Keith Meadows

The Diabetes Health Profile (DHP): a new instrument for assessing the psychosocial profile of insulin requiring patients--development and psychometric evaluation.

The aim of the studies was to evaluate the psychometric properties and construct validity of the Diabetes Health Profile (DHP-1). Content for the DHP-1 was derived following in-depth interviews with 25 insulin dependent and insulin requiring patients, a review of the literature and discussions with health care professionals. Initial analysis of the factor structure of the DHP-1 was carried out on the responses of 239 insulin dependent and insulin requiring patients, with a mean age of 40.85 years (SD=13.0), resulting in a 43 item three factor solution. The 43 item version of the DHP-1 was completed by 2,239 insulin dependent/requiring patients (mean age = 39.8, SD=10) years. Fifty-one per cent were men. A forced three factor Principal Factoring Analysis with varimax rotation was carried out. Eleven items were excluded with item factor cross loadings >0.30 or item factor loadings <0.30. PAF analysis of the 32 items resulted in a three factor solution accounting for 33% of the total explained variance. The three factors were interpreted as Psychological Distress, Barriers to Activity and Disnhibited Eating. Factor congruence between subsamples were: Psychological distress (0.93), Barriers to Activity (0.93) and Disinhibited Eating (0.99). Coefficients of congruence between men and women were 0.94, 0.92 and 0.99 for Psychological Distress, Barriers to Activity and Disinhibited Eating respectively. Internal consistency of the three factors (Cronbachs α) were: Psychological Distress (0.86), Barriers to Activity (0.82), and Disinhibited Eating (0.77). Construct-convergent validity was investigated on a sample of 233 insulin dependent and insulin requiring patients (mean age = 51.46 years). Psychological Distress and Barriers to Activity subscales correlated with the Hospital Depression and Anxiety Scale = 0.50 to 0.62, p<0.01 and subscales of the SF-36 (range: r=−0.17 to -0.62, p<0.01). These findings lend support to the construct validity and reliability of the DHP-1 and that it is suitable for further development.

The validity and reliability of the Diabetes Health Profile (DHP) in NIDDM patients referred for insulin therapy

Recently, a new diabetes-specific questionnaire, the Diabetes Health Profile (DHP), has been developed to identify psychosocial dysfunctioning of insulin-requiring (NIDDM) and insulin-dependent diabetes mellitus (IDDM) patients. The DHP comprises three dimensions: psychological distress (PSY: 14 items), barriers to activity (BAR: 12 items) and disinhibited eating (EAT: five items). This study investigates the psychometric properties of the DHP in Dutch noninsulin-dependent diabetes mellitus (NIDDM) patients referred for insulin therapy. In addition, the relation-ship between patient characteristics and the DHP outcome was examined. The factor structure found was similar but not identical to former studies, but construct validity was supported by high correlations of our factor structure and the original factor outcome and Cronbachs α. The three factors explained 32% of the variance, supporting earlier findings. It was shown that Cronbachs α was satisfactory (0.72, 0.72 and 0.79). Convergent validity showed strong and significant correlations between the PSY/BAR dimensions and predicted corresponding scales of the RAND-36. However, the PSY/BAR dimensions also showed, although less strong, significant correlations with the non-corresponding RAND-36 scales. The EAT dimension showed only correlations with two of the RAND-36 dimensions, thus measuring a different trait. Regression analysis showed that older patients had less problems with items of the EAT dimension and that no difference was found between men and women, supporting earlier findings. The hyperglycaemic complaint ‘fatigue’ gave a significantly lower score (more problems) on the PSY and BAR dimensions. Younger age, the presence of hypertension and retinopathy resulted in a significantly lower score on the EAT dimension. DHP outcome was not significantly influenced by duration of diabetes, HbA1c (indicator of glycemic control), serum total cholesterol, body mass index, chronic diabetes complications and comorbidity. Overall, the psychometric properties were good considering the small and diverse sample, suggesting that the DHP is promising for use in NIDDM patients, although more study is necessary in a larger sample.

Using health-related quality of life measures in minority ethnic groups An approach to translating measures into Bengali (Sylheti)

Objectives: To describe an approach to the adaptation and qualitative evaluation of existing generic and disease-specific health outcome measures for use with Bengali (Sylheti) speaking patients with asthma. Sylheti is a Bengali dialect with no written form. Methods: We developed a Bengali (Sylheti) translation of an outcomes interview for use during a randomised controlled trial in East London. The outcomes interview comprised five validated health-related quality of life scales: the Hospital Anxiety and Depression Scale, the AQ20, the Hilton/Sibbald asthma self-management questionnaire, the North of England asthma symptom scale, and the EuroQol EQ-5D. An initial translation was developed using a range of sources. Further linguistic validation was carried out by a comparison of the Sylheti translation with the English original by a lay and expert panel to establish technical, conceptual, content, and semantic equivalence. Results: The translation and validation process identified a range of issues concerning technical, content, conceptual, and semantic equivalence. The main difficulties surrounded the translation of emotional concepts and the achievement of conceptual equivalence. Conclusion: The adapted measures met a number of the criteria required for their use in a cross-cultural setting. Quantitative work is needed to establish the full extent of the functional equivalence of the measures.

NHS attitudes to good medical practice.

Perceptions of good medical practice among senior NHS staff were collected through a survey. There are differences between the perceived seriousness of poor communication skills and poor technical skills.