Behind HbA1c: the role of self-efficacy in diabetes care

Purpose: This thesis aims to illustrate the Italian validation of a scale measuring self-efficacy in diabetes management (Diabetes Management Self-Efficacy Scale, DMSES) in adults with diabetes. Methods: Two cross-sectional studies were conducted with patients attending the Diabetology Unit of San Marino and Bologna Hospitals. In study I, patients completed a socio-demographic and clinical data form, the Italian version of the DMSES (IT-DMSES) and 3 self-report questionnaires measuring diabetes distress (PAID-5), psychological well-being (WHO-5) and depression (PHQ-9). Psychometric testing included construct validity (Principal Component Analysis), internal consistency (Cronbach’s α coefficient) and convergent/discriminant validity (Spearman’s correlation coefficient). In study II, a network analysis of the IT-DMSES was conducted to investigate the differences in self-efficacy between type 1 and type 2 diabetes and between males and females. Results: Overall, 105 patients with type 1 diabetes and 306 with type 2 diabetes were recruited at the two study sites. The IT-DMSES proved to consist of two factors, including disease management and lifestyle management. The second factor showed a good convergent validity with the well-being index. Results from network analysis showed that disease management and lifestyle management are two spatially distinct but related clusters of items, consistent across types of diabetes and genders. The pattern of correlations among items proved to be significantly different between type 1 and 2 diabetes. Conclusions: IT-DMSES can be used in research and clinical practice in people living with diabetes to assess self-efficacy. In type 1 diabetes, educational interventions aimed at empowering patients in coping with their disease are likely to affect both disease management and lifestyle management. On the contrary, in type 2 diabetes, educational interventions targeted on disease management may have a limited effect on the adoption of healthy lifestyles and vice versa.