The present study reported the stages of designing and developing a scale for evaluating social support for self-care in middle-aged patients with type II diabetes and the findings indicated satisfactory psychometric properties for the questionnaire. Social support for self-care is a crucial issue in adults with diabetes . It can contribute to treatment adherence and the outcomes. For instance, evidence suggests that encouraging families to exercise with their diabetic patients could increase physical activity among these people .
There are a number of scales for measuring social support [43–46] but to the authors’ best knowledge, there are only two questionnaires for assessing social support in diabetic patients the Diabetes Social Support Questionnaire, and the Diabetes Care Profile (DCP) [47–49]. The DSSQ is a well-known instrument and has been used in a number of studies on social support for self-care in diabetic patients [47, 50]. It was primarily developed for type I diabetic patients and measures insulin injection, blood glucose testing, meal plan, exercise and emotional support. The Diabetes Care Profile (DCP) is a set of different sections and one section including six questions related to social support. The DCP asks the support that one receives for meal plan, medicine, foot care, physical activity, testing blood sugar and emotional item . However, the focus of current study was to develop a scale containing the five most important diabetes related behaviors namely nutrition, physical activity, self-monitoring of blood glucose (SMBG), foot care and smoking. It is argued that when addressing self-care activities in diabetic patients, it is important to address the unmet needs for social support . As different aspects of social support for self-care in diabetes patients might be considered, it is recommended that when assessing social support, there is need to decide which aspects of support are relevant to measure in any specific situation . In this study, we thought diabetic patients need instrumental, informational and emotional support for self-care and thus, we considered these three aspects of social support and incorporated them to the all dimensions of the questionnaire as needed.
Performing both exploratory and factor analyses, the results indicated a good structure for this new instrument. Exploratory factor analysis indicated that the five-factor structure of the questionnaire could jointly account for 72.3% of the total observed variance. It seems that a careful selection of items related to social support for self-care might be the reason why we obtained such satisfactory results . CFA also showed that factor structure of this scale was appropriate.
A reliable instrument can increase the power of the study to recognize real significant correlations and differences in the study . Internal consistency of the final scale as measured by the Cronbach’s alpha coefficient was found to be 0.94 indicating a desirable reliability. In addition, ICC showed appropriate stability for the scale as it was examined by 15 patients with a 2-weeks interval (0.87).
The main feature of the S4-MAD was the fact that it was developed for middle age diabetic patients (the main affected age group), and contained items on foot care and smoking. However, we did not include items on medications since neither patients nor experts did address the topic during the course of scale development. In addition a unique item (item 18) was included in this new instrument on reminding patients for blood glucose test every three months. The other characteristic of our questionnaire was related to its wording structure. Unlike other questionnaires that contain short statements for each item we used prolonged and complete sentences in order to help patients to understand the items and avoid confusion. Finally, we believe without losing any important dimension on social support for self-care, the S4-MAD is relatively a short questionnaire and easy to use.
This study however had few limitations. For example we did not perform concurrent validity in order to demonstrate the instrument correlates well with a measure that has previously been validated in Iran. Yet, the study had a number of strengths. Notably we recruited two separate samples for the study. In fact, as recommended, we used one sample for the EFA and another sample for the CFA.