Developing a Valid and Reliable Questionnaire of the Stages of Change in Self-management of Patients With Type 2 Diabetes Among the Iranian Population

Introduction Diabetes mellitus (DM) as one of the most important health problems is characterized by high and suddenly rising blood glucose levels (1-3). One out of three people in the world is expected to have type 2 diabetes mellitus (T2DM) by 2050 (4). In patients with T2DM, self-management behaviors affect the compliance of medical procedures and decrease their consequences. Thus, assessing the success of self-management programs seems essential in this regard. Self-management in diabetes requires a dynamic process including using blood glucose-lowering drugs and insulin injections, a healthy diet consisting of low saturated fat intake, sufficient amounts of fruits and vegetables, and physical activities (5,6). In DM, the disorder occurs in carbohydrate, protein, and fat metabolism (7). The objectives of diet therapy in diabetes include providing all the essential components of foods (i.e., macronutrients, vitamins, and minerals), achieving and maintaining healthy weight, providing the required energy, preventing severe changes in blood glucose concentration, obtaining normal levels of glucose as much as possible (without increasing the risk of hypoglycemia), and adjusting the serum level of lipoproteins (8). Exercise reduces blood glucose and has a major role in improving the efficacy of insulin. In addition, exercise reduces the blood glucose level while it improves bloodstream and muscle tuning by enhancing the uptake of glucose by the muscles and improving the function of insulin. Thus, exercise is introduced as one of the treatment procedures for diabetes (9). Nowadays, with the development of research in medical, social, and educational science and research, several measures are performed using questionnaires for quantifying individuals and societies’ behaviors (10). Considering that most of the behavioral studies are in this scope and questionnaires are required for their assessment, measurement tools need to be both valid and reliable. Currently, there are various instruments for assessing management and self-management behaviors Abstract Objectives: The present study aimed to develop a valid and reliable questionnaire regarding the stages of change in the selfmanagement of patients with type 2 diabetes mellitus (T2DM). Materials and Methods: In the first section of this cross-sectional study, the stages of change in self-management of patients with T2DM questionnaire were developed by the researcher. The questionnaire included eight questions in the field of using medication, a healthy diet, and physical activity. In the second section, the content validity and face validity of the questionnaire were assessed by the opinions of 11 expert panelists in the field of health education and nutritional sciences. Finally, construct validity was carried out by exploratory factor analysis (EFA) among 206 patients with T2DM in an outpatient clinic in Ardabil in the northwest of Iran. Results: The total content validity index (CVI), content validity ratio (CVR), and face validity were 0.60-0.91, 0.81-1, and 4.324. 82, respectively. The number of questions increased up to 10. In addition, EFA results showed that Kaiser-Mayer-Olkin and the total variance extracted were 0.69 and 23.6, respectively, and Bartlett tests were statistically significant (P=0.000). Finally, reliability analysis indicated a moderate level of internal consistency (ICC = 0.89) and Cronbach’s alpha of 0.63. Conclusions: This questionnaire with 10 items and one factor was found to be valid and reliable as a simple and effective tool for self-care on the stages of change in patients with T2DM.