Division of Research, Kaiser Permanente Northern California, Oakland, California.
Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
Pediatr Diabetes. 2019 Nov;20(7):1007-1015. doi: 10.1111/pedi.12898. Epub 2019 Jul 29.
Adaptive diabetes-specific attitudes and behaviors, known as diabetes strengths, relate to positive self-management and quality of life outcomes in type 1 diabetes (T1D), but have not been studied in preadolescence. To facilitate strengths-based care and research on this topic, we developed and evaluated the psychometric properties of a measure of diabetes strengths for children age 9 to 13.
Participants were 187 children receiving care for T1D at a tertiary care children's hospital. They completed the 12-item self-report Diabetes Strengths and Resilience scale for children (DSTAR-Child), which we adapted from a measure validated for adolescents. Youth completed the DSTAR-Child twice, and measures of relevant constructs at baseline: general and diabetes-related quality of life, depressive symptoms, and diabetes distress. Parents rated children's engagement in self-management behaviors and general resilience. We extracted HbA1c from the medical record.
The DSTAR-Child total score demonstrated reliability, including internal consistency and stability across two time points. The total score was significantly associated in expected directions with psychosocial measures and glycemic control but not self-management behaviors. In confirmatory factor analyses, the best-fitting structure contained two latent factors tapping intrapersonal and interpersonal strengths. Resulting subscale scores also appeared reliable and valid.
This brief, practical measure of diabetes strengths demonstrated sound psychometric properties. Diabetes strengths appeared unrelated to self-management behaviors, perhaps because of the primary role of adult caregivers in T1D management for preadolescents. As a research and clinical tool, the DSTAR-Child can facilitate greater understanding of diabetes strengths and inform strengths-based strategies to foster resilient T1D outcomes.
适应糖尿病的特殊态度和行为，称为糖尿病优势，与 1 型糖尿病（T1D）的积极自我管理和生活质量结果有关，但在青春期前尚未研究过。为了促进这一主题的基于优势的护理和研究，我们开发并评估了一种适用于 9 至 13 岁儿童的糖尿病优势测量方法的心理测量特性。
参与者是在一家三级儿童保健医院接受 T1D 治疗的 187 名儿童。他们完成了 12 项自我报告的儿童糖尿病优势和韧性量表（DSTAR-Child），该量表是从为青少年验证的量表改编而来的。青少年两次完成 DSTAR-Child，并在基线时完成相关构念的测量：一般和糖尿病相关的生活质量、抑郁症状和糖尿病困扰。父母评估孩子参与自我管理行为和一般适应力的情况。我们从病历中提取 HbA1c。
DSTAR-Child 总分表现出可靠性，包括内部一致性和两个时间点的稳定性。总分与心理社会测量和血糖控制呈预期方向显著相关，但与自我管理行为无关。在验证性因素分析中，最佳拟合结构包含两个潜在因素，分别涉及内在力量和人际力量。由此产生的分量表得分也似乎可靠和有效。
这种简短、实用的糖尿病优势测量方法具有良好的心理测量特性。糖尿病优势似乎与自我管理行为无关，这可能是因为在青少年时期，成年人在 T1D 管理中起着主要作用。作为一种研究和临床工具，DSTAR-Child 可以促进对糖尿病优势的更深入了解，并为培养有弹性的 T1D 结果提供基于优势的策略。
