| Objectives1.To develop a self-management behavior scale for patients with gestational diabetes mellitus(GDM),and to test its reliability and validity,in order to provide a scientific and effective tool to evaluate the self-management behavior of GDM patients.2.To investigate the present situation of GDM patients'self-management behavior,and to preliminarily explore the relevant influencing factors,with the purpose of providing reference basis for formulating personalized self-management strategies.Methods1.Taking the Integrated Theory of Health Behavior Change as the conceptual framework,combining the task of self-management of chronic diseases and self-management behaviors recommended by the American Association of Diabetes Educators,the operational definition of self-management behaviors of GDM patients and dimensions of the scale were determined.By referring to the existing self-management behavior scale,the item pool of GDM patients'self-management behavior scale was formed through literature review and group discussion.2.Invited 30 domestic experts that experienced in the field of GDM to participate two rounds of Delphi Method consultation,and the entries that met the inclusion indexes were selected to form the initial GDM patients'self-management behavior scale.3.With the convenience sampling method,320 GDM patients from two hospitals in Guangzhou and Jiangmen were investigated by using the initial GDM patients'self-management behavior scale.Items were further screened by item analysis method,correlation coefficient method,Cronbach's?coefficient method and exploratory factor analysis method.The final GDM self-management behavior scale was composed of the remaining items.4.With the convenience sampling method,240 GDM patients from two hospitals in Guangzhou and Jiangmen were investigated by using the final GDM patients'self-management behavior scale.The reliability was evaluated by test-retest reliability,split-half reliability and Cronbach's?coefficient.The validity was assessed by content validity,construct validity and criterion-related validity.Descriptive statistics,Non-parametric test,Spearman correlation coefficients and multiple linear regression were used to analyze the status of GDM patients'self-management behavior,and to preliminarily explore its related influencing factors.Results1.Establishment of the scale item poolCombining the results of literature review and group discussion,the scale included 45 items under 7 dimensions.2.The consultation results of Delphi methodThe effective return rates of the two rounds of expert consultation were 90.9%and 100%respectively,and the rate of expert opinion put forward were 43.4%and30%respectively.The mean value of the authority coefficient(Cr)were 0.872 and0.87,respectively.The mean value of the importance score(M_j)of the dimensions were 4.6 and 4.7,and the mean value of the importance score(M_j)of the items were4.4 and 4.6.The mean value of variation(K_j)of the dimensions were 0.13 and 0.12,and the mean value of variation(K_j)of the items were 0.16 and 0.13.The Kendall's W of the dimension were 0.248 and 0.382,and the Kendall's W of the item were 0.285and 0.406,all of which were statistically significant(P<0.05).The initial GDM patients'self-management behavior scale was constructed with 7 dimensions and 50items.3.Screening results of the initial scaleA total of 320 questionnaires was issued and 316 valid questionnaires were recovered,with an effective return rate of 98.8%.13 items were deleted by using four methods.The final GDM patients'self-management behavior scale contained 7dimensions and 37 items.4.The evaluation results of the scale(1)The results of feasibility testA total of 240 questionnaires were distributed and 237 were effectively recovered,with an effective recovery rate of 98.8%and the average completion time was 10.10±3.06 minutes.(2)The results of reliability test(1)The test-retest reliability:the test-retest reliability coefficient of the total scale was 0.930(95%CI:0.853,0.967),and that of the 7 dimensions ranged from 0.699 to0.955,all of which were statistically significant(P<0.05).(2)The split-half reliability:the split-half reliability coefficient of the total scale was 0.940,and that of the 7 dimensions ranged between 0.769 to 0.914,all of which have statistical significance(P<0.001).(3)The Cronbach's?coefficient:the Cronbach's?coefficient of the total scale was 0.951,and that of the 7 dimensions ranged from 0.806 to 0.949.(3)The results of validity test(1)Content validity:the content validity index(S-CVI)of the total scale was0.907,and that of each item ranged from 0.8 to 1.0.(2)Construct validity:the confirmatory factor analysis results showed that the model fitted well.The factor load value of the items was between 0.50 and 0.98,the combined reliability(C.R)was between 0.85 and 0.96,and the average variance extract(AVE)of the dimensions was between 0.50 and 0.87.(3)Criterion-related validity:the correlation coefficient between the total score of the scale and the Chinese version of The Summary of Diabetes Self-Care Activities Measure(SDSCA)was 0.614,which was statistically significant(P<0.001).5.The results of preliminary application of the scale(1)The status of GDM patients'self-management behaviorThe average score of the GDM patients'self-management behavior scale was142.96±22.35,and the scores of each dimension were from low to high in order of weight management,medication management,risk assessment and treatment,blood glucose monitoring,exercise management,psychosocial adaptation and diet management.Patients with intermediate or lower scores in the total scale accounted for 81.86%.(2)The analysis results of influencing factorsThe influencing factors of diet management included health education,family history of DM,education level,residence,and family average monthly income.The influencing factors of exercise management included health education.The influencing factors of weight management included health education,pre-pregnancy BMI,delivery times,residence,and family history of DM.The influencing factors of medication management included history of GDM and health education.The influencing factors of the blood glucose monitoring management dimension included health education,education level,residence and history of GDM.The influencing factors of the risk assessment and treatment dimension included education level and history of GDM.The influencing factors of psychosocial adaptation were residence,history of GDM and health education.Conclusion1.The GDM patients'self-management behavior scale include 37 items and 7dimensions:diet management,exercise management,weight management,medication management,blood glucose monitoring,risk assessment and treatment,and psychosocial adaptation.2.The GDM patients'self-management behavior scale was of good reliability and validity,which can accurately assess the level of self-management behavior of GDM patients.3.The self-management behaviors of most GDM patients in the study were at the medium or lower level,and the influencing factors included pre-pregnancy BMI,delivery times,education level,family average monthly income,residence,history of GDM,family history of DM and health education. |
PDF Full Text Request