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VOLUME 8 NUMBER 4 • NOVEMBER 2011
ACHIEVING BEST PRACTICE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Key messages
• Integrating the patient perspective into lifestyle programme
evaluation is fundamental to demonstrating the benefits of
the programmes for patients. It also provides valuable feed-
back for HCPs and helps them collaborate with patients to
manage diabetes over the course of the disease
• Key patient-relevant concepts of greatest interest for life-
style programme evaluation from a patient perspective are
psychological adjustment to diabetes, motivation to change
and self-efficacy
• Among existing, well-validated instruments, the PAID, MEI
and DMSES scales appear to be the instruments of choice to
assess the effect of type 2 diabetes lifestyle programmes on
patients’ behaviours and perceptions
motivation. It is created to be both responsive to treatment effects
and able to discriminate among patients with different clinical char-
acteristics.
23
Although the MEI was developed through focus groups
and cognitive interviews with individuals being treated for depres-
sion, all items are carefully worded to be applicable across various
populations, including diabetes patients. The MEI short form, with
a recall period of the previous seven days, is expected to be sensi-
tive to behavioural modification programmes and can be used to
compare the motivation levels of type 2 diabetic patients over the
course of lifestyle intervention programmes.
Measures assessing self-efficacy
Two potential candidates to assess self-efficacy were found and meet
most of the appraisal criteria: the DES-SF and the DMSES. Although
the DES-SF offers comprehensive and coherent coverage of the self-
efficacy concept and shows interesting results in educational pro-
gramme assessment,
33-35
the item wording and the item scaling are
complex and require considerable cognitive effort from the patients
to answer the questions. The DMSES is preferred for its simplicity,
although further research on this instrument is warranted to assess its
responsiveness over time. This instrument showed a small improve-
ment in confidence in self-care following an educational intervention
in primary care in patients with type 2 diabetes.
32
Conclusion
Health-related quality of life, patient satisfaction, and patient adher-
ence to treatment are important PROs that should improve when
using well-designed lifestyle-modification programmes. However,
when assessing the effectiveness of a new programme, the primary
focus of assessment should be measurable, observable changes at
the patient level, which are specific and direct outcomes of the inter-
vention.
Psychological adjustment, motivation and self-efficacy are
key patient-relevant concepts to consider when evaluating
transtheoretical model-based lifestyle interventions in diabetes from
a patient perspective. Specific validated instruments exist, which
reliably assess these key concepts. Of the instruments identified in
our work, the PAID, the MEI and the DMSES questionnaires are
the best existing candidates to assess psychological adjustment,
motivation to change and self-efficacy, respectively.
After evaluation, programmes that have shown beneficial
effects at patient level and that have proved to be well designed
and cost effective can be generalised and implemented in clinical
practice settings. Indeed, setting goals, providing patient education
for achieving these goals, and monitoring the patient’s progress
using PRO instruments adapted to the context of clinical practice,
are critical in clinical practice for maintenance of healthy behav-
iours, as well as supporting patient adherence and persistence to
pharmacological therapies.
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