Leonard E Egede1, Charles Ellis. 1. Department of Medicine, Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC, USA. egedel@musc.edu
Abstract
OBJECTIVE: This study describes the development and validation of the Diabetes Fatalism Scale (DFS) in adults with type 2 diabetes. METHODS: Thirty-five items were derived from focus groups, literature review, and expert opinion. The items were pilot tested on 20 adults with diabetes and then administered to 216 primary care patients with type 2 diabetes to assess the validity and reliability of the scale. Exploratory factor analysis (Principal Component Analysis with Varimax rotation) yielded a 12-item scale with three subscales. Pearson's correlation was used to test the DFS's association with diabetes self-care, HbA1c and quality of life. Multiple linear regression was used to assess association between the DFS and HbA1c controlling for demographics, comorbidity and insulin use. RESULTS: Cronbach's alpha for the 12-item DFS scale was 0.804 indicating internal consistency. The DFS is scored in such a way that higher scores represent greater diabetes fatalism. The DFS scores were not significantly correlated with age, years of education, or diabetes duration. Whites, men, those with government or no insurance, and those with 3+ comorbid conditions had significantly higher DFS scores. DFS was significantly correlated with self management understanding (r = -0.35, p < 0.001), control problems (r = 0.22, p = 0.002), self-care ability (r = -0.30, p < 0.001), and self-care adherence (r = -0.23, p < 0.001). The DFS was significantly correlated with HbA1c (r = 0.20, p = 0.004) and mental health component of SF-12 (r = -0.24, p = 0.001). In multivariate models, adjusting for demographics, comorbidity and insulin use, the DFS was independently associated with increased HbA1c (beta 0.21, p = 0.005). CONCLUSIONS: The DFS is a valid and reliable measure of diabetes fatalism. Diabetes fatalism is associated with self-care problems, poor glycemic control, and decreased quality of life.
OBJECTIVE: This study describes the development and validation of the Diabetes Fatalism Scale (DFS) in adults with type 2 diabetes. METHODS: Thirty-five items were derived from focus groups, literature review, and expert opinion. The items were pilot tested on 20 adults with diabetes and then administered to 216 primary care patients with type 2 diabetes to assess the validity and reliability of the scale. Exploratory factor analysis (Principal Component Analysis with Varimax rotation) yielded a 12-item scale with three subscales. Pearson's correlation was used to test the DFS's association with diabetes self-care, HbA1c and quality of life. Multiple linear regression was used to assess association between the DFS and HbA1c controlling for demographics, comorbidity and insulin use. RESULTS: Cronbach's alpha for the 12-item DFS scale was 0.804 indicating internal consistency. The DFS is scored in such a way that higher scores represent greater diabetes fatalism. The DFS scores were not significantly correlated with age, years of education, or diabetes duration. Whites, men, those with government or no insurance, and those with 3+ comorbid conditions had significantly higher DFS scores. DFS was significantly correlated with self management understanding (r = -0.35, p < 0.001), control problems (r = 0.22, p = 0.002), self-care ability (r = -0.30, p < 0.001), and self-care adherence (r = -0.23, p < 0.001). The DFS was significantly correlated with HbA1c (r = 0.20, p = 0.004) and mental health component of SF-12 (r = -0.24, p = 0.001). In multivariate models, adjusting for demographics, comorbidity and insulin use, the DFS was independently associated with increased HbA1c (beta 0.21, p = 0.005). CONCLUSIONS: The DFS is a valid and reliable measure of diabetes fatalism. Diabetes fatalism is associated with self-care problems, poor glycemic control, and decreased quality of life.