Study On Developing A Brief Version Of Self-management Knowledge Attitude Behavior(KAB) Assessment Scale For Diabetes Patient

ObjectiveTo develop a brief version scale for evaluate diabetes patient’s self-management Knowledge, Attitude and Behavior (KAB) with good validity and reliability in a shorter time based on the complete version scale.Subjects and methods"self-management KAB assess scale for diabetes patient"(the total scale) is developed by Chinese Diabetes Management Project of china NCNCD in2008."the total scale" assess diabetes patients self-management KAB completely and Detailed by98items which divide to knowledge, attitude and behavior subscales and seven dimensions. In a432participants survey, Cronbach’s a coefficients of the total scale" and three sub-scales were0.944,0.930,0.834and0.881respectively and with good validity.In order to make a quicker assessment, we developed a brief version scale (the brief scale) based on the total scale. The study steps as follows:firstly, selected the core items from "the total scale" by two round Delphi consultation. According to the diabetes self-management KAB theory system, the brief scale should retained the three subscales and measure dimensions. Secondly, through pilot study modified some items to make it can be understand easily by patients. Thirdly, evaluated the validity and reliability of the brief scale by a community-based filed survey. At last, developed a score method of the brief scale.1. Delphi expert consultation:20authority experts who specialize in the field of diabetes clinical and chronic disease self-management, and familiar with the relevant content of diabetes self-management were selected. Face to face and E-mail consultation methods were employed in two rounds Delphi expert consultations. In the first round of expert consultation, experts were asked to select the core items from every dimension and explain the extent of familiarity and basis of judgment; and in the second round the significance of the core items, which were selected by experts in first round, were graded. The items which enter into the brief scale were determined according to concentration and harmonious of expert opinion.2. The pilot study of brief scale:through a face to face survey about50patients, modified the item in logical order and expression.3. The field survey of brief scal:diabetes patients from Xinkaipu community, which is one of a pilot community of china diabetes management project, were investigated to evaluate acceptability, validity, reliability and responsibility of the brief scale. The acceptability was evaluated by pass rate and complete time; the validity of the brief scale was assess by face validity, content validity and construct validity; and the Cronbach’s a coefficient,0coefficient, Ω coefficient and split-half reliability were using to evaluate the internal consistency reliability; the responsibility was used to evaluate sensitivity of the brief scale.4. The using method of the brief scale:Diabetes patient’s self-management KAB is evaluate through the score of the brief scale. To score the brief scale need steps as follow:Firstly, choose a suitable grade of item points and score every option of items.Secondly, got the weights of every item in the brief scale and three subscale by factor analysis.Thirdly, sum the product of items score and weight in the brief scale or three subscale, then convert to a standard score to evaluate Diabetes patients self-management KAB.Results1. Delphi expert consultation:16and15experts response were got and42core items were screened after two rounds of Delphi expert consultation. Positive coefficients of experts were80%and93.8%in two rounds of consultation respectively.the experts authority levels are0.90, coordination coefficient is0.38. The chi-square test was significant, which indicate the concentration of experts opinion was acceptable.2. The pilot study of brief scale:65diabetes patients were surveyed in the pilot study of the brief scale, and four items which evaluate the patients’self-management behavior were modified, so that the expression of items can be understood by patients easily.3. The field survey of brief scale:350diabetes patients were surveyed in the field survey of brief scale,346completed questionnaires were got, and the average investigation time was11minutes.3.1Character of subjects:149men and197women completed the questionnaires, average age of these patients was63.60±8.88years,and average duration was6.59±5.33years, retirees were68.8%.3.2validity of the brief scale:the items of the brief scale were approbated by experts, shows the brief scale with good face validity and content validity. The principal components factor analysis indicate that the construct validity of the brief scale and three subscales were acceptable, the common factor of the brief scale and three subscales which explain the total variance were over50%, all items held moderate loading(>0.4),(See Table1).3.3Reliability of the brief scale:The Cronbach’s α coefficients,θ coefficient, Ω coefficient, and split-half reliability of the brief scale and three subscale were meet a good standard (θ coefficient of attitude subscales except), indicate that the brief scale and three subscales with an acceptable internal consistency reliability,(See table2). 3.4Responsibility of the brief scale:Patients were divided into the high score group and low score group if the score of the brief scale more than upper27%or less than lower27%, then compared the score of the brief scale and three subscale between two groups by t test, results were all significant, indicate the brief scale and three subscale with good sensitivity.4. The using method of the brief scale4.1The grade and score of item options:3and5points options were used by the brief scale according to Character of subjects, and every option of items were scored.4.2The weight of items:Every item of the brief scale and three sub-scale were weighted by factor analysis.4.3The score method was developed successfully to evaluate Diabetes patients self-management KAB.For example:the attitude subscale option is "very important, important, normal, unimportant, very unimportant", scored to1,0.8,0.6,0.4,0.2, the initial score is sum of the items product of score and weight, then convert the initial score into standard points.(Table3). Summary of results42core items of the total scale were screened after two rounds of Delphi expert consultation. Four items which evaluate the patients’self-management behavior were modified in the pilot study. Collected data relate to self-management to evaluate acceptability, validity, reliability and responsibility of the brief scale by field study.1.16and15experts response were got and42core items were screened after two rounds of Delphi expert consultation. Positive coefficients of experts were80%and93.8%in two rounds of consultation respectively, the experts authority levels are0.90.2. The items of the brief scale were approbated by experts, shows the brief scale with good face validity and content validity. Factor analysis results indicate that the construct validity of the brief scale and three subscales were acceptable.3. The internal consistency reliability coefficients were meet a good standard, indicate that the brief scale and three subscales with an acceptable internal consistency reliability.4. Every item of the brief scale and three sub-scale were weighted by factor analysis, and developed a score method.Innovation of the studyA brief scale for evaluate diabetes patient s self-management KAB with good validity and reliability was developed. The survey of community diabetes patients shows that the brief scale is applicable to old patients with low education level.ConclusionA brief scale, which approbated by experts with two round Delphi consultation, based on "the total scale "were developed. The average investigation time by the brief scale was11minutes, and the indicators of construct validity all meet the good standard, The reliability coefficients of the internal consistency also in a good standard, and developed a simple using method. In conclusion, the brief scale can evaluate self-management KAB of diabetes patients in a shorter time and with good quality.