Self-Efficacy in Children with Diabetes Mellitus: Testing of a Measurement Instrument
Kappen, Michel J. Ms, Rn, Bijl, Jaap J. van der PhD, Rn, Vaccaro-Olko, Mary Joan Ms, Rn, Cs, Fnp, Cde, Scholarly Inquiry for Nursing Practice
The study reported here assessed the psychometric properties of an instrument to measure diabetes management self-efficacy in Dutch children, ages 8 to 12. Content validity of the item list was tested by consulting an expert panel of diabetes nurse specialists and a child-oriented rating scale was developed. A pretest was conducted to assess whether the instrument was clear and comprehensible for children. Then the instrument was tested in children with diabetes at the outpatient diabetes clinics for children at three Dutch hospitals. Reliability and criterion-related validity of the instrument were assessed. The instrument was judged content valid by the expert panel of diabetes nurse specialists, and the language of the instructions, the items and the rating scale was found to be clear and understandable for children of this age group. The study yielded only a moderate internal consistency estimate (Cronbach's = 0.71) and limited support for criterion-related validity. Several useful theoretical and methodological issues were identified.
Diabetes mellitus is a chronic metabolic disorder, involving a defect in insulin production, insulin action or both, and resulting in hyperglycemia. Type 1 diabetes results from a cell-mediated autoimmune process which leads to complete destruction of the beta cells of the pancreas and an absolute deficiency of insulin production. Exogenous insulin by injection or continuous insulin pump therapy is required for glucose homeostasis. In type 2 diabetes, the defect in insulin production stems from both insulin resistance and a relative insulin deficiency, or a primary insulin secretory defect with insulin resistance. This type of diabetes usually afflicts people who are sedentary, obese and older and is initially managed by diet, exercise, and weight reduction, though oral hypoglycemic agents are also commonly required to achieve glycemic control. Type 1 diabetes represents 10%-15% of cases, while the more prevalent form of diabetes, type 2, accounts for 85%-90%.
In diabetes mellitus, self-management is critical for preventing complications but difficult for all; it is even more challenging for children and their families. In order to ensure an acceptable blood glucose level, children and their parents need to master a complex set of diabetes self-management tasks, and most of the tasks need to be executed daily. The diabetes nurse specialist plays a central role in teaching knowledge and skills to children with diabetes and their parents. Research on the effect of diabetes education, however, has revealed that knowledge and skills have limited effects on actual diabetes self-management behaviors (Kaplan et al., 1985; Padgett et al., 1988; Pennings-van der Eerden, 1992). Clearly interventions that focus on behavior change are needed to obtain better effects.
According to Bandura (1982,1986,1992), self-efficacy, or people's judgments about their ability to organize and execute courses of action to attain desired outcomes, determines whether or not knowledge and skills are actually employed to successfully execute the courses of action. Thus self-efficacy may be a key element in successful self-management behavior. A number of studies have found that self-efficacy was a major predictor of successful diabetes self-management. These studies, however, used samples of adults with diabetes and data from the studies cannot be used to determine the predictive value of self-efficacy in children with diabetes (Kappen, 1995). A clearer understanding of self-efficacy in children requires additional research, which in turn requires valid and reliable instruments for measuring self-efficacy in children.
If children are to be reliable and accurate reporters of self-efficacy, a measurement instrument must be tailored to their developmental level (LaGreca, 1990; Reynolds, 1993). A child needs both the general skills to complete an instrument and the ability to self-perceive, since self-efficacy is a kind of self-perception (Flammer, 1995). …