Crush Diabetes Knowledge, Attitudes, and Beliefs Survey (CDKA)

Abstract

The Crush Diabetes Knowledge, Attitudes, and Beliefs Survey (CDKA; Mokhtari et al., 2023) is a specialized, 25-item psychological instrument designed to assess health literacy and motivational factors related to chronic disease prevention among middle school students. The scale specifically evaluates their fundamental knowledge of diabetes, associated risk factors, the importance of exercise, and maintaining a healthy lifestyle. Furthermore, the CDKA measures affective components, including students’ attitudes, beliefs, and their explicit intent to change behaviors essential for diabetes prevention. Developed and validated by a team of registered dietitians with expertise in adolescent health, the instrument’s psychometric properties—including factor analysis, reliability, and validity—have been rigorously reported.

Keywords

Knowledge, Diabetes, Adolescents, Attitudes, Beliefs, Intent to Change, Health Attitudes, Health Knowledge, Physical Illness (Attitudes Toward), Readiness to Change, Health Attitude Measures, Adolescent Health.

Authors

Mokhtari, Pari, Jordan, Kristine C., Wilson, Andrew, Sisco-Taylor, Brittany, Metos, Julie M.

Purpose

The primary purpose of the CDKA survey is to provide a standardized tool for researchers and health professionals to quantify the baseline understanding and motivational readiness of middle school students concerning diabetes. This assessment is crucial for identifying knowledge gaps and behavioral barriers, which in turn informs the development and implementation of effective, targeted health education programs aimed at mitigating the risk of Type 2 diabetes.

The scale’s dual focus on cognitive understanding (knowledge) and motivational factors (attitudes, beliefs, and intent to change) ensures a comprehensive evaluation of the psychological determinants influencing healthy behavior adoption in this critical age group.

Construct

The CDKA operationalizes the psychological construct of health behavior determinants related to chronic disease prevention. The instrument is structured around two major subscales: the Knowledge Section and the Attitudes, Beliefs, and Intent to Change Section.

The scale utilizes an eight-factor model to delineate specific components of the construct: Insulin, General Information, Prevention, Untrue Definition (within Knowledge), and Intent to Change, Attitudes and Beliefs: Lifestyle, Attitudes and Beliefs: Psychosocial, and Attitudes and Beliefs: Emotional (within the Attitudes section). This multi-factor structure allows for a detailed analysis of adolescent perceptions regarding disease mechanism, prevention strategies, and the personal impact of the disease.

Validity

The validity of the CDKA was primarily established through content validity assessment. The instrument was developed by expert registered dietitians specializing in adolescent diabetes, ensuring clinical relevance and accuracy of the items.

The overall Content Validity Index (CVI) for the questionnaire items was reported as 0.95. This high CVI score indicates that the content of the scale is highly relevant and representative of the constructs it intends to measure, affirming its suitability for assessing knowledge and attitudes toward diabetes prevention in the target population.

Reliability

The CDKA demonstrated strong psychometric reliability through measures of internal consistency and temporal stability.

Internal consistency was assessed using Cronbach’s alpha coefficients. The Knowledge section achieved an alpha value of 0.70, and the Attitudes, Beliefs, and Intent to Change sections also yielded 0.70. These values are generally considered acceptable for newly developed psychological scales.

Test-Retest Reliability further confirmed the scale’s stability. The questionnaire exhibited good reliability for the person-average measures (Rkf), with a value of 0.8 reported for the Knowledge section and 0.7 for the Attitudes, Beliefs, and Intent to Change sections, suggesting consistent results over repeated administrations.

Factor Analysis

Both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were employed to investigate the scale’s underlying dimensional structure.

In the Exploratory Factor Analysis, a scree plot analysis indicated that four components were appropriate for extraction within each of the two main questionnaire sections (Knowledge; Attitudes, Beliefs, and Intent to Change). Factor loadings for the Knowledge section items were generally strong, falling between 0.5 and 0.8. Loadings for the Attitudes, Beliefs, and Intent to Change section ranged from 0.4 to 0.9, with all factor loadings exceeding the minimum acceptable threshold of 0.4.

The Confirmatory Factor Analysis supported the acceptable fit of the hypothesized 4-factor model for both sections. For the Knowledge section, key fit indices included Chi-squared = 79.4 (P < 0.001) and RMSEA = 0.04. For the Attitudes, Beliefs, and Intent to Change section, the fit indices were Chi-squared = 165.7 (P < 0.001) and RMSEA = 0.07. These RMSEA values demonstrate acceptable model fit, validating the proposed factor structure.

Instrument

Test Type: Original

Format: The CDKA is a 25-item questionnaire divided into two sections. The Knowledge section consists of 12 True/False items, with an added “I do not know” option to reduce guessing. Correct responses score 1, while incorrect or “do not know” responses score 0 (maximum score is 12). The Attitudes, Beliefs, and Intent to Change section is comprised of 13 items answered using five response categories, ranging from strongly disagree to strongly agree.

Language Available: English

Population Group: Human (Male, Female)

Age Group: Childhood (birth–12 yrs), School Age (6–12 yrs), Adolescence (13–17 yrs)

Population Details: Respondents were middle school students aged 12–14 from the United States.

Test Methodology: Test Validity, Content Validity, Test Reliability, Internal Consistency, Test-Retest Reliability, Factor Analysis, Confirmatory Factor Analysis, Exploratory Factor Analysis.

Keywords

Knowledge, Attitudes, Beliefs, Intent to Change, Insulin, Test Reliability, Psychometrics, Adolescent Health.

Authors (Principal Investigator Details)

Mokhtari, Pari

Author ORCID Identifier: http://orcid.org/0000-0003-0451-1580

Affiliation Email addresses: [email protected] (Pari Mokhtari)

Correspondence Address: University of Utah, College of Health, Department of Nutrition and Integrative Physiology, Salt Lake City, Utah, United States, 84112.

Permissions & Fee and Test Year

Permissions: May be used for Research/Teaching.

Commercial: No

Fee: No

Test Year: 2023

Reference’s

Mokhtari, P., Jordan, K. C., Wilson, A., Sisco-Taylor, B., & Metos, J. M. (2023). Development and validation of a diabetes questionnaire for middle school students. Journal of Nutrition Education and Behavior, 55(2), 135–144. https://doi.org/10.1016/j.jneb.2022.11.004

Items of the Crush Diabetes Knowledge, Attitudes, and Beliefs Survey (CDKA)

Number of items: This measure consists of 25 items.

Test Items Available: Yes

Test Location: 2023-46605-010, Table 3, Page 139; 2023-46605-010, Table 4, Page 140

Factors and Subscales:

• Subscales: Knowledge; Attitudes, Beliefs, and Intent to Change.

• Factors: Insulin; General Information; Prevention; Untrue Definition; Intent to Change; Attitudes and Beliefs: Lifestyle; Attitudes and Beliefs: Psychosocial; Attitudes and Beliefs: Emotional.

Knowledge Section

• You get diabetes when your body cannot make or use insulin

• Insulin is a hormone in the blood that controls blood sugar

• The pancreas makes insulin

• Diabetes occurs only in adults

• There are 2 main types of diabetes: type 1 and type 2

• Eating too much sugar and other sweet foods and drinks may lead to excess body weight

• Kids with diabetes should exercise regularly

• Type 1 diabetes can be prevented by eating healthy foods and exercising

• If you are overweight, you are more likely to get type 1 diabetes

• A family history of diabetes is a risk factor for developing diabetes

• Diabetes is when you have low sugar in your blood

• Type 1 diabetes is the most common form of diabetes

Note. Knowledge items are rated as True or False, with an added I do not know option.

Attitudes, Beliefs, and Intent to Change Section

• I plan to eat less food that contains sugar in the next wk

• I plan to drink less soda, energy drinks, and other sugary drinks next wk

• I plan to exercise more in the next wk

• I believe exercise can help prevent type 2 diabetes

• I believe eating healthy food can prevent type 2 diabetes

• I understand what diabetes is

• I believe if you get diabetes, it will affect almost every part of your life

• I believe diabetes is hard because you never get a break from this disease

• I believe everyone with diabetes should keep their blood sugar close to normal

• I believe type 2 diabetes is a very serious disease

• I believe type 2 diabetes is not as serious as type 1 diabetes

• I believe the emotional effects of diabetes are small

• I believe a person with diabetes can control diabetes and lead a normal life

Note. Items are rated on a 5-point scale (from strongly disagree to strongly agree).