Diabetes Attitudes Questionnaire

Abstract

The Diabetes Attitudes Questionnaire (DAQ), developed by Anderson and colleagues in 2000, is a specialized psychometric instrument designed to assess an individual’s attitudes, readiness for change, and self-efficacy concerning the comprehensive management of their diabetes. The scale comprises 28 items structured across three primary factors, focusing particularly on the behavioral and psychosocial challenges inherent in chronic disease management. It utilizes a 5-point Likert scale to quantify the degree of agreement regarding various aspects of self-care, including goal setting, barrier identification, emotional coping, and motivation related to the condition.

Keywords

Diabetes Attitudes Questionnaire, DAQ, diabetes self-management, psychosocial factors, readiness to change, goal setting, attitudes, chronic disease.

Authors

R.M. Anderson, J.T. Fitzgerald, M.M. Funnell, D.G. Marrero, C. Feste.

Purpose

The fundamental purpose of the DAQ is to provide clinicians and researchers with a quantifiable measure of a patient’s internal psychological landscape regarding their diabetes care. It is specifically designed to assess areas where a patient feels competent (or incompetent) and motivated (or resistant) to engage in necessary self-management behaviors. By identifying specific deficits in attitudes or perceived self-efficacy, healthcare providers can tailor educational and motivational interventions to maximize adherence and improve health outcomes.

The scale serves as a diagnostic tool to pinpoint barriers to effective self-care, moving beyond simple knowledge assessment to evaluate the emotional and behavioral components of living with a chronic condition. This focus on attitude and readiness makes it highly valuable in motivational interviewing and patient-centered counseling settings, facilitating a deeper understanding of the patient’s perspective on their treatment regimen.

Construct

The primary construct measured by the Diabetes Attitudes Questionnaire is the patient’s psychosocial self-efficacy and perceived readiness for change related to diabetes self-management. This construct encompasses the belief in one’s ability to successfully execute the required behaviors (e.g., setting goals, overcoming barriers, coping with stress) necessary to manage diabetes effectively, as well as the internal mental state concerning their current care regimen.

The scale operationalizes this broad construct through three distinct sub-domains: Managing Psychosocial Aspects, Assessing Dissatisfaction and Readiness to Change, and Setting and Achieving Goals. Together, these domains cover the cognitive, emotional, and behavioral intentions critical for sustained self-care engagement.

Validity

The DAQ, often used interchangeably or alongside the related Diabetes Empowerment Scale (DES), has established strong construct validity. The original validation work by Anderson and colleagues demonstrated that the three hypothesized factors clearly differentiate, aligning theoretically with established models of health behavioral change and self-efficacy theory.

Furthermore, the scale exhibits evidence of concurrent and predictive validity, showing significant correlations with clinical outcomes, such as glycosylated hemoglobin (HbA1c) levels, and established measures of general self-efficacy and quality of life in individuals managing diabetes. The scale items are grounded in clinical relevance and patient experiences, supporting strong content validity.

Reliability

The Diabetes Attitudes Questionnaire demonstrates high internal consistency across all three measured factors, indicating excellent reliability. The Cronbach’s alpha coefficients reported in the initial validation studies are robust, suggesting that the items within each subscale reliably measure the intended underlying construct.

The reported reliability coefficients for the three subscales are:

• Managing the psychosocial aspects of diabetes (9 items): α = 0.93.
• Assessing dissatisfaction and readiness to change (9 items): α = 0.81.
• Setting and achieving goals (10 items): α = 0.91.

These high reliability scores confirm that the DAQ is a statistically sound instrument appropriate for use in clinical assessment and research settings focused on diabetes self-care.

Factor Analysis

The structure of the Diabetes Attitudes Questionnaire was confirmed through factor analysis, which yielded three distinct and highly interpretable factors. This structure supports the understanding that a patient’s attitude toward their diabetes care is a complex, multidimensional construct, rather than a single unified trait.

The three identified factors, which collectively account for the variance in patient responses, and their corresponding item distributions are:

1. Managing the Psychosocial Aspects of Diabetes: This factor includes items 18, 20 through 27. It assesses the patient’s perceived ability to cope with diabetes-related stress, seek and utilize support, maintain motivation, and possess sufficient self-knowledge to make appropriate self-care choices.
2. Assessing Dissatisfaction and Readiness to Change: This factor includes items 1 through 4, 15 through 17, 19, and 28. It measures the patient’s current level of satisfaction or dissatisfaction with their care, their readiness to implement changes, and their awareness of the emotional impact of the disease.
3. Setting and Achieving Goals: This factor includes items 5 through 14. It focuses on the patient’s practical self-efficacy regarding goal setting, including identifying realistic goals, developing workable plans, recognizing barriers, and generating strategies to overcome obstacles.

Instrument

Test Type: Self-report questionnaire / Psychosocial Assessment Scale

Format: 28 items administered via a 5-point Likert scale (5= Strongly Agree, 4= Somewhat Agree, 3= Neutral, 2= Somewhat Disagree, 1= Strongly Disagree).

Language Available: Primarily English (Original validation).

Population Group: Individuals diagnosed with Diabetes (Type 1 or Type 2).

Age Group: Adults.

Population Details: Used broadly in clinical and research settings to evaluate behavioral and motivational aspects of diabetes management in patients.

Test Methodology: Respondents rate the degree to which they agree or disagree with statements regarding their attitudes and capabilities concerning diabetes self-care.

Keywords

Psychometric scale, chronic disease management, patient education, motivational interviewing, self-care behaviors, factor analysis, Cronbach’s alpha.

Authors

Author ORCID Identifier: N/A (Information not available in source)

Affiliation Email addresses: N/A (Information not available in source)

Correspondence Address: N/A (Information not available in source)

Permissions & Fee and Test Year

The Diabetes Attitudes Questionnaire (DAQ) was developed and published around 2000, evolving from earlier work on the Diabetes Empowerment Scale (DES). The instrument is frequently available for non-commercial academic research and clinical use, often requiring direct permission from the primary authors or the associated research institution (e.g., the University of Michigan Diabetes Research Center).

The instrument can be located at: http://diabetesresearch.med.umich.edu/Tools_SurveyInstruments.php#das

Reference’s

• Anderson, R.M., Fitzgerald, J.T., Funnell, M.M., Feste, C. (1997). Diabetes Empowerment Scale (DES): A measure of psychosocial self-efficacy. Diabetes 46:269A.
• Anderson, R.M., Funnell, M.M., Fitzgerald, J.T., Marrero, D.G. (2000). The diabetes empowerment scale: a measure of psychosocial self-efficacy. Diabetes Care, 23, 739–743.
• Anderson, R.M., Funnell, M.M., Nwankwo, R., Gillard, M.L., Fitzgerald, J.T., Oh, M. (2001). Evaluation of a problem based, culturally specific, patient education program for African Americans with diabetes. Diabetes 50(Suppl. 2): A195.
• Anderson, R. M., Fitzgerald, J. T., Gruppen, L. D., Funnell, M. M., & Oh, M. S. (2003). The diabetes empowerment scale-short form. Diabetic Care, 5, 1641–1642.
• Peterson, A. N., Speer, P. W., & McMillan, D. W. (2008). Validation of a brief sense of community scale: Confirmation of the principle theory of sense of community. Journal of Community Psychology, 36, 61–73.
• Peterson, Speer, & McMillan, (2008). brief sense of community scale. In: Simmons C. A., Lehmann P. (eds). Tools for strengths-based assessment and evaluation, New York, NY: Springer, pp. 356-357. (2013).

Items of the Diabetes Attitudes Questionnaire

In general, I believe that I:

1. know what part(s) of taking care of my diabetes that I am satisfied with.
2. know what part(s) of taking care of my diabetes that I am dissatisfied with.
3. know what part(s) of taking care of my diabetes that I am ready to change.
4. know what part(s) of taking care of my diabetes that I am not ready to change.
5. can choose realistic diabetes goals.
6. know which of my diabetes goals are most important to me.
7. know the things about myself that either help or prevent me from reaching my diabetes goals.
8. can come up with good ideas to help me reach my goals.
9. am able to turn my diabetes goals into a workable plan.
10. can reach my diabetes goals once I make up my mind.
11. know which barriers make reaching my diabetes goals more difficult.
12. can think of different ways to overcome barriers to my diabetes goals
13. can try out different ways of overcoming barriers to my diabetes goals.
14. am able to decide which way of overcoming barriers to my diabetes goals works best for me.
15. can tell how I’m feeling about having diabetes.
16. can tell how I’m feeling about caring for my diabetes
17. know the ways that having diabetes causes stress in my life.
18. know the positive ways I cope with diabetes-related stress.
19. know the negative ways I cope with diabetes-related stress.
20. can cope well with diabetes related stress.
21. know where I can get support for having and caring for my diabetes.
22. can ask for support for having and caring for my diabetes when I need it.
23. can support myself in dealing with my diabetes.
24. know what helps me stay motivated to care for my diabetes.
25. can motivate myself to care for my diabetes.
26. know enough about diabetes to make self-care choices that are right for me.
27. know enough about myself as a person to make diabetes care choices that are right for me.
28. am able to figure out if it is worth my while to change how I take care of my diabetes.