Carlton J, Elliott J, Rowen D, Stevens K, Basarir H, Meadows K, Brazier J
School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, Sheffield, S1 4DA, UK.
Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
Health Qual Life Outcomes. 2017 Jul 18;15(1):146. doi: 10.1186/s12955-017-0719-4.
The prevalence of diabetes mellitus (DM) is increasing dramatically, placing considerable financial burden on the healthcare budget of each country. Patient self-management is crucial for the control of blood glucose, which largely determines the chances of developing diabetes-related complications. Self-management interventions vary widely, and a method is required for assessing the impact of self-management. This paper describes the development of a questionnaire intended for use to measure the impact of self-management in diabetes.
An iterative development process was undertaken to identify the attributes of self-management using 5 steps. First, a literature review was undertaken to identify and understand themes relating to self-management of DM to inform a topic guide. Second, the topic guide was further refined following consultation with a Patient and Public Involvement group. Third, the topic guide was used to inform semi-structured interviews with patients with Type 1 DM (T1DM) and Type 2 DM (T2DM) to identify how self-management of DM affects individuals. Fourth, the research team considered potential attributes alongside health attributes from an existing measure (Diabetes Health Profile, DHP) to produce an instrument reflecting both health and self-management outcomes simultaneously. Finally, a draft instrument was tested in a focus group to determine the wording and acceptability.
Semi-structured interviews were carried out with 32 patients with T1DM and T2DM. Eight potential attributes were identified: fear/worry/anxiety, guilt, stress, stigma, hassle, control, freedom, and feeling supported. Four of these self-management attributes were selected with four health attributes (mood, worry about hypos (hypoglycaemic episodes), vitality and social limitations) to produce the Health and Self-Management in Diabetes (HASMID) questionnaire.
HASMID is a short questionnaire that contains eight items each with four response levels to measure the impact of self-management in diabetes for both T1DM and T2DM. The measure was developed using a mixed-methods approach that involved semi-structured interviews with people with diabetes. The measure has high face validity. Ongoing research is being undertaken to assess the validity of this questionnaire for measuring the impact of self-management interventions in economic evaluation.
糖尿病（DM）的患病率正在急剧上升，给各国的医疗保健预算带来了相当大的经济负担。患者自我管理对于血糖控制至关重要，而血糖控制在很大程度上决定了发生糖尿病相关并发症的几率。自我管理干预措施差异很大，因此需要一种方法来评估自我管理的影响。本文描述了一份旨在用于测量糖尿病自我管理影响的问卷的开发过程。
采用迭代开发过程，通过5个步骤确定自我管理的属性。首先，进行文献综述以识别和理解与糖尿病自我管理相关的主题，为主题指南提供信息。其次，在与患者及公众参与小组协商后，对主题指南进行进一步完善。第三，使用主题指南对1型糖尿病（T1DM）和2型糖尿病（T2DM）患者进行半结构化访谈，以确定糖尿病自我管理如何影响个体。第四，研究团队将潜在属性与现有测量工具（糖尿病健康概况，DHP）中的健康属性相结合，以生成一个同时反映健康和自我管理结果的工具。最后，在一个焦点小组中对问卷初稿进行测试，以确定措辞和可接受性。
对32例T1DM和T2DM患者进行了半结构化访谈。确定了8个潜在属性：恐惧/担忧/焦虑、内疚、压力、耻辱感、麻烦、控制、自由和感到得到支持。从这些自我管理属性中选择了4个，与4个健康属性（情绪、对低血糖发作的担忧、活力和社交限制）一起，生成了糖尿病健康与自我管理（HASMID）问卷。
HASMID是一份简短的问卷，包含8个项目，每个项目有4个回答级别，用于测量T1DM和T2DM患者糖尿病自我管理的影响。该测量工具采用混合方法开发，其中包括对糖尿病患者进行半结构化访谈。该测量工具具有较高的表面效度。正在进行的研究旨在评估该问卷在经济评估中测量自我管理干预影响的有效性。
