Development and evaluation of a psychometric instrument to assess problems related to illness acceptance in diabetes: the Denial versus Integration of Diabetes Scale (DIDS).

Professorship/Faculty: Clinical Psychology and Psychotherapy  
Authors: Schmitt, Andreas; Reimer, Andre; Ehrmann, Dominic; Kulzer, Bernhard ; Haak, Thomas; Hermanns, Norbert
Publisher Information: Bamberg : OPUS
Year of publication: 2016
Pages / Size: 1 pdf-Datei (1 S.)
Source/Other editions: Ursprünglich in: Diabetologia 58 (2015) Supplement 1, S456 (946-P)
Year of first publication: 2015
Language(s): English
Licence: German Act on Copyright 
DOI: 10.1007/s00125-015-3687-4
URN: urn:nbn:de:bvb:473-opus4-465215
Document Type: Other
Background and aims: Insufficient diabetes acceptance has been associated
with reduced self-care and glycaemic control. However, satisfactory
tools to measure diabetes acceptance are lacking. Therefore, the
Denial versus Integration of Diabetes Scale (DIDS) was developed. This
report presents its development and preliminary evaluation.
Materials and methods: 56 items were generated and revised based on
patient feedback and expert reviews (27 directed towards acceptance/
integration, e. g. ‘I accept diabetes as a part of my life’, 29 towards
denial/non-acceptance/avoidance, e. g. ‘I often push diabetes to the back
of my mind’). A four-point Likert scale (3 - ‘applies to me very much’ to 0
- ‘does not apply to me’) was used for responses. Negatively keyed items
were reverse-scored; hence, higher scores indicate higher acceptance. The
items were tested in a pilot study with 222 patients (age 49±16 y.; 49%
female; BMI 30±7; 64% type 1 DM; duration 17±11 y.; HbA1c 8.5±
1.7%) to exclude unsatisfactory items and define the scale. A subsequent
validation study is recruiting; at the time of this report, 66 patients (age 48
±13 y.; 46% female; BMI 28±5; 62% type 1 DM; duration 14±10 y.;
HbA1c 8.0±1.0%) had been included, providing data on diabetes nonacceptance
(AADQ), self-care (DSMQ), treatment satisfaction (DTSQ),
diabetes distress (PAID), depression (PHQ-9) and HbA1c (central lab).
Analyses comprised item and scale properties, exploratory factor analyses
(EFA), correlations and t-Test.
Results: Item selection: Initially, 5 items were excluded for psychometric
problems. Through EFA, 8 items were excluded for loadings on noninterpretable
factors, finally yielding an interpretable four-factor structure.
Based on this, 11 items were excluded for poor statistical or semantic fit
and 4 for redundancy, leading to the final 28-item scale. Scales/reliability:
EFA of the selected items yielded four factors (71% explained variance),
interpreted as ‘acceptance/integration’ (7 items, Cronbach’s α=0.93),
‘treatment motivation’ (7 items, α=0.93), ‘denial/defence’ (7 items, α=
0.91) and ‘emotional suffering’ (7 items, α=0.92). The derived subscales
were highly correlated, providing summing to a reliable total score (α=
0.97). Reliability was again tested on the validation sample, yielding the
following α coefficients (scales in above order): 0.91, 0.91, 0.90, 0.87 and
0.96. Validity: A correlation of -0.76 (P<0.01) was found with the
AADQ, a measure of diabetes non-acceptance. The correlation with
HbA1c was -0.45 (P<0.01). Patients with higher DIDS scores (suggesting
higher acceptance; n=34) compared to those with lower ones (n=32;
median split) reported better self-care, particularly regarding diet (6.4±
1.9 vs. 4.0±2.0, P<0.01), glycaemic self-management (8.7±1.9 vs. 7.1±
2.3, P<0.01) and physician visiting (9.2±1.3 vs. 7.9±3.3, P<0.01), and
showed better glycaemic control (HbA1c: 7.6±1.1 vs. 8.3±1.1%,
P<0.05). They also reported higher treatment satisfaction (30±4 vs. 24
±6), less diabetes distress (21±15 vs. 37±16) and less depressive symptoms
(6±4 vs. 9±6); all P<0.01.
Conclusion: The DIDS appears reliable and valid in assessing problems
related to illness acceptance in both major types of diabetes. It may help
explain inadequate self-care and suboptimal glycaemic control. Further
data to expand these initial findings are being collected.
Peer Reviewed: Ja
International Distribution: Ja
Release Date: 19. April 2016

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