment effectiveness. As part of a larger descriptive correlational study conducted with 87 Mexican American adults in a southwest metropolitan area, data were collected during one-on-one interviews during outpatient visits using the Diabetes Symptom Self-care Inventory and analyzed with descriptive methods, t tests, and chi(2)s. Participants experienced 4.9 diabetes-related symptoms in a 30-day period and used a variety of treatments to self-manage the symptoms. Many of the self-management strategies were not appropriate for the most common causes of the symptoms. Few people tested their blood glucose levels in response to symptoms even though most owned glucometers. Most people who experience diabetes symptoms used self-care to treat the symptoms, did not verify the cause of the symptom, and perceived their treatments as effective. The appropriateness of the treatments used cannot be evaluated without knowing the etiology of the symptom for a particular person and time. Clinicians must assess symptoms and their treatments to best develop effective individualized treatments.

Psychosocial and Demographic Factors Related to Health Behaviors in the 1st Trimester

To explore the relationship of psychosocial and demographic variables to health behaviors in early pregnancy. First trimester findings presented from a prospective study of weight gain in pregnancy. A comprehensive health care system in central Texas. 114 pregnant women (75% white, 13% African American, 10% Hispanic, 2% Asian) of 12 weeks gestation or less. Self-Care Inventory, which includes diet/eating, substance abuse, recklessness, hygiene-related practices, sleep/rest, and exercise behaviors. In regression analysis the final model of demographic and psychosocial variables showed that higher depressive symptoms, lower internal locus of control for fetal health, and lower family income were related to poorer health behaviors in the 1st trimester of pregnancy. Health behaviors in early pregnancy may be affected by psychosocial factors such as depressive symptoms. Greater emphasis should be given to such factors in research and prenatal assessments.

Self-care agency and factors related to this agency among patients with coronary heart disease

The aim of this study was to assess the self-care agency and factors related to this agency among patients with coronary heart disease ( N = 250) measured with a self-care inventory (Self-as-Carer Inventory, SCI). A secondary aim was to analyze the ability of the SCI inventory based on Orem's self-care deficit theory to measure the self-care agency of patients with coronary heart disease. Factor analysis yielded four factors which represent the key aspects of self-care, such as evaluation, implementation, decision-making, significance of knowledge, attitudes, motivation and physical prerequisites of self-care. The most important precondition for self-care in our study was ‘appreciation of and motivation to self-care’. This factor had numerous correlations with the background factors. Age, sex, socioeconomic status, employment status, health behavior, such as alcohol use and smoking, other diseases, such as diabetes, and satisfaction with sex life were related to the patients' self-care agency. It can be concluded that the self-care agency of our patients was moderate and many background factors were related to it. The SCI inventory seems to cover the self-care requirements of these patients, but the clinical use of SCI is precarious. The items are still too abstract and the questionnaire is therefore too difficult to fill in for many patients.

Adolescents With Diabetes: Gender Differences in Psychosocial Functioning and Glycemic Control

This study evaluated gender differences in glycemic control among adolescents with insulin-dependent diabetes mellitus (IDDM). Drawing upon a conceptual model, the role of diabetes-specific and psychological variables in predicting gender differences in adolescents' glycemic control was examined. Following routine appointments for medical care, 42 adolescents with IDDM completed several measures: Test of Diabetes Knowledge and Problem Solving-Revised; Self-Care Inventory; Beck Depression Inventory; and the State-Trait Anxiety Inventory. Metabolic control was assessed via HbA[sub 1c] assays. Findings revealed that girls were in worse metabolic control than boys and reported more symptoms of depression and anxiety. Furthermore, gender differences in metabolic control could be explained by the greater depressive symptomatology reported by adolescent girls. Possible reasons for the linkage between depression and poor metabolic control are discussed, as well as directions for future research and clinical implications.