Summary of Diabetes Self-Care Activities (SDSCA)

Abstract

The Summary of Diabetes Self-Care Activities (SDSCA) is a widely utilized, validated self-report questionnaire designed to measure the frequency of key self-care behaviors necessary for effective diabetes management. Developed by Toobert, Hampson, and Glasgow in 2000, the instrument assesses adherence across five critical behavioral domains: Diet, Exercise, Blood-Glucose Testing, Foot Care, and Smoking Status. The SDSCA is essential for clinical and research purposes, providing a quantitative measure of patient compliance with prescribed regimens, typically referencing activities performed over the past seven days.

Keywords

Diabetes self-care, self-management, adherence, physical activity, blood glucose monitoring, foot care, health behavior, SDSCA, Type 2 Diabetes, health psychology.

Authors

D.T. Toobert, S.E. Hampson, R.E. Glasgow

Purpose

The primary purpose of the SDSCA is to quantify and track the frequency of specific behaviors undertaken by individuals to manage their diabetes effectively. By focusing on the preceding seven days, the scale provides a recent snapshot of adherence to the complex and multifaceted diabetes regimen, which includes lifestyle modifications and medical adherence.

The scale serves as a practical tool for researchers studying intervention efficacy and for clinicians seeking to identify specific areas where patients may require additional education or support. The modular structure allows for focused assessment of critical areas such as dietary compliance (general and specific diet behaviors) and proactive monitoring activities like blood-glucose testing and foot care.

Construct

The SDSCA measures the psychological construct of adherence to prescribed medical and behavioral regimens for diabetes. This construct is operationalized through the frequency of concrete, observable self-care activities. The scale is built upon the premise that successful diabetes control is achieved through consistent, daily execution of these behaviors.

The construct is multidimensional, recognizing that diabetes care is not monolithic. It separates adherence into distinct sub-constructs, ensuring that a deficit in one area (e.g., exercise) does not mask sufficient adherence in another (e.g., medication taking). This approach allows for nuanced reporting and targeted clinical intervention.

Validity

The validity of the SDSCA is supported by its consistent use across multiple studies, leading to the revised 2000 version which synthesized results from seven studies. The scale demonstrates strong face and content validity, as the items directly reflect the established clinical guidelines for effective diabetes self-management.

While the overall scale structure is robust, the authors noted specific considerations for scoring, particularly regarding the specific diet subscale. Due to low inter-item correlations within the specific diet items (e.g., consumption of fruits/vegetables vs. high-fat foods), researchers are often recommended to use the individual items rather than relying solely on the aggregated subscale score, thus enhancing precision in behavioral measurement.

Reliability

The reliability of the SDSCA has been established across diverse populations with both Type 1 and Type 2 Diabetes. The scale typically exhibits acceptable internal consistency for its main subscales (Diet, Exercise, Blood-Glucose Testing, and Foot Care), reflecting that items within each domain generally measure the same underlying self-care behavior.

Test-retest reliability is generally favorable, suggesting that patient reporting of self-care activities is stable over short periods. The scale’s design, focusing on the measurable frequency (0–7 days) of behaviors, contributes to its reliability by minimizing subjective interpretation compared to scales relying on attitude or intention.

Factor Analysis

Based on the structure derived from the 2000 revision, the SDSCA is organized into five distinct factors or regimen areas. These factors are empirically supported and reflect the primary domains of self-management:

• Diet (General and Specific components)
• Exercise
• Blood-Glucose Testing
• Foot Care
• Smoking Status

The factor structure confirms the multidimensional nature of diabetes self-care, allowing for separate scores to be calculated for each component. This approach is superior to a single composite score, as it provides actionable data for clinical feedback regarding specific behavioral adherence.

Instrument

Test Type: Self-report frequency questionnaire

Format: Brief version (11 items, plus smoking) and Expanded Version (includes additional items on adherence to professional recommendations, medications, and detailed foot care). Responses are primarily frequency counts (0–7 days).

Language Available: English (Original), with numerous translations available globally due to its widespread use.

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

Age Group: Typically adults, though adaptable for adolescents depending on the complexity of the regimen.

Population Details: Used across various demographics and clinical settings, including primary care and specialized endocrinology research.

Test Methodology: Retrospective recall method, requiring the respondent to report the number of days in the past seven days they engaged in a specific self-care activity.

Keywords

Diabetes self-care activities, D.T. Toobert, S.E. Hampson, R.E. Glasgow, adherence measurement, health behavior inventory, self-management scale.

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: Not provided in source content.

Correspondence Address: Not provided in source content.

Permissions & Fee and Test Year

The SDSCA is generally considered a publicly available instrument for non-commercial research and clinical use, often accessible without a fee, though users should confirm current licensing terms with the original authors or publishing institutions. The definitive revised scale was published in 2000.

Reference’s

Toobert, D.T., Hampson, S.E., and Glasgow, R.E. (2000). The Summary of Diabetes self-care Activities Measure: results from 7 studies and a revised scale. Diabetes Care, 23(7), 943-950.

The full instrument is available online via ResearchGate: https://www.researchgate.net/publication/12423077

Items of the Summary of Diabetes Self-Care Activities (SDSCA)

Original Items (Brief Version):

1. How many of the last SEVEN DAYS have you followed a healthful eating plan? __________ Days Last Week
2. On average‚ over the past month‚ how many DAYS PER WEEK have you followed your eating plan? __________ Days Last Week
3. On how many of the last SEVEN DAYS did you eat five or more servings of fruits and vegetables? __________ Days Last Week
4. On how many of the last SEVEN DAYS did you eat high fat foods such as red meat or full-fat dairy products? __________ Days Last Week
5. On how many of the last SEVEN DAYS did you participate in at least 30 minutes of physical activity? __________ Days Last Week
6. On how many of the last SEVEN DAYS did you participate in a specific exercise session (such as swimming‚ walking‚ biking) other than what you do around the house or as part of your work? __________ Days Last Week
7. On how many of the last SEVEN DAYS did you test your blood sugar? __________ Days Last Week
8. On how many of the last SEVEN DAYS did you test your blood sugar the number of times recommended by your health care provider? __________ Days Last Week
9. On how many of the last SEVEN DAYS did you take your recommended diabetes medication? __________ Days Last Week
10. On how many of the last SEVEN DAYS did you take your recommended number of diabetes pills? __________ Days Last Week
11. On how many of the last SEVEN DAYS did you check your feet? __________ Days Last Week
12. On how many of the last SEVEN DAYS did you inspect the inside of your shoes? __________ Days Last Week
13. On how many of the last SEVEN DAYS did you wash your feet? __________ Days Last Week
14. Have you smoked a cigarette- even one puff-during the last seven days?
    ! No.
    ! Yes: How many cigarettes did you smoke on an average day? __________ Days Last Week
15. How many alcoholic drinks would you say you have consumed per day‚ on average‚ during the past SEVEN DAYS?
    (A single alcoholic drink is equivalent to 1 ounce of liquor or 4 ounces of wine or 12 ounces of beer) __________ Days Last Week
16. On how many of the last SEVEN DAYS did you take dietary supplements (like vitamins) to help manage your diabetes? __________ Days Last Week
17. On how many of the last SEVEN DAYS did you take herbs‚ drink teas‚ or use other diabetes remedies that you found on your own (or‚ that your doctor did not tell you about) to manage your diabetes? __________ Days Last Week

Additional Items for the Expanded Version:

Self-Care Recommendations

1A. Which of the following has your health care team (doctor‚ nurse‚ dietitian‚ or diabetes educator) advised you to do?

Please check all that apply:

• a) Follow a low-fat eating plan
• b) Follow a complex carbohydrate diet
• c) Reduce the number of calories you eat to lose weight
• d) Eat lots of food high in dietary fiber
• e) Eat lots (at least 5 servings per day)of fruits and vegetables
• f) Eat very few sweets (for example: desserts‚ non-diet sodas‚ candy bars)
• g) Other (specify):
• h) I have not been given any advice about my diet by my health care team.

2A. Which of the following has your health care team (doctor‚ nurse‚ dietitian or diabetes educator) advised you to do?

Please check all that apply:

• a) Get low level exercise (such as walking) on a daily basis.
• b) Exercise continuously for a least 20 minutes at least 3 times a week.
• c) Fit exercise into your daily routine (for example‚ take stairs instead of elevators‚ park a block away and walk‚ etc.)
• d) Engage in a specific amount‚ type‚ duration and level of exercise.
• e) Other (specify):
• f) I have not been given any advice about exercise by my health care team.

3A. Which of the following has your health care team (doctor‚ nurse‚ dietitian‚ or diabetes educator) advised you to do?

Please check all that apply:

• a. Test your blood sugar using a dr‎op of blood from your finger and a color ch‎art.
• b. Test your blood sugar using a machine to read the results.
• c. Test your urine for sugar.
• d. Other (specify):
• e. I have not been given any advice either about testing my blood or urine sugar level by my health care team.

4A. Which of the following medications for your diabetes has your doctor prescribed?

Please check all that apply.

• a. An insulin shot 1 or 2 times a day.
• b. An insulin shot 3 or more times a day.
• c. Diabetes pills to control my blood sugar level.
• d. Other (specify):
• e. I have not been prescribed either insulin or pills for my diabetes.

Diet

5A. On how many of the last SEVEN DAYS did you space carbohydrates evenly through the day?

Medications

6A. On how many of the last SEVEN DAYS‚ did you take your recommended diabetes medication?

OR

7A. On how many of the last SEVEN DAYS did you take your recommended insulin injections?

8A. On how many of the last SEVEN DAYS did you take your recommended number of diabetes pills?

Foot Care

9A. On how many of the last SEVEN DAYS did you wash your feet?

10A. On how many of the last SEVEN DAYS did you soak your feet?

11A. On how many of the last SEVEN DAYS did you dry between your toes after washing?

Smoking

12A. At your last doctor’s visit‚ did anyone ask about your smoking status?

• 0. No
• 1. Yes

13A. If you smoke‚ at your last doctor’s visit‚ did anyone counsel you about stopping smoking or offer to refer you to a stop-smoking program?

• 0. No
• 1. Yes
• 2. Do not smoke.

14A. When did you last smoke a cigarette?

• More than two years ago‚ or never smoked
• One to two years ago
• Four to twelve months ago
• One to three months ago
• Within the last month
• Today