评估 2 型糖尿病管理中的自我效能感：糖尿病管理自我效能量表（IT-DMSES）意大利版本的验证。
Assessing self-efficacy in type 2 diabetes management: validation of the Italian version of the Diabetes Management Self-Efficacy Scale (IT-DMSES).
机构信息
Department of Biomedical and Neuromotor Sciences, Section of Hygiene and Biostatistics, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK.
出版信息
Health Qual Life Outcomes. 2018 Apr 23;16(1):71. doi: 10.1186/s12955-018-0901-3.
BACKGROUND
Being highly self-efficacious is a key factor in successful chronic disease self-management. In the context of measuring self-efficacy in type 2 diabetes management, the Diabetes Management Self-Efficacy Scale (DMSES) is the most widely used scale. The aim of this study was to adapt the English version of the scale to Italian and to evaluate the psychometric properties of the Italian version of DMSES in type 2 diabetes (IT-DMSES).
METHODS
We conducted a cross-sectional study of people with type 2 diabetes attending the Endocrine-Metabolic Disease Care Unit of the Internal Medicine Department of San Marino State Hospital between October 2016 and February 2017. Patients completed a socio-demographic and clinical data form, the IT-DMSES and 3 self-report questionnaires measuring diabetes distress (PAID-5), psychological well-being (WHO-5) and depression (PHQ-9). Psychometric testing included construct validity (principal component analysis), internal consistency (Cronbach's α coefficient) and convergent/discriminant validity (Spearman's correlation coefficient). Decision tree analysis was performed to classify patients into homogeneous subgroups of self-efficacy based on their demographic and clinical characteristics.
RESULTS
Participants were 110 males and 55 females, mean age of 65.2 years (SD ± 9), 56.9% had been diagnosed for 1-15 years, 63% had HbA1c level > 53 mmol/mol. Two main factors underlain the construct of self-efficacy in diabetes management: 'Disease Management' and "Lifestyles Management". Disease Management had a good reliability (α = .849) and Lifestyle Management had an excellent reliability (α = .902) indicating that the instrument is internally consistent. A negative and weak correlation was found between Lifestyle management, PAID-5 (r = - 0.258, p = < 0.01) and PHQ-9 (r = - 0.274, p = < 0.01) and a positive one with WHO-5 (r = 0.325, p < 0.01) supporting convergent validity. Disease management was uncorrelated with PAID-5 (r = - 0.142, p = 0.083), PHQ-9 (r = - 0.145, p = 0.076) and weekly correlated with WHO-5 (r = 0.170, p = 0.037) confirming discriminant validity. Higher levels of self-efficacy in lifestyle management were found in patients diagnosed for at least 1 year up to 15 years and aged > 65 years and the poorest self-efficacy was found in males < 65 years.
CONCLUSIONS
Results support the validity and reliability of IT-DMSES. The scale can be used in research and clinical practice to monitor type 2 diabetes self-management over time.
背景
高度的自我效能感是成功管理慢性疾病的关键因素。在衡量 2 型糖尿病管理中的自我效能感方面，糖尿病管理自我效能量表（DMSES）是使用最广泛的量表。本研究旨在将该量表的英文版本改编为意大利语，并评估其在 2 型糖尿病患者中的心理测量特性（IT-DMSES）。
方法
我们对 2016 年 10 月至 2017 年 2 月期间在圣马力诺国家医院内科内分泌代谢疾病护理单元就诊的 2 型糖尿病患者进行了一项横断面研究。患者完成了一份社会人口统计学和临床数据表格、IT-DMSES 和 3 份自我报告问卷，分别测量糖尿病困扰（PAID-5）、心理幸福感（WHO-5）和抑郁（PHQ-9）。心理测量测试包括结构有效性（主成分分析）、内部一致性（Cronbach's α 系数）和收敛/判别有效性（Spearman 相关系数）。决策树分析用于根据患者的人口统计学和临床特征将其分类为自我效能感的同质亚组。
结果
参与者包括 110 名男性和 55 名女性，平均年龄为 65.2 岁（标准差±9），56.9%的患者确诊时间为 1-15 年，63%的患者糖化血红蛋白水平>53mmol/mol。糖尿病管理自我效能的结构有两个主要因素：“疾病管理”和“生活方式管理”。疾病管理具有良好的可靠性（α=0.849），生活方式管理具有极好的可靠性（α=0.902），表明该工具具有内部一致性。生活方式管理与 PAID-5（r=-0.258，p<0.01）和 PHQ-9（r=-0.274，p<0.01）呈负相关且较弱，与 WHO-5 呈正相关（r=0.325，p<0.01），支持收敛有效性。疾病管理与 PAID-5（r=-0.142，p=0.083）、PHQ-9（r=-0.145，p=0.076）无相关性，与 WHO-5 呈每周相关性（r=0.170，p=0.037），证实了判别有效性。在至少确诊 1 年至 15 年和年龄>65 岁的患者中，生活方式管理的自我效能感水平较高，而在年龄<65 岁的男性患者中，自我效能感水平最差。
结论
结果支持 IT-DMSES 的有效性和可靠性。该量表可用于研究和临床实践，以随时间监测 2 型糖尿病的自我管理。
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