PhD, RN, Certified Diabetes Educator, Department of Diabetes Management, Lee's Endocrinology Clinic, Pingtung, Taiwan, ROC.
BSN, RN, Certified Diabetes Educator, Division of Endocrinology & Metabolism, Tri-Service General Hospital, Taipei, Taiwan, ROC.
J Nurs Res. 2019 Oct;27(5):e42. doi: 10.1097/jnr.0000000000000316.
Insulin-naive patients are often reluctant to receive insulin treatment, and even insulin-treated patients frequently have poor rates of adherence to their prescribed insulin injection regimes. Assessing attitudes toward insulin injection may help in the design of interventions that improve the insulin injection behaviors of patients with type 2 diabetes (T2DM). The concept of decisional balance has been associated with behavior in many studies and may be useful in assessing the attitude of patients with T2DM toward insulin injection. Decisional balance for insulin injection (DBII) has not been widely assessed in patients with T2DM.
The aim of this study was to develop an insulin injection (DBII) scale that is valid for insulin-naive and insulin-treated patients and to test the psychometric characteristics of this scale based on the concept of decisional balance.
This cross-sectional study administered an 18-item DBII scale, including pro and con subscales, to 95 insulin-naive and 237 insulin-treated patients in Taiwan. The decisional balance score was calculated as the mean score of the pro subscale minus the mean score of the con subscale. Construct validity was examined using exploratory factor analysis and confirmatory factor analysis; concurrent validity was assessed by examining the association between the score of the DBII scale and the stages of behavioral change and of hemoglobin A1c for, respectively, insulin-naive patients and insulin-treated patients; and reliability was assessed using internal consistency and test-retest reliability.
A 13-item DBII scale supported by exploratory factor analysis and confirmatory factor analysis was developed. The stages of behavioral change and hemoglobin A1c levels were found to be significantly associated with the scores of decisional balance of the 13-item DBII scale for both insulin-naive and insulin-treated patients. The Cronbach's α ranged between .78 and .92.
The 13-item DBII scale is appropriately short and possesses satisfactory validity and reliability for both insulin-naive and insulin-treated patients with T2DM. Healthcare providers may use this scale as a checklist to guide clinical discussions related to insulin therapy with both insulin-naive and insulin-treated patients with T2DM across time.
胰岛素初治患者通常不愿意接受胰岛素治疗，即使接受胰岛素治疗的患者也经常不能很好地坚持其规定的胰岛素注射方案。评估对胰岛素注射的态度可能有助于设计干预措施，改善 2 型糖尿病（T2DM）患者的胰岛素注射行为。在许多研究中，决策平衡的概念与行为相关，可能有助于评估 T2DM 患者对胰岛素注射的态度。T2DM 患者的胰岛素注射决策平衡（DBII）尚未得到广泛评估。
本研究旨在开发一种适用于胰岛素初治和胰岛素治疗患者的胰岛素注射（DBII）量表，并基于决策平衡的概念检验该量表的心理测量学特征。
这项横断面研究向台湾的 95 名胰岛素初治患者和 237 名胰岛素治疗患者发放了包括正、负分量表在内的 18 项 DBII 量表。决策平衡评分的计算方法是正分量表的平均分减去负分量表的平均分。通过探索性因子分析和验证性因子分析检验结构效度；通过检验 DBII 量表评分与胰岛素初治患者行为改变阶段和血红蛋白 A1c 的关系，评估同期效度；通过内部一致性和重测信度评估信度。
通过探索性因子分析和验证性因子分析，开发了一个包含 13 个项目的 DBII 量表。胰岛素初治和胰岛素治疗患者的行为改变阶段和血红蛋白 A1c 水平与 13 项 DBII 量表的决策平衡评分显著相关。Cronbach's α 值介于 0.78 和 0.92 之间。
13 项 DBII 量表对于胰岛素初治和胰岛素治疗的 T2DM 患者既简短又具有适当的有效性和信度。医疗保健提供者可以使用该量表作为检查表，指导与胰岛素治疗相关的临床讨论，适用于不同时间点的胰岛素初治和胰岛素治疗的 T2DM 患者。
