Abstract
The cornerstone of diabetes management is self-management—a set of skilled behaviors to manage one’s own illness. Education for diabetes self-management is a vital component of overall management. Nevertheless, lack of knowledge concerning the various aspects of diabetes acts as one of the barriers to achieve optimal diabetes control. The objectives of the study were to develop a test to measure the knowledge of symptoms, causes and risk factors, complications, and management of type 2 diabetes and standardize the test initially by establishing the psychometric properties and norms on an Indian clinical sample. This new test named as Diabetes Mellitus Knowledge Test (DMKT) was developed through four phases—item writing, content validation, item analysis and reliability, and establishment of validity and development of norm—involving three clinical samples (n1 = 10, n2 = 212, n3 = 268) basing on cross-sectional survey design. The DMKT consisted of 37 items having dichotomous response category that were distributed under four theoretical dimensions—symptoms (9 items), causes and risk factors (12 items), complications (11 items), and management (5 items). The reliability of the test was found to be .76. The convergent validity and norm were established. The implications and short-comings of the DMKT were discussed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
International Diabetes Federation. Diabetes Atlas (6th ed.). Brussels: Author. Retrieved from http://www.idf.org/diabetesatlas; 2013. https://doi.org/10.1177/193229681300700132.
Parry O, Peel E, Douglas M, Lawton J. Issues of cause and control in patient accounts of type 2 diabetes. Health Educ Res. 2006;21:97–107. https://doi.org/10.1093/her/cyh044.
Sevick MA, Trauth JM, Ling BS, Anderson RT, Piatt GA, Kilbourne AM, et al. Patients with complex chronic diseases: perspectives on supporting self-management. J Gen Intern Med. 2007;22(3):438–44. https://doi.org/10.1007/s11606-007-0316-z.
Goodall T, Halford NK. Self management of diabetes mellitus: a critical review. Health Psychol. 1991;10:1–8. https://doi.org/10.1037/0278-6133.10.1.1.
Mohan V, Venkatraman JV, Pradeepa R. Epidemiology of cardiovascular disease in type 2 diabetes: the Indian scenario. J Diab Sci Technol. 2010;4(1):158–70. https://doi.org/10.1177/193229681000400121.
American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care. 2000;23(1):32–42.
Merriam-Webster’s online Dictionary. (2015). Retrieved March 10, 2015, from http://www.merriam-webster.com/dictionary/knowledge.
Knight K, Badamgarav E, Henning JM, Hasselblad V, Gano AD Jr, Ofman JJ, et al. A systematic review of diabetes disease management programs. Am J Manag Care. 2005;11(4):242–50.
Al-Sarayra AI, Khalidi RS. Awareness and knowledge about diabetes mellitus among students at Al-Ba qa' applied university. Pak J Nutr. 2012;11(11):1023–8. Retrieved from http://www.pjbs.org/pjnonline/. https://doi.org/10.3923/pjn.2012.1023.1028.
Hawal NP, Kambar S, Patil S, Hiremath MB. Knowledge, attitude and behaviour regarding self-care practices among type 2 diabetes mellitus patients residing in an urban area of South India. Int Multidiscip Res J, 2013 2(12). Retrieved from http://irjs.info/index.php/irjs/index.
Fitzgerald JT, Funnell MM, Hess GE, Barr PA, Anderson RM, Hiss RG, et al. The reliability and validity of a brief diabetes knowledge test. Diabetes Care. 1998;21(5):706–10. https://doi.org/10.2337/diacare.21.5.706.
Torres HC, Virginia AH, Schall VT. Validation of diabetes mellitus knowledge (DKN-A) and attitude (ATT-19) questionnaires. Revista de SaudePublica. 2005;39(6):906–11.
Dunn SM, Bryson JM, Hoskins PL, Alford JB, Handelsman DJ, Turtle JR. Development of the diabetes knowledge (DKN) scales: forms DKNA, DKNB, and DKNC. Diabetes Care. 1984;7(1):36–41. https://doi.org/10.2337/diacare.7.1.36.
Collins GS, Mughal S, Barnett AH, Fitzgerald J, Lloyd CE. Modification and validation of the revised diabetes knowledge scale. Diabet Med. 2011;28(3):306–10. https://doi.org/10.1111/j.1464-5491.2010.03190.x.
Huizinga MM, Elasy TA, Wallston KA, Cavanaugh K, Davis D, Gregory RP, et al. Development and validation of the diabetes numeracy test (DNT). BMC Health Serv Res. 2008;8:96.
Garcia AA, Villagomez ET, Brown SA, Kouzekanani K, Hanis CL. The Starr County diabetes education study: development of the Spanish language diabetes knowledge questionnaire. Diabetes Care. 2001;24(1):16–21. https://doi.org/10.2337/diacare.24.1.16.
Thompson B, Levitov JE. Using microcomputers to score and evaluate test items. Collegiate Microcomputer. 1985;3:163–8.
Wood DA. Test construction: development and interpretation of achievement tests. Columbus, OH: Charles E. Merrill Books, Inc.; 1960. https://doi.org/10.1001/archpsyc.1960.01710060064009.
Crocker L, Algina J. Introduction to classical and modern test theory. New York: Holt, Rinehart and Winston; 1986. https://doi.org/10.1207/s15326888chc1502_3.
Lord FM. The relationship of the reliability of multiple-choice test to the distribution of item difficulties. Psychometrika. 1952;18:181–94.
Kelley TL. The selection of upper and lower groups for the validation of test items. J Educ Psychol. 1939;30:17–24. https://doi.org/10.1037/h0057123.
Ebel RL, Frisbie DA. Essentials of educational measurement. Englewood Cliffs, NJ: Prentice-Hall; 1986.
Kuder GF, Richardson MW. The theory of the estimation of test reliability. Psychometrika. 1937;2(3):151–60. https://doi.org/10.1007/BF02288391.
Pongmesa T, Li SC, Wee HL. A survey of knowledge on diabetes in the central region of Thailand. Value Health. 2009;12(s3):S110–3. https://doi.org/10.1111/j.1524-733.2009.00641.x.
McPherson ML, Smith SW, Powers A, Zuckerman IH. Association between diabetes patients’ knowledge about medications and their blood glucose control. Res Social Admin Pharma. 2008;4:37–45. https://doi.org/10.1016/j.sapharm.2007.01.002.
Al-Qazaz HK, Sulaiman SA, Hassali MA, Shafie AA, Sundram S, et al. Diabetes knowledge, medication adherence and glycemic control among patients with type 2 diabetes. Int J Clin Pharm. 2011;33:1028–35. https://doi.org/10.1007/s11096-011-9582-2.
Atak N, Gurkan T, Kose K. The effect of education on knowledge, self- management behaviours and self -efficacy of patients with type 2 diabetes. Aust J Adv Nurs. 2008;26(2):66–74.
Ingram M, Torres E, Redondo F, Bradford G, O’Toole ML. The impact of promotor as on social support and gylcemic control among members of a farmworker community on the US-Mexico border. Diabetes Educator. 2007;33(6):172S–8S.
McEwen M, Baird M, Pasvogel A, Gallegos G. Health–illness transition experiences among Mexican immigrant women with diabetes. Fam Commun Health. 2007;30(3):201–12. https://doi.org/10.1097/01.FCH.0000277763.70031.0d.
Cohen S, Hoberman H. Positive events and social support as buffers of life change stress. J Appl Soc Psychol. 1983;13:99–125. https://doi.org/10.1111/j.1559-1816.1983.tb02325.x.
Swain S, Hariharan M. ‘Health communication between doctors and patients: Impact on patient adherence and disease prognosis’. (Unpublished doctorate thesis). University of Hyderabad: Hyderabad, India. 2013, DOI: https://doi.org/10.4103/0974-2727.119876.
Kim MT, Hill MN, Bone LR, Levine DM. Development and testing of the hill-bone compliance to high blood pressure therapy scale. Prog Cardiovasc Nurs. 2000;15(3):90–6. https://doi.org/10.1111/j.1751-7117.2000.tb00211.x.
Acknowledgements
We are thankful to Ms. Durgesh Nandinee and Ms. Kavya Chelli for their help. We extend our gratitude to the authorities of the clinics for permitting us to work with their patients. We are also thankful to all the participants for their kind and voluntary participation. Nevertheless, we are grateful to all the authors whose instruments and research findings we have referred while developing this measure and cited in our text.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Before starting the study, approval was obtained from the institutional ethics committee.
Conflict of interest
The authors declare that they have no conflict of interest.
APPENDIX 1
APPENDIX 1
Diabetes Mellitus Knowledge Test (DMKT)
Instructions: “This test measures a person’s knowledge of diabetes mellitus and consists of right and wrong answers. Below are certain terms/phrases written under four sections—Section A (Symptoms), Section B (Causes and risk factors), Section C (Complications), and Section D (Management). Please read each of the following terms/phrases carefully. If the term/phrase is true for diabetes mellitus please encircle Ⓣ and if you know that it is not true for diabetes mellitus, please encircle Ⓕ. Please respond to all the terms/phrases one by one and be genuine in your answer.”
Section A: Symptoms | Response | Section C: Complications | Response | ||
|---|---|---|---|---|---|
#1. | Frequent cold | T/ F | **25. | Loss of appetite | T / F |
*2. | Frequent hunger | T/ F | *26. | Coma | T / F |
*3. | Blurry vision | T/ F | *27. | Foot ulcer | T / F |
**4. | Difficulty in breathing | T / F | #28. | Chest pain | T / F |
*5. | Dizziness | T / F | *29. | Kidney failure | T / F |
*6. | Excessive thirst | T / F | *30. | Gangrene | T / F |
*7. | Weight loss | T / F | **31. | Tonsillitis | T / F |
#8. | Bleeding from the nose | T / F | **32. | Jaundice | T / F |
*9. | Frequent urination | T / F | *33. | Urinary infection | T / F |
#10 | Joint pains | T / F | *34. | Heart disease | T / F |
*11. | Slow healing of wounds | T / F | *35. | Cataract | T / F |
*12. | Physical weakness | T / F | **36. | Headache | T / F |
Section B: Causes and Risk Factors | Response | Section D: Management | Response | ||
*13. | Heredity | T / F | #37. | Regular medication | T / F |
*14. | Inadequate secretion of insulin | T / F | **38. | Excessive consumption of white bread | T / F |
*15. | Overweight | T / F | *39. | Low fat diet | T / F |
**16. | Contact with diabetic people | T / F | #40. | Regular physical exercise | T / F |
**17. | Blood transfusion | T / F | #41. | Maintenance of body weight | T / F |
**18. | Old age | T / F | #42. | Consumption of sweets | T / F |
*19. | Lack of physical activity | T / F | #43. | Regular check up of blood sugar level | T / F |
*20. | Poor diet | T / F | *44. | Low salt diet | T / F |
**21. | Consumption of red meat | T / F | *45. | Usage of footwear inside the house | T / F |
**22. | High cholesterol | T / F | **46. | Avoidance of cold weather | T / F |
*23. | Stress | T / F | #47. | Reduced consumption of rice | T / F |
**24. | Head injury | T / F | #48. | High fiber diet | T / F |
© It is mandatory to obtain permission from the corresponding author to use this test, in any forms, for research.
Details about the DMKT
-
The final version of DMKT consists of 37 items after deleting items marked with # basing on item analysis.
-
The items marked with * are to be positively scored (True = 1, False = 0).
-
The items marked with ** are to be negatively scored (True = 0, False = 1).
-
Items in each dimension: Symptoms (Items No: 2, 3, 4, 5, 6, 7, 9, 11, and 12), Causes and risk factors (Items No: 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, and 24), Complication (Items No: 25, 26, 27, 29, 30, 31, 32, 33, 34, 35, and 36), and Management (Items No: 38, 39, 44, 45, and 46).
Rights and permissions
About this article
Cite this article
Padhy, M., Padiri, R.A., Hariharan, M. et al. Diabetes Mellitus Knowledge Test: development, psychometric evaluation, and establishing norms for Indian population. Int J Diabetes Dev Ctries 39, 206–217 (2019). https://doi.org/10.1007/s13410-018-0644-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13410-018-0644-z