Characteristics of Diabetes Self-Care Agency in Japan Based on Statistical Cluster Analysis.

INTRODUCTION: Considering the situation where the number of people with diabetes is increasing, we need to find ways to support more efficient and effective outpatient clinics. Therefore, it is necessary to develop effective support methods and to elaborate a strategy as a system for support after grasping the characteristics of the entire population of people with diabetes. OBJECTIVE: The purpose of this study was to identify the characteristics of the diabetes population in outpatient settings by differences in self-care agency and to examine how to support them based on the recognized characteristics. METHODS: Participants were 261 people with diabetes under outpatient care in Japanese institutions from whom demographic data on age, gender, HbA1c, and treatment method were collected as well as self-care agency data based on the Instrument of Diabetes Self-Care Agency consisting of 40 items. The data were analyzed using cluster analysis to compare age, gender, HbA1c, duration of diabetes, type of diabetes, and insulin therapy between clusters. RESULTS: The analysis identified six clusters, including a group with favorable HbA1c but low total self-care agency scores that were likely to affect their blood glucose control in the future, although accounting for as small a portion as 3% of the total. In addition, a cluster with poor HbA1c and generally low self-care agency was also identified accounting for about a quarter of the total population. These clusters were considered to require further support. Clusters having markedly low self-care agency items, stress-coping ability, or the ability to make the most of the support available were also identified. CONCLUSION: The six clusters need to be assisted in focusing on mental or social support. Accordingly, consideration of the support system for people with diabetes based on an understanding of the cluster characteristics seemed to enable more efficient and effective support.

Structural model of self-care agency in patients with diabetes: A path analysis of the Instrument of Diabetes Self-Care Agency and body self-awareness.

AIM: The aim of this study was to examine a causal model of self-care agency by exploring the relationship between the structure of "body self-awareness" and the structure of the Instrument of Diabetes Self-Care Agency (IDSCA). METHODS: The participants were 353 patients with diabetes. The internal consistency of the six items for body self-awareness was examined by calculating the factor structure using principal factor analysis and Cronbach's alpha. In order to examine the relationship between the seven factors in the IDSCA, a path analysis was conducted. RESULTS: With regard to the factor structure, the factor loading of these five items was 0.511-0.743 (α = 0.739). In the path analysis, "body self-awareness" was influenced by the "ability to acquire knowledge" and had a direct effect (0.33) on the "motivation to self-manage", while "motivation to self-manage" had an effect (-0.32) on the "ability to self-manage". The Goodness-of-Fit Index was 0.974. CONCLUSION: "Body self-awareness" plays a part in the self-care operation process and serves as an intermediary factor to enable the performance of self-care operations by making the most use of self-care agency. Moreover, striking a proper balance between self-management that is focused on the treatment of diabetes and a person's ability for self-management of diabetes was found to be important.

Reliability and Validity of a Shortened Version of an Instrument for Diabetes Self-Care Agency.

PURPOSE: The purpose of this study was to develop a shortened version of the Instrument of Diabetes Self-Care Agency (IDSCA). METHODS: In the development of the shortened version of IDSCA, intraclass correlation coefficient 2 (ICC2) analysis was done to determine items to be deleted. However, the 7 subscales were retained. The shortened IDSCA was evaluated for internal consistency, reproducibility, concurrent validity, criterion-related validity, and goodness of fit. RESULTS: The shortened IDSCA included 35 items addressing 7 subscales. High ICC2 (.804) and a high Cronbach's alpha (.89) indicate internal consistency and reproducibility. A high correlation (.62) between the shortened version of the IDSCA and the Self-Care Agency Questionnaire indicated concurrent validity. CONCLUSION: The shortened IDSCA provides a reliable and valid measure of self-care agency of individuals with diabetes.