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. 

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