Summary of Diabetes Self-care Activities: A confirmatory factor analytic approach


      • A five-factor and four-factor structure of the SDSCA is proposed.
      • Both models have high fit indices.
      • Exercise, blood-glucose testing and foot care demonstrated adequate discriminant validity.
      • The SDSCA constructs exhibited good construct reliabilities.


      Diabetes self-care activities is an important aspect for Type 2 Diabetes Mellitus (T2DM) patients. The aim of this study was to examine the construct validity of the Summary of Diabetes Self-Care Activities (SDSCA) measure. This was a cross-sectional study whereby T2DM patients were recruited from endocrine clinics in hospitals. The patients gave their informed consent before the interview. The SDSCA measure was used to gather information about the patients’ diabetes self-care. Internal consistency reliability was measured by the Cronbach’s Alpha value while the construct validity was measured by Confirmatory Factor Analysis. The fit indices for both the four-factor and five-factor structures were high (CFI >0.90 and GFI >0.90). The interconstruct correlations of the SDSCA scale was found to be highest between general and specific diet. The constructs of the SDSCA demonstrated adequate convergent validities. The SDSCA measure was found to be a valid one.


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        • Choi E.J.
        • Nam M.
        • Kim S.H.
        • Park C.G.
        • Toobert D.J.
        • Yoo J.S.
        • Chu S.H.
        Psychometric properties of a Korean version of the summary of diabetes self-care activities measure.
        Int. J. Nurs. Stud. 2011; 48: 333-337
        • McNabb W.L.
        Adherence in diabetes: can we define it and can we measure it?.
        Diabetes Care. 1997; 20: 215-218
        • Glasgow R.E.
        • Fisher E.B.
        • Anderson B.J.
        • LaGreca A.
        • Marrero D.
        • Johnson S.B.
        • Rubin R.R.
        • Cox D.J.
        Behavioral science in diabetes. Contributions and opportunities.
        Diabetes Care. 1999; 22: 832-843
        • Rubin R.R.
        • Peyrot M.
        Psychosocial problems and interventions in diabetes.
        Diabetes Care. 1992; 15: 1640-1657
        • Ary D.V.
        • Toobert D.
        • Wilson W.
        • Glasgow R.E.
        Patient perspective on factors contributing to nonadherence to diabetes regimen.
        Diabetes Care. 1986; 9: 168-172
        • Toobert D.
        • Hampson S.
        • Glasgow R.E.
        The Summary of Diabetes Self-Care.
        Diabetes Care. 2000; 23: 943-950
        • Glasgow R.E.
        Outcomes of and for diabetes education research.
        Diabetes Educ. 1999; 25: 74-88
        • Glasgow R.E.
        • Osteen V.L.
        Evaluating Diabetes Education Are we measuring the most important outcomes?.
        Diabetes Care. 1992; 15: 1423-1432
        • Johnson S.B.
        Methodological issues in diabetes research.
        Diabetes Care. 1992; 15: 1658-1667
        • Toobert D.J.
        • Glasgow R.E.
        Assessing diabetes self-management: the Summary of Diabetes Self-Care Activities Questionnaire.
        in: Bradley C. Handbook of Psychology and Diabetes: A Guide to Psychological Measurement in Diabetes Research and Practice. Harwood Academic Publishers/Gordon, Langhorne, PA, England1994: 351-375
        • Bujang M.A.
        • Ismail M.
        • Khairul N.
        • Mohd B.
        • Baharum N.
        • Othman H.
        Validation of the Summary of Diabetes Self-Care Activities (SDSCA).
        Malays. J. Public Health Med. 2016; 16: 227-234
        • Kim S.
        • Love F.
        • Quistberg D.A.
        • Shea J.A.
        Association of health literacy with self-management behavior in patients with diabetes.
        Diabetes Care. 2004; 27: 2980-2982
        • Lin K.
        • Yang X.
        • Yin G.
        • Lin S.
        Diabetes Self-Care Activities and Health-Related Quality-of-Life of individuals with type 1 diabetes mellitus in Shantou, China.
        J. Int. Med. Res. 2016; 44: 147-156
        • Young-Hyman D.
        • De Groot M.
        • Hill-Briggs F.
        • Gonzalez J.S.
        • Hood K.
        • Peyrot M.
        Psychosocial care for people with diabetes: a position statement of the American diabetes association.
        Diabetes Care. 2016; 39: 2126-2140
        • Jalaludin M.
        • Fuziah M.
        • Hong J.
        • Mohamad Adam B.
        • Jamaiyah H.
        Reliability and validity of the revised Summary of Diabetes Self-Care Activities (SDSCA) for Malaysian children and adolescents.
        Malays. Fam. Phys. 2012; 7: 10-20
        • Weinger K.
        • Butler H.A.
        • Welch G.W.
        • La Greca A.M.
        Measuring diabetes self-care: a psychometric analysis of the Self-Care Inventory-Revised with adults.
        Diabetes Care. 2005; 28: 1346-1352
        • Gopichandran V.
        • Lyndon S.
        • Angel M.K.
        • Manayalil B.P.
        • Blessy K.R.
        • Alex R.G.
        • Balraj V.
        Diabetes self-care activities: a community-based survey in urban southern India.
        Natl. Med. J. India. 2012; : 14-17
        • Huang M.-F.
        • Courtney M.
        • Edwards H.
        • McDowell J.
        Factors that affect health outcomes in adults with type 2 diabetes: a cross-sectional study.
        Int. J. Nurs. Stud. 2010; 47: 542-549
        • Huang M.-F.
        • Courtney M.
        • Edwards H.
        • McDowell J.
        Validation of the Chinese version of the Problem Areas in Diabetes (PAID-C) scale.
        Diabetes Care. 2010; 33: 38-40
        • Michels M.J.
        • Helena M.
        • Coral C.
        • Sakae T.M.
        • Damas T.B.
        • Furlanetto L.M.
        Questionnaire of Diabetes Self-Care Activities: translation, cross-cultural adaptation and evaluation of psychometric properties.
        Arq. Bras. Endocrinol. Metab. 2010; 54: 644-651
        • Vincent D.
        • McEwen M.M.
        • Pasvogel A.
        The validity and reliability of a Spanish version of the summary of diabetes self-care activities questionnaire.
        Nurs. Res. 2008; 57: 101-106
        • Pastors G.
        • Warshaw H.
        • Daly A.
        • Franz M.
        • Kulkarni K.
        The evidence for the effectiveness of medical nutrition therapy in diabetes management.
        Diabetes Care. 2002; 25: 608-613
        • Marshall J.
        • Bessesen D.
        Dietary fat and the development of type 2 diabetes.
        Diabetes Care. 2002; 25: 620-622
        • Salmerón J.
        • Hu F.B.
        • Manson J.E.
        • Stampfer M.J.
        • Colditz G.A.
        • Rimm E.B.
        • Willett W.C.
        Dietary fat intake and risk of type 2 diabetes in women.
        Am. J. Clin. Nutr. 2001; 73: 1019-1026
        • Lai L.C.
        Prevention of type 2 diabetes.
        Malays. J. Pathol. 2002; 24: 71-76
        • Chan C.
        Preventing Chronic Diseases in Middle-Income Countries: The Malaysia Diabetes Prevention Program.
        • Nor Shazwani M.N.
        • Suzana S.
        • Hanis Mastura Y.
        • Lim C.J.
        • Teh S.C.
        • Mohd Fauzee M.Z.
        • Norliza M.
        Assessment of physical activity level among individuals with type 2 diabetes mellitus at Cheras Health Clinic, Kuala Lumpur.
        Malays. J. Nutr. 2010; 16: 101-112
        • Redmond E.H.
        Diabetes Self-care Activities in Older Adults and the Ability of a Nutrition and Diabetes Education Program to Effect Change.
        • Abbott C.A.
        • Carrington A.L.
        • Ashe H.
        • Bath S.
        • Every L.C.
        • Griffiths J.
        • Boulton A.J.
        The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort.
        Diabet. Med. J. Br. Diabet. Assoc. 2002; 19: 377-384
        • Glasgow R.E.
        • Toobert D.J.
        • Riddle M.
        • Donnelly J.
        • Mitchell D.L.
        • Calder D.
        Diabetes-specific social learning variables and self-care behaviors among persons with type II diabetes.
        Health Psychol. 1989; 8: 285-303
        • Ruggiero L.
        • Glasgow R.
        • Dryfoos J.
        • Rossi J.
        • Prochaska J.
        • Orleans T.
        • Johnson S.
        Diabetes Self-Management Self-reported recommendations and paterns in large population.
        Diabetes Care. 1997; 20: 568-576
        • Murata G.H.
        • Shah J.H.
        • Hoffman R.M.
        • Wendel C.S.
        • Adam K.D.
        • Solvas P.A.
        • Duckworth W.C.
        Intensified blood glucose monitoring improves glycemic control in stable, insulin-treated veterans with type 2 diabetes: the Diabetes Outcomes in Veterans Study (DOVES).
        Diabetes Care. 2003; 26: 1759-1763
        • Rost K.M.
        • Flavin K.S.
        • Schmidt L.E.
        • McGill J.B.
        Self-care predictors of metabolic control in NIDDM patients.
        Diabetes Care. 1990; 13: 1111-1113
        • Kurtz S.M.S.
        Adherence to diabetes regimens: empirical status and clinical applications.
        Diabetes Educ. 1990; 16: 50-56
        • Toljamo M.
        • Hentinen M.
        Adherence to self-care and glycaemic control among people with insulin-dependent diabetes mellitus.
        J. Adv. Nurs. 2001; 34: 780-786
        • Delamater A.M.
        Improving patient adherence.
        Clin. Diabetes. 2006; 24: 71-77
        • Shrivastava S.
        • Shrivastava P.
        • Ramasamy J.
        Role of self-care in management of diabetes mellitus.
        J. Diabetes Metab. Disord. 2013; 12: 14