Diabetes Empowerment Scale–Short Form (DES-SF)

Abstract

The Diabetes Empowerment Scale–Short Form (DES-SF) is an abbreviated measure derived from the original 35-item Diabetes Empowerment Scale (DES). Developed by Anderson and colleagues, this instrument is designed to assess the level of psychosocial self-efficacy and empowerment among individuals managing diabetes. The DES-SF consists of eight items rated on a 5-point Likert scale, providing a quick and reliable assessment of crucial dimensions related to diabetes self-management and goal attainment.

The scale focuses specifically on the patient’s perceived ability to cope with the challenges of the condition, set achievable goals, and engage in effective self-care behaviors, making it a valuable tool in both clinical settings and research for evaluating the impact of educational and behavioral interventions.

Keywords

Diabetes Empowerment Scale–Short Form, DES-SF, self-efficacy, diabetes management, empowerment, psychosocial, chronic illness, patient readiness, goal setting, readiness to change.

Authors

Anderson, R.M., Funnell, M.M., Fitzgerald, J.T., Marrero, D.G., Gruppen, L. D., Oh, M. S.

Purpose

The primary purpose of the DES-SF is to provide a brief, psychometrically sound tool for clinicians and researchers to measure the degree of empowerment felt by individuals with diabetes. Empowerment in this context refers to the patient’s belief in their ability to understand and effectively manage the complexities of their chronic condition, thereby improving adherence and health outcomes.

Specifically, the scale assesses key areas necessary for successful long-term diabetes care, including identifying areas of dissatisfaction, setting manageable goals, coping with stress, and seeking necessary social support. It serves as an indicator of a person’s readiness to engage actively in the self-care process and fosters a collaborative approach between the patient and the healthcare provider.

Construct

The underlying psychological construct measured by the DES-SF is psychosocial self-efficacy related to diabetes management. Self-efficacy, as defined by Bandura, is the belief in one’s capacity to execute behaviors necessary to produce specific performance attainments. A high level of self-efficacy is strongly correlated with improved adherence to complex self-care regimens.

In the context of the DES-SF, this construct encompasses the patient’s confidence in handling the emotional, social, and behavioral challenges inherent in living with a chronic condition like diabetes. This includes managing psychosocial aspects, coping with related stress, and successfully implementing personalized self-care behaviors necessary for metabolic control.

Validity

The validity of the DES-SF is supported by its derivation from the empirically validated, longer-form Diabetes Empowerment Scale (DES), published in 2000. The DES-SF demonstrates strong construct validity, shown to correlate positively with measures of proactive self-care behavior and negatively with indicators of diabetes-related distress or poor glycemic control.

Original validation studies confirmed that both the long and short scales effectively measure the intended dimensions of empowerment, showing appropriate discriminant validity from measures of general health status, while maintaining a strong relationship with specific diabetes outcomes. The selection of the eight items ensures maximum content coverage of the core empowerment dimensions while minimizing administration time.

Reliability

The DES-SF demonstrates high internal consistency, a key measure of reliability. The scale items are cohesive, ensuring they measure the same underlying construct. The reliability data provided in the source content refers to the factors identified in the original, longer scale, which showed exemplary internal consistency across the measured dimensions of empowerment.

The factors demonstrated high Cronbach’s Alpha coefficients ($alpha$):

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

These high scores confirm that the core components of diabetes empowerment are measured consistently, reinforcing the utility of the DES-SF as a reliable clinical and research tool.

Factor Analysis

The original Diabetes Empowerment Scale (DES), from which the short form is derived, was structured around three primary factors, identified through rigorous factor analysis. These factors represent the key domains of patient empowerment essential for managing diabetes effectively:

• Managing the psychosocial aspects of diabetes: This factor focuses on emotional and social coping strategies, reflecting the ability to handle the burden of the condition.
• Assessing dissatisfaction and readiness to change: This dimension measures the individual’s awareness of areas needing improvement and their motivation to initiate behavioral change.
• Setting and achieving goals: This factor evaluates the ability to translate abstract intentions into concrete, actionable self-care plans.

The 8 items comprising the DES-SF were selected specifically through statistical analysis to ensure they maximally represent these three dimensions efficiently, allowing the short form to retain the multidimensional nature of the original construct while significantly reducing the burden on the respondent.

Instrument

Test Type: Self-Report Questionnaire / Psychometric Scale

Format: 8 items, 5-point Likert scale

Language Available: English (Original); translations may be available depending on the research group.

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

Age Group: Adolescents and Adults

Population Details: The scale is used widely in clinical and educational settings to assess patient readiness and self-efficacy in managing a chronic condition, often utilized before and after diabetes education programs.

Test Methodology: Respondents rate their agreement with each statement using the 5-point scale (1 = Strongly Disagree to 5 = Strongly Agree). Scores are typically summed and averaged to yield a total empowerment score. Higher scores indicate greater levels of empowerment and confidence regarding diabetes care.

Keywords

Psychosocial self-efficacy, DES, chronic disease management, patient education, internal consistency, Cronbach’s Alpha, health behavior change, survey instrument, R.M. Anderson, readiness to change.

Authors

Author ORCID Identifier: Not specified in source.

Affiliation Email addresses: Refer to the University of Michigan Diabetes Research Center for current contact information.

Correspondence Address: Contact R.M. Anderson, University of Michigan Medical School, USA (as per original publication).

Permissions & Fee and Test Year

The Diabetes Empowerment Scale–Short Form (DES-SF) was developed and published in 2003. The original full scale (DES) was published in 2000. This instrument can be found at: http://diabetesresearch.med.umich.edu/Tools_SurveyInstruments.php.

Information regarding permissions, licensing, and any associated fees for use in research or clinical practice should be sought directly from the primary authors or the entity hosting the instrument, typically the University of Michigan Diabetes Research Center.

Reference’s

The instrument is based on the following foundational research:

• 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., Fitzgerald, J. T., Gruppen, L. D., Funnell, M. M., & Oh, M. S. (2003). The diabetes empowerment scale-short form. Diabetic Care, 5, 1641–1642.
• Anderson et al. (2003). Diabetes Empowerment Scale–Short Form. In: Simmons C. A., Lehmann P. (eds). Tools for strengths-based assessment and evaluation, New York, NY: Springer, pp. 358-359. (2013). The related Google Scholar profile can be accessed here: Google Scholar.

Items of the Diabetes Empowerment Scale–Short Form (DES-SF)

In general, I believe that I:

1. know what part(s) of taking care of my diabetes that I am dissatisfied with.
2. am able to turn my diabetes goals into a workable plan.
3. can try out different ways of overcoming barriers to my diabetes goals.
4. can find ways to feel better about ha‎ving diabetes.
5. know the positive ways I cope with diabetes related stress.
6. can ask for support for ha‎ving and caring for my diabetes when I need it.
7. know what helps me stay motivated to care for my diabetes.
8. know enough about myself as a person to make diabetes care choices that are right for me.

Scoring:

5= Strongly Agree, 4= Somewhat Agree, 3= Neutral, 2= Somewhat Disagree, 1= Strongly Disagree