VOLUME 8 NUMBER 4 • NOVEMBER 2011
151
SA JOURNAL OF DIABETES & VASCULAR DISEASE
ACHIEVING BEST PRACTICE
Table 2. Description of patient-reported outcomes instruments (
n
= 6)
Acronym
Full name of the
Availability of full scale
Languages
Dimensions
(number of items)
questionnaire
ADS
Appraisal of Diabetes
Carey
et al
. Reliability and
Original language: US English
One dimension
(
n
= 7)
Scale
validity of the appraisal of
No translations
Stressful impact of diabetes
diabetes scale.
J Behav Med
1991;14:43-51
/
RCMAR/ADS.html
ATT39
Psychological Adjustment
Bradley (1994) in
Handbook
Original language: UK English
39-item scale. Six dimensions:
(
n
= 39)
to Diabetes Scale
of Psychology and Diabetes
Translations: German, Greek,
perceived levels of stress,
ATT19
(224-26 and 230-31,
Canadian English, French and
adaptation, guilt, alienation,
(
n
= 19)
respectively)
Italian
illness conviction, and
tolerance for ambiguity
19-item scale. One dimension:
diabetes integration
PAID
Problem Areas in
Polonsky
et al
. Assessment
Original language: US English
Four dimensions: diabetes-
(
n
= 20)
Diabetes scale
of diabetes-related distress.
Translations: Chinese, Danish,
related emotional problems,
Diabetes Care
Dutch, Finnish, German,
treatment-related problems,
1995;18:54-60.
Japanese, Portuguese,
food-related problems and
Portuguese for Brazil, Spanish
social support-related
problems
MEI
Motivation and Energy
From author: SE Fehnel, RTI
Original language: US English
Three dimensions: mental
Long-form
Inventory
Health Solutions, RTI
More than 30 translations
energy, social motivation
(
n
= 27)
International, Research
available
and physical energy
Short-form
Triangle Park, NC 27709-
(
n
= 18)
2194, USA.
DES-SF
Diabetes Empowerment
MDRTC,
.
Original language: US English
Eight dimensions: need for
(
n
= 8)
Scale Short Form
edu/mdrtc/
Translations: Chinese, Spanish change, developing a plan,
overcoming barriers, asking
for support, supporting
oneself, coping with
emotion, motivating
oneself, making diabetes
care choices appropriate for
one’s priorities and
circumstances
DMSES
Diabetes Management
From author: Dr. Jan
Original language: Dutch
Different structure
(
n
= 20)
Self Efficacy Scale
McDowell, Queensland
Translations: UK English, English according to language
University of Technology,
for Australia, Turkish and
version (three to four
Australia. j.mcdowell@qut.
Chinese
dimensions
edu.au
Of the numerous questionnaires identified, only six instruments
were found that addressed psychological adjustment, motivation
and self-efficacy and had documented evidence of development
methodology and psychometric properties. Three of these assessed
indicators of psychological adjustment: the PAID scale,
17-19
the ADS
20
and the ATT-39/ATT-19.
21,22
One measure assessed motivation: the
MEI.
23
Two measured self-efficacy: the DES-SF
24,25
and the DMSES.
26-29
These instruments are briefly described in Table 2.
Measures assessing psychological adjustment
Of the three measures of psychological adjustment, only the PAID
satisfies all criteria. The PAID demonstrates evidence of adequate
psychometric testing, responsiveness to change through similar
educational intervention
19,30-32
and appropriateness to the targeted
type 2 diabetes population. In addition, patients were involved in its
development and comprehension testing. The ADS and ATT-39/19
are acceptable tools and meet all except one or two key appraisal
criteria. The ADS has interesting content; however, its develop-
ment did not involve patients and no responsiveness and sensitiv-
ity to change data following similar educational interventions are
available. The ATT-39 is relatively long (39 items), which can be a
burden for patients; it has an item scaling that is often criticised,
as respondents are faced with cognitively complex tasks (such as
disagree
that weight-control is
not a problem
for them). The ATT-19
is at a relatively early stage of development and more information is
needed to assess its sensitivity to detect change in patient psycho-
logical adjustment following educational intervention.
Measures assessing motivation
The MEI instrument is the only identified instrument that assesses
