Mean Scores and Standard Deviation Scores for DSEQ Questions
Mean Scores and Standard Deviation Scores for DSEQ Questions
The DSEQ consists of questions answered on a six point Likert scale ranging from ‘never’ to ‘always’. Items are scored using a 6 point scale with “0” as “Never” and “5” as “Always”.
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The questionnaire asks questions about living with diabetes. For each question asked, there are two columns to answer. One column asks how important you think that it is to do the action listed. The other column asks how sure you are that you can do the action listed. Respondents circled one answer in both columns for each question.
Mean and standard deviation scores are given for each item (question) of the DSEQ for belief and action for the initial test (Test A) of the survey sample in Table 3. Detailed descriptive statistics are provided for each item of the DSEQ for the initial testing, Test A (n=478 with 186 using insulin) and for the repeat testing, Test B (n= 332 with 135 using insulin) of the survey sample in Appendix 1. Reviewing the items individually may be useful in understanding the concerns of respondents. Scores on individual items may clarify respondent’s perceptions about belief in the importance of aspects of diabetes care and their ability in performing that skill or communicating about an aspect of diabetes. For example adjusting diabetes care when having the flu (# 3), giving the correct amount of insulin when having a cold or the flu (#56), exercising when one doesn’t feel like it (# 17), and being able to solve problems resulting from diabetes (# 41), have close to a full point of difference in belief and action ratings. Statistically significant differences between belief and action scores are given by scale (p.21). It is also interesting to note that there is little difference in belief and action scores and narrower standard deviation scores for the insulin questions (#53 to 58) with the exception of #56 that relates to managing insulin when having the flu.
Table 3
Mean and Standard Deviation Scores for DSEQ Scale Items
Item
Number
Test A Results DSEQ Statement
Mean Belief
Standard Deviation Belief
Mean Action
Standard Deviation Action
1. Prevent low blood sugar reactions when exercising. 4.554 0.896 3.667 1.158 2. Figure out what to do when blood sugar is high. 4.650 0.731 3.702 1.230 3. Adjust diabetes self-care when having a cold or flu. 4.247 1.038 3.255 1.297 4. Figure out what to do when blood sugar is low. 4.729 0.752 4.228 1.122 5. Fit diabetes plan into usual lifestyle. 4.611 0.689 3.826 0.916 6. Follow diabetes plan when daily routine changes. 4.427 0.801 3.480 0.998
7. Resist overeating or missing meals when I am anxious or nervous.
8. Ask for support from family / friends in keeping diabetes routine.
4.406 0.892 3.410 1.242 4.020 1.177 3.448 1.393
9. Check feet every day. 4.122 1.123 3.849 1.250
10. Do activities that I enjoy while taking care of my diabetes.
4.443 0.783 3.939 1.054
11. Manage diabetes plan when feeling sad. 4.315 0.975 3.579 1.177 12. Follow my way of eating when at a party. 4.354 0.826 3.377 1.057 13. Exercise several times a week. 4.572 0.837 3.590 1.372
14. Resist overeating or missing meals when depressed or down.
4.416 0.895 3.504 1.245
15. Apply proper lotion to feet. 4.016 1.220 3.628 1.393 16. Take care of my diabetes when I am frustrated. 4.438 0.882 3.645 1.052 17. Exercise when I don’t feel like it. 4.246 0.959 2.934 1.311
18. Talk about the effect of diabetes on my life with family / friends.
3.787 1.247 3.400 1.386
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Item
Number
Test A Results DSEQ Statement
Mean Belief
Standard Deviation Belief
Mean Action
Standard Deviation Action
19. Know about medications that I take for diabetes. 4.692 0.796 4.275 1.140 20. Eat meals at the same time every day. 4.357 0.879 3.633 1.159
21. Stay on my eating plan when staying with family / friends.
4.349 0.842 3.482 1.062
22. Feel sure of my ability to manage diabetes. 4.622 0.677 3.847 1.084 23. Cut toe nails the right way. 4.406 0.984 3.874 1.364 24. Test blood when away from home. 4.603 0.843 4.306 1.047 25. Recognize when blood sugar is high. 4.690 0.698 4.038 1.156
26. Stay on my meal plan when people around me don’t know that I have diabetes.
27. Exchange one food for another in the same food group.
28. Be active when there are a lot of demands at home or at work.
4.456 0.848 3.818 1.044 4.194 1.012 3.516 1.289 4.284 0.895 3.372 1.210
29. Carry out daily diabetes care. 4.598 0.754 4.030 1.020 30. Stop a low blood sugar reaction when having one. 4.741 0.771 4.157 1.219
31. Know when to call a health professional about foot problems.
4.642 0.770 4.139 1.168
32. Plan how to handle delayed meals. 4.412 0.841 3.808 1.031
33. Avoid overeating or missing meals when angry or upset.
34. Manage diabetes when disagreeing with family or a friend.
4.375 0.937 3.568 1.178 4.331 0.980 3.776 1.074
35. Manage my diabetes when on holidays. 4.593 0.731 3.792 1.029
36. Avoiding overeating or missing meals when having to say no to others.
4.298 1.040 3.793 1.071
37. Know about “lab tests” for diabetes. 4.464 0.981 3.940 1.298
38. Understand the effect that diabetes has on family or friends.
39. Avoid overeating or missing meals when happy or relaxed.
40. Be in control of diabetes so can spend time with family / friends.
4.083 1.142 3.597 1.191 4.408 0.907 3.976 0.963 4.558 0.788 4.108 0.958
41. Be able to solve problems resulting from diabetes. 4.538 0.865 3.648 1.104
42. Avoid overeating or missing meals when watching TV.
4.378 1.061 4.060 1.105
43. Talk to family about their chances of getting diabetes. 4.258 1.147 3.966 1.193 44. Take care of myself and my diabetes. 4.743 0.576 4.064 0.989 45. Be active when feeling tired. 4.137 1.019 3.101 1.161
46. Ask health professionals about managing diabetes care.
4.651 0.667 4.088 1.122
47. Deal with my feelings about living with diabetes. 4.515 0.853 3.913 1.168
48. Understand other people’s feelings about me having diabetes.
49. Discuss concerns about diabetes complications with health professionals.
50. Have a plan about what I need to do in case I become ill.
51. Ask health professional to explain why a change in diabetes care is needed.
52. Tell health professionals when I don’t agree with their suggestions.
3.907 1.276 3.543 1.229 4.656 0.699 4.133 1.121 4.416 0.955 3.389 1.286 4.584 0.788 4.012 1.228 4.281 1.108 3.675 1.397
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Item
Number
Test A Results
DSEQ Statement
Please answer the following questions only if you are taking insulin.
Mean Belief
Standard Deviation Belief
Mean Action
Standard Deviation Action
53. Give myself insulin using the proper method. 4.903 0.474 4.730 0.793 54. Take insulin when away from home. 4.927 0.390 4.901 0.377
55. Figure out how much insulin to take when there is a change in my usual day.
56. Give the correct amount of insulin when having a cold or the flu.
57. Change the amount of insulin based on blood sugar test result.
58. Choose a different spot to inject the insulin into each time I give myself a needle.
Test Score Statistics
4.713 0.782 4.037 1.286 4.747 0.674 3.784 1.314 4.694 0.769 4.086 1.361 4.732 0.606 4.516 0.874
The Spearman Brown coefficients for Test A and Test B for Belief and Action scores (Questions 1 to 52) are given for odd/even items and split half data (Appendix 2). It became clear through the process of completing the statistical analyses that there were statistically significant differences in participant’s scores for belief and action and that combining belief and action scores was not useful, therefore belief and action scores are given separately (Appendix 17). Results for both Test A and Test B are listed.
Test A Belief – Odd/even 0.973
Test A Belief – Split Half 0.934
Test A Action– Odd/even 0.961
Test A Action – Split Half 0.937
Test B Belief – Odd/even 0.971
Test B Belief – Split Half 0.940
Test B Action– Odd/even 0.969
Test B Action – Split Half 0.940
Test Score Statistics by Scale
The factor analyses section of the manual will explain the process by which scales were derived for the DSEQ. The test score statistics for Scales 1 to 5 are given by scale (Appendix 3).
Scale 1 is composed of items 38, 42, 39, 34, 33, 48, 8, 11, 36, 32, 43, 7, 16, 18, 47, 35, and 40. The Spearman Brown coefficients are .952 (odd/even) and 0.937 (split/half).
Scale 2 is composed of items 49, 51, 46, 31, 52, 37, 50, and 41. The Spearman Brown coefficients are .893 (odd/even) and .823 (split/half).
Scale 3 is composed of items 30, 4, 1 and 19. The Spearman Brown coefficients are 0.717 (odd/even) and 0.721 (split/half).
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Scale 4 is composed of items 17, 6, 5, 2, 13, 22, 45, 10, 25, 44, 14, 28, and 3. The Spearman Brown coefficients are 0.891 (odd/even) and 0.893 (split/half).
Scale 5 is composed of items 15, 23, 9, 20, 21, 24, 29, 26, 27, and 12. The Spearman Brown coefficients are 0.849 (odd/even) and 0.817 (split/half).
Scale for Persons Using Insulin
Scale 6 is composed of the insulin questions (53, 54, 55, 56, 57, and 58) that were grouped together and not included in the factor analysis. The Spearman Brown coefficients for Test A and Test B for Belief and Action scores (Questions 53 to 58) are given for odd/even items and split half data for the insulin questions (Appendix 4). The results are given for Test A and Test B separately. As these questions are few in number and were not randomized, the odd/even item results are inconsistent as expected, while the split-half coefficients range from .854 to .899.
Test A Belief – Odd/even 0.834
Test A Belief – Split Half 0.899
Test A Action– Odd/even 0.420
Test A Action – Split Half 0.854
Test B Belief – Odd/even 0.627
Test B Belief – Split Half 0.922
Test B Action– Odd/even 0.881
Test B Action – Split Half 0.893
Item Reliability Statistics
Item reliability statistics were completed for belief and action total scores (questions 1 to 52) of the DSEQ. Detailed item reliability statistics are provided in Appendix 5. Ranges for the reliability for individual items are as follows:
Test A Belief 0.373 to 0.813
Test A Action 0.439 to 0.908
Test B Belief 0.381 to 0.737
Test B Action 0.405 to 0.791
Item reliability statistics were also completed for belief and action and combined belief and action scores for questions 53 to 58 (Appendix 4). The insulin items were grouped together and there were 182 respondents who used insulin who responded to Test A and 129 respondents for Test B. Ranges for the reliability for individual items about insulin are as follows:
Test A Belief 0.687 to 0.857
Test A Action 0.325 to 0.879
Test B Belief 0.783 to 0.899
Test B Action 0.711 to 0.822
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Scale Reliabilities
The factor analyses section of the manual will explain the process by which scales were derived for the DSEQ. The range of test item reliabilities are given by scale below and in detail in Appendix 6.
Scale 1 – Belief 0.519 to 0.914
Scale 1 – Action 0.516 to 0.881
Scale 2 – Belief 0.437 to 0.800
Scale 2 – Action 0.595 to 0.968
Scale 3 – Belief 0.566 to 0.696
Scale 3 – Action 0.598 to 0.708
Scale 4 – Belief 0.345 to 0.725
Scale 4 – Action 0.471 to 0.759
Scale 5 – Belief 0.507 to 0.920
Scale 5 – Action 0.554 to 0.791
Factor Analyses of the DSEQ
The principal component factor analysis that was completed on the convenience sample from the Rideau Valley Project (n=80) was described on pages 16 to 25. The DSEQ was reanalyzed following the larger survey sample.
Factor analysis (n=478) for 2, 3, 4 and 5 factors is provided in Appendix 8 for Belief and Action scores and combined Belief and Action Scores for Tests A and B for questions 1 to 52 (insulin questions were excluded and form an independent scale).
Five scales were derived by Principal Component Factor Analysis (Varimax Rotation) based on results for 478 respondents using the Belief items for Test A. Eigenvalues were set at greater than 1 and factor loadings for the scales are shown in Table 4. The concepts measured by the scales are described below. Table 4 shows the items that comprise the scales and the factor loading for each item. The five scales account for 59% of the variance in the DSEQ. Items that comprise the scales are listed by scale and are provided in order from highest to lowest factor loading in Table 4. The scales are named based on the ideas/concepts of the items that comprise the scales.
DSEQ Scales
Managing Social, Emotional and Food-Related Aspects of Diabetes Scale 1 is composed of items 38, 42, 39, 34, 33, 48, 8, 11, 36, 32, 43, 7, 16, 18, 47, 35, and 40. This scale explains 17.78 % of the variance in the DSEQ (Items 1 to 52).
Communicating With Health Professionals and Planning
Scale 2 is composed of items 49, 51, 46, 31, 52, 37, 50, and 41. This scale explains 10.61% of the variance in the DSEQ (Items 1 to 52).
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Managing Low Blood Sugars
Scale 3 is composed of items 30, 4, 1 and 19. This scale explains 6.42% of the variance in the DSEQ (Items 1 to 52).
Managing Diabetes Related To Exercise, Blood Glucose And Prevention. Scale 4 is composed of items 17, 6, 5, 2, 13, 22, 45, 10, 25, 44, 14, 28, and 3. This scale explains 13.69 % of the variance in the DSEQ (Items 1 to 52).
Integrating Knowledge And Day To Day Care.
Scale 5 is composed of items 15, 23, 9, 20, 21, 24, 29, 26, 27, and 12. This scale explains 10.45 % of the variance in the DSEQ (Items 1 to 52).
Managing insulin
Scale 6 is composed of the insulin questions (53, 54, 55, 56, 57, and 58) that were grouped together and not included in the factor analysis.
Table 4
Factor Analysis Results – Diabetes Self-Efficacy Questionnaire (DSEQ) Item Item Statement Factor Loading
Scale 1 Managing Social, Emotional And Food-Related Aspects Of Diabetes 38 Understand the effect that diabetes has on family or friends. 0.737 42 Avoid overeating or missing meals when watching TV. 0.734 39 Avoid overeating or missing meals when happy or relaxed. 0.698 34 Manage diabetes when disagreeing with family or a friend. 0.689 33 Avoid overeating or missing meals when angry or upset. 0.681 48 Understand other people’s feelings about me having diabetes. 0.678 8 Ask for support from family / friends in keeping diabetes routine. 0.661 11 Manage diabetes plan when feeling sad. 0.636 36 Avoiding overeating or missing meals when having to say no to others. 0.634 32 Plan how to handle delayed meals. 0.596 43 Talk to family about their chances of getting diabetes 0.551 7 Resist overeating or missing meals when I am anxious or nervous. 0.546 16 Take care of my diabetes when I am frustrated. 0.523 18 Talk about the effect of diabetes on my life with family / friends. 0.506 47 Deal with my feelings about living with diabetes. 0.483 35 Manage my diabetes when on holidays. 0.482 40 Be in control of diabetes so can spend time with family / friends. 0.413
Scale 2 Communicating With Health Professionals And Planning 49 Discuss concerns about diabetes complications with health professionals. 0.799 51 Ask health professional to explain why a change in diabetes care is needed. 0.783 46 Ask health professionals about managing diabetes care. 0.647 31 Know when to call a health professional about foot problems. 0.627 52 Tell health professionals when I don’t agree with their suggestions. 0.572 37 Know about “lab tests” for diabetes. 0.505 50 Have a plan about what I need to do in case I become ill. 0.486 41 Be able to solve problems resulting from diabetes. 0.477
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Scale 3
Managing Low Blood Sugars
30 Stop a low blood sugar reaction when having one. 0.814 4 Figure out what to do when blood sugar is low. 0.757 1 Prevent low blood sugar reactions when exercising. 0.706 19 Know about medications that I take for diabetes. 0.551
Scale 4 Managing Diabetes Related To Exercise, Blood Glucose And Prevention.
17 Exercise when I don’t feel like it. 0.650 6 Follow diabetes plan when daily routine changes. 0.648 5 Fit diabetes plan into usual lifestyle. 0.644 2 Figure out what to do when blood sugar is high. 0.643 13 Exercise several times a week 0.612 22 Feel sure of my ability to manage diabetes. 0.580 45 Be active when feeling tired. 0.530 10 Do activities that I enjoy while taking care of my diabetes. 0.522 25 Recognize when blood sugar is high. 0.518 44 Take care of myself and my diabetes. 0.513 14 Resist overeating or missing meals when depressed or down. 0.502 28 Be active when there are a lot of demands at home or at work. 0.498 3 Adjust diabetes self-care when having a cold or flu. 0.447
Scale 5 Integrating Knowledge And Day To Day Care.
15 Apply proper lotion to feet. 0.693 23 Cut toe nails the right way. 0.659 9 Check feet every day. 0.636 20 Eat meals at the same time every day. 0.619 21 Stay on my eating plan when staying with family / friends. 0.587 24 Test blood when away from home. 0.564 29 Carry out daily diabetes care. 0.560 26 Stay on my meal plan when people around me don’t know that I have diabetes. 0.502 27 Exchange one food for another in the same food group. 0.451 12 Follow my way of eating when at a party 0.393
Scale 6 Managing insulin
*Questions about insulin were not included in the factor analysis.
53 Give myself insulin using the proper method.
54 Take insulin when away from home.
55 Figure out how much insulin to take when there is a change in my usual day. 56 Give the correct amount of insulin when having a cold or the flu.
57 Change the amount of insulin based on blood sugar test result.
58 Choose a different spot to inject the insulin into each time I give myself a needle. Test/Retest Statistics
The total scores for items 1 to 52 and the 6 scales including the questions (Scale 6) that were completed by those using insulin were analyzed for stability and change between Test A and Test B using a matched sample. The survey was sent to respondents who provided their name and address and completed the consent form for a second survey (n=302) that was sent at 3 months. Of those who agreed to complete a second
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questionnaire, 89 used insulin. The DSEQ was tested for stability (Repeated Measures ANOVA) using the matched sample of respondents who completed both questionnaires. The scales (Appendix 11) that remained stable (did not demonstrate statistically significant change) over the 3 month period included all of the Belief scales: Belief Scale 1 (F Ratio 1.595, Prob 0.208), Belief Scale 2 (F Ratio 1.503, Prob 0.221), Belief Scale 3 (F Ratio 0.302, Prob 0.583), Belief Scale 4 (F Ratio 0.395, Prob 0.530), Belief Scale 5 (F Ratio 0.330, Prob 0.566), and Belief Scale 6 (F Ratio 0.562, Prob 0.456). Action scores that remained stable were Action Scale 1 (F Ratio 0.151, Prob 0.698), Action Scale 2 (F Ratio 0.248, Prob 0.619), and Action Scale 6 (F Ratio 0.649, Prob 0.429). Action Scale 3 (F Ratio 4.985, Prob 0.026), Action Scale 4 (F Ratio 7.913, Prob 0.005) and Action Scale 5 (F Ratio 5.074, Prob 0.025) demonstrated change. While 196 of the respondents had no education between questionnaires, 106 persons had education about diabetes from one or more of a physician, a community diabetes program or a hospital program. When the data by group (those who participated in educational programs versus those not educated since the previous test) were analyzed, no pattern emerged. Length of time between tests, receipt of multiple interventions and variability of diabetes education may account for these findings.
Discriminative Ability of the DSEQ
Differences in Belief and Action Self-Efficacy Scores
Belief and Action scores were compared using t Tests with Bonferroni probability. Participants’ perception of belief in the importance of the issue and their perception of their ability to take action on the issue or skill in their day to day management of diabetes care were compared. Results are presented by DSEQ scale in Appendix 10. There are statistically significant differences in Belief and Action scores on Test A for Scale 1 (t = 11.766, Prob = 0.000), Scale 2 (t = 13.426, Prob = 0.000), Scale 3 (t = 14.887, Prob = 0.000), Scale 4 (t = 22.741, Prob = 0.000), Scale 5 (t = 15.673, Prob = 0.000) and Scale 6 (t = 3.264, Prob = 0.004). Belief about the importance of an aspect of care is not statistically related to confidence in carrying out that aspect of care.
Differences by Attendance at Diabetes Education Programs
Participants who agreed to participate by completing the second survey were asked if they had attended a diabetes education program in the community or in the hospital or if they had received education from their physician since they had completed the first survey. Of the respondents, 196 had not received any education and 106 had one or more educational contacts with one or more of the above services. The DSEQ was not able to discriminate between the educated and non-educated groups in the survey group. This is not a surprising finding given that there was no consistency in location, person providing the education, approach to education, nor time involved in these educational contacts. The DSEQ did discriminate between those who were educated in the wait-list control design in the Rideau Valley study (p. 5 to 10). While the scales were revised following the survey, the items that comprise the questionnaire were not changed. Although the
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DSEQ needs further study (as it is utilized in future diabetes education programs) it appears to be a useful tool for outcome measurement of diabetes education programs.
