Diabetes Family Responsibility Questionnaire (DFRQ)

Abstract

The Diabetes Family Responsibility Questionnaire (DFRQ) is a specialized psychometric instrument designed to assess the distribution of daily diabetes management tasks between youth and their parents or caregivers. Developed by Anderson et al. in 1990, the scale provides critical insight into the shared care model necessary for effective chronic illness management, particularly in the context of Type 1 diabetes. The DFRQ helps researchers and clinicians understand the developmental shift in responsibility that occurs as children progress through adolescence.

The instrument typically includes two main components: a scale measuring the perceived allocation of responsibilities (who performs the task—parent, youth, or shared) and a scale assessing the frequency of family conflict arising from these tasks. Subsequent revisions, such as the updated and revised Diabetes Family Conflict Scale (Hood et al., 2007), have enhanced the measure’s utility in correlating responsibility sharing and conflict levels with clinical outcomes, such as glycaemic control.

Keywords

Diabetes, Family responsibility, Shared care, Adherence, Glycaemic control, Adolescent psychology, Conflict, Self-management, Insulin management, Pediatric psychology.

Authors

Anderson, B. J., Auslander, W. F., Jung, K. C., Miller, P., Santiago, J. V.

Purpose

The primary purpose of the DFRQ is to systematically quantify the extent to which specific, essential diabetes care tasks are initiated and executed by the child or adolescent versus the parent. This measurement is crucial because the transition of responsibility from parent to youth is a key developmental milestone that directly impacts treatment adherence and long-term health outcomes for individuals with Type 1 Diabetes.

Furthermore, the DFRQ and its related forms, such as the Diabetes Family Conflict Scale, are used to identify potential sources of disagreement or tension within the family unit related to illness management. High levels of family conflict surrounding tasks like blood glucose monitoring or insulin administration are consistently linked to suboptimal adherence and poorer metabolic outcomes, highlighting the scale’s utility in clinical assessment and intervention planning.

Construct

The DFRQ measures the psychological construct of Shared Responsibility for Chronic Illness Management within the family system. This construct acknowledges that successful diabetes care requires continuous coordination and negotiation between the youth and their caregiver, particularly during the developmental period of adolescence when youth are striving for autonomy.

The scale operationalizes this construct by differentiating between the degree of responsibility (parent-led, shared, or youth-led) for various tasks that fall into two general categories: direct management tasks (e.g., injections, adjusting insulin dosage) and indirect management tasks (e.g., making appointments, communicating with school personnel). The subsequent conflict component measures the interpersonal strain associated with negotiating these responsibilities.

Validity

The DFRQ and its revisions have demonstrated robust construct validity across numerous studies. Research consistently shows that the perceptions of responsibility sharing, particularly the mismatch between youth and parent perceptions, are highly correlated with clinical markers. For instance, studies by Anderson and colleagues have established that high levels of conflict measured by the related scales are significantly associated with poor glycaemic control (higher HbA1c levels) and decreased adherence to treatment regimens.

Furthermore, the scale exhibits face validity, as the items cover the comprehensive range of medical, social, and logistical tasks required for daily diabetes management. The differentiation between youth-reported and parent-reported responsibility levels provides a unique measure of consensus or disagreement, which itself is a validated predictor of adjustment in pediatric chronic illness.

Reliability

While specific psychometric statistics are not provided in the source excerpt, published research utilizing the DFRQ and the updated Diabetes Family Conflict Scale (DFCS) generally reports acceptable to strong internal consistency. The conflict subscale, in particular, often shows good reliability (Cronbach’s alpha typically in the 0.80s), indicating that items within the subscale measure a coherent underlying construct of family tension related to diabetes care. Test-retest reliability has also been supported in longitudinal studies examining changes in responsibility over time in adolescents with Type 1 Diabetes.

Factor Analysis

The updated versions of the scale (such as the DFCS described by Hood et al., 2007) typically yield a multi-factor structure, especially concerning the conflict items. The conflict items are generally categorized into two factors based on principal components analysis:

• Factor 1: Direct Management Tasks (DM): This factor encompasses conflict related to immediate, physiological actions necessary for metabolic maintenance, such as remembering to check blood sugars, taking insulin, and adjusting doses.
• Factor 2: Indirect Management Tasks (IM): This factor includes conflict related to logistical, social, and long-term care tasks, such as making appointments, telling teachers or friends about diabetes, and managing supplies.

This factor structure allows researchers to pinpoint whether family strain is focused on the demanding day-to-day medical procedures or the broader social and administrative aspects of living with a chronic condition.

Instrument

Test Type: Psychosocial Self-report/Parent-report Questionnaire

Format: Multi-item questionnaire utilizing Likert-type scales. The responsibility component uses a 3-point scale measuring the degree of parental versus youth initiation/execution (1 = Parent took responsibility, 3 = Youth took responsibility). The conflict component typically uses a frequency scale (e.g., Almost never, Sometimes, Almost always) over the past month.

Language Available: English (Original)

Population Group: Youth/Adolescents and their primary caregivers/parents.

Age Group: Typically utilized with youth aged 10 to 18 (adolescence).

Population Details: Individuals diagnosed with Type 1 diabetes and their family members, often studied in pediatric endocrinology or psychology clinics.

Test Methodology: Respondents (youth and parent separately) rate specific tasks based on who takes responsibility for them, or how frequently arguments occur regarding them.

Keywords

Chronic illness, Pediatric psychology, Self-efficacy, Treatment adherence, Insulin management, Adolescent development, Family systems, Responsibility transition, Metabolic control.

Authors

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

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

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

Permissions & Fee and Test Year

The original version of the DFRQ was published in 1990 by Anderson, Auslander, Jung, Miller, and Santiago. Subsequent revisions, notably the Diabetes Family Conflict Scale (DFCS) update, were published in 2007. The instrument is widely used in academic and clinical research settings. While typically available for non-commercial research use, researchers should contact the primary authors, particularly Dr. Barbara J. Anderson, for formal permission and the most current version.

The instrument can be found referenced in several academic sources. The original PDF for the 2009 thesis by Andreassen, which utilized the instrument, can be accessed here: http://vuir.vu.edu.au/15507/1/Andreassen2009.pdf.

Reference’s

• Anderson, B. J., Auslander, W. F., Jung, K. C., Miller, P., & Santiago, J. V. (1990). Assessing family sharing of diabetes responsibilities. Journal of Pediatric Psychology, 15(4), 477-492.
• Anderson, B. J., & Brackett, J. (2000). Diabetes during childhood. In F. J. Snoek & T. C. Skinner (Eds.), Psychology in Diabetes Care (pp. 1-23). Chichester: John Wiley & Sons.
• Anderson, B. J., Vangsness, L., Connell, A., Butler, D., Goebel-Fabbri, A. & Laffel, L. M. B. (2002). Family conflict, adherence, and glycaemic control in youth with short duration Type 1 diabetes. Diabetic Medicine, 19(8); 635–642.
• Anderson, B. J. (2004). Family conflict and diabetes management in youth: Clinical lessons from child development and diabetes research. Diabetes Spectrum, 17(1), 22-26.
• Anderson, B. J., & Wolpert, H. A. (2004). A developmental perspective on the challenges of diabetes education and care during the young adult period. Patient Education & Counseling, 53(3), 347-352.
• Hood, Korey K., Butler, Deborah A., Anderson, Barbara J. and Laffel, Lori. (2007). Updated and Revised Diabetes Family Conflict Scale. Diabetes Care, 30(7), 1764-1769.
• Andreassen, Hege Kristine. (2009). Separation-Individuation and its Effect on Diabetes Management and Diabetes Control in Young Women with Type 1 Diabetes. Other Degree thesis, Victoria University.
• Vesco. Anthony T., Anderson, Barbara J., Laffel, Lori M. B., Dolan, Lawrence M., Ingerski, Lisa M., and Hood, Korey K. (2010). Responsibility Sharing between Adolescents with Type 1 Diabetes and Their Caregivers: Importance of Adolescent Perceptions on Diabetes Management and Control. Journal of Pediatric Psychology; 35(10), 1168–1177.

Items of the Diabetes Family Responsibility Questionnaire (DFRQ)

Situation or task:

1. Remembering day of clinic appointment
2. Telling teachers about diabetes
3. Remembering to take morning or evening injection
4. Making appointments with dentists and other doctors
5. Telling relatives about diabetes
6. Taking more or less insulin according to results of blood sugar or urine tests
7. Noticing differences in health, such as weight changes or signs of an infection
8. Telling friends about diabetes
9. Noticing the early signs of an insulin reaction
10. Giving insulin injections
11. Deciding what should be eaten when family has meals out (restaurants, friend’s home)
12. Examining feet and making sure shoes fit properly
13. Carrying some form of sugar in case of an insulin reaction
14. Explaining absences from school to teachers or other school personnel
15. Rotating injection site
16. Checking expiration dates on medical supplies
17. Remembering times when blood sugar or urine should be tested

Scoring for Responsibility Items:

1 = Parent(s) took or initiated responsibility for this almost all of the time

2 = Parent(s) and I shared responsibility for this about equally

3 = I took or initiated responsibility for this almost all of the time

During the PAST MONTH, I have argued with my parent(s) about…

1. Remembering to give shots or to bolus (pump)*
2. Taking more or less insulin depending on results*
3. Remembering to check blood sugars*
4. Remembering clinic appointments**
5. Giving shots or boluses (pump)*
6. Meals and snacks
7. Results of blood sugar monitoring*
8. The early signs of low blood sugar*
9. What to eat when away from home
10. Making appointments with dentists and doctors**
11. Telling teachers about diabetes**
12. Telling friends about diabetes
13. Carrying sugar/carbs for reactions**
14. School absences**
15. Supplies
16. Telling relatives about diabetes**
17. Rotating injection sites or infusion sets (pump) **
18. Changes in health (like weight or infections) **
19. Logging blood sugar results**

Factor 1 (direct management tasks) items are italicized; factor 2 (indirect management tasks) are not.

*Designates a revised item; **designates an added item

Scoring for Conflict Items:

Almost never, Sometimes, Almost always