Appraisal of Diabetes Scale (ADS)

Abstract

The Appraisal of Diabetes Scale (ADS) is a concise, 7-item self-report scale designed to measure an individual’s cognitive and emotional appraisal of living with diabetes. Developed by Carey and colleagues in 1991, the ADS utilizes a 5-point Likert scale response format, allowing for quick administration (approximately 5 minutes). The scale serves as an efficient screening tool to assess a patient’s level of psychological adjustment to the disease, perceived control, and potential risk for noncompliance with necessary medical regimens. Lower total scores on the ADS indicate a more positive and adaptive appraisal strategy regarding diabetes management.

Keywords

Appraisal of Diabetes Scale, ADS, Diabetes, Psychological Adjustment, Glycemic Control, Self-Appraisal, Behavioral Medicine, Compliance, Chronic Illness.

Authors

Carey MP, Jorgensen RS, Weinstock RS, Sprafkin RP, Lantinga LJ, Carnrike CL Jr, Baker MT, Meisler AW.

Purpose

The primary purpose of the Appraisal of Diabetes Scale (ADS) is to quickly and reliably assess the subjective psychological appraisal that an individual holds regarding their diabetes condition. This assessment focuses on how the patient perceives the impact, threat, and controllability of the disease in their daily life.

The ADS is specifically designed to be an incisive, rapid screening tool. Its brevity (7 items, 5-minute completion time) makes it highly practical for clinical settings where quick identification of patients struggling with adjustment or at risk for noncompliance is crucial. A key feature of the scale is its straightforward interpretation: lower total scores are indicative of a more positive and adaptive appraisal strategy, suggesting better psychological adjustment and potentially better adherence to the treatment plan.

Construct

The Appraisal of Diabetes Scale measures the construct of illness appraisal within the context of chronic disease, specifically diabetes. This construct is operationalized through seven core items that capture various dimensions of the patient’s subjective experience.

These dimensions include perceived emotional distress (upset), perceived control over the disease, the degree of uncertainty experienced, perceived likelihood of the disease worsening, causal attributions regarding control (internal vs. external factors), perceived coping effectiveness, and the extent to which the disease interferes with life goals. By quantifying these perceptions, the ADS provides a measure of psychosocial adaptation to the chronic condition.

Validity

The validity of the Appraisal of Diabetes Scale (ADS) was initially established and examined in the foundational 1991 paper by Carey et al. published in the Journal of Behavioral Medicine. The scale has demonstrated its utility in distinguishing between individuals based on their emotional and cognitive responses to their diagnosis, providing a critical link between psychological appraisal and health outcomes.

Subsequent research has supported its predictive validity, showing its relevance in clinical outcomes. For instance, ADS scores have been effectively utilized in studies analyzing the influence of external factors, such as family environment (Trief et al., 1998) and work environment (Trief et al., 1999), on critical health markers, including glycemic control and overall psychosocial adaptation among adults living with the condition.

Reliability

The reliability of the ADS was comprehensively documented in the initial psychometric investigation by Carey et al. (1991). The development phase involved testing the scale on a cohort of 200 male subjects, two-thirds of whom were receiving insulin treatment.

Reliability testing included the assessment of temporal stability. Half of the initial study cohort completed the ADS across three separate time points over the course of one week to assess consistency over time. The scale demonstrated sufficient stability and internal consistency for use as a clinical and research instrument. Importantly, no significant difference was observed between ADS scores for insulin-dependent and non-insulin-dependent subjects, suggesting consistent reliability across different treatment groups.

Factor Analysis

The source material focuses on the scale’s overall psychometric properties but does not explicitly detail the results of factor analytic studies. As a 7-item scale designed to measure a global subjective appraisal of illness, the ADS is generally treated as a unidimensional scale yielding a single total score reflecting the positivity of the appraisal strategy. The original 1991 publication by Carey et al. contains the definitive factor analytic data supporting its structure.

Instrument

Test Type: Psychometric Self-report scale

Format: 7 items utilizing a 5-point Likert scale response format.

Language Available: English (Original), Japanese (Translation provided in source content).

Population Group: Adults with diabetes (Type 1 and Type 2).

Age Group: Adults (mean age of initial sample was 58 years).

Population Details: Initial validation sample consisted of 200 male subjects. All subjects underwent routine monitoring of Glycated Hemoglobin (HbA1c) levels. The scale is applicable to both insulin-dependent and non-insulin-dependent patients.

Test Methodology: Easily administered in written or oral form. Scoring involves reverse-scoring two specific items (Items #2 and #6) and summing all seven items. Lower total scores reflect a more positive appraisal.

Keywords

Illness Appraisal, Coping Effectiveness, Perceived Control, HbA1c, Psychometrics, Health Psychology, Chronic Disease Management, Self-Efficacy.

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: [email protected]

Correspondence Address: Michael P. Carey, PhD, Director, Centers for Behavioral & Preventive Medicine, Professor, Department of Psychiatry & Human Behavior (Medicine), Professor, Behavioral and Social Sciences (Public Health), Brown University, Coro Building, Suite 314, One Hoppin Street, Providence, RI 02903.

Permissions & Fee and Test Year

The Appraisal of Diabetes Scale (ADS) was first published and validated in 1991. The authors explicitly stated that “There is no manual,” suggesting that primary access and usage instructions are derived directly from the foundational academic publication (Carey et al., 1991). Information regarding current usage fees or formal licensing requirements is not provided in the source material.

Reference’s

• Carey, M. P., Jorgensen, R. S., Weinstock, R. S., Sprafkin, R. P., Lantinga, L. J., Carnrike, C. L. M., Jr., Baker, M. T., & Meisler, A. W. (1991). Reliability and validity of the appraisal of diabetes scale. Journal of Behavioral Medicine, 14, 43-51.
• Garratt, A.M., Schmidt, L., & Fitzpatrick, R. (2002). Patient-assessed health outcome measures for diabetes: a structured review. Diabetic Medicine, 19, 1-11.
• Trief, P.M., Grant, W., Elbert, K., & Weinstock, R.S. (1998). Family environment, glycemic control, and the psychosocial adaptation of adults with diabetes. Diabetes Care, 21, 241-245.
• Trief, P.M., Aquilino, C., Paradies, K., & Weinstock, R.S. (1999). Impact of the work environment on glycemic control and adaptation to diabetes. Diabetes Care, 22, 569-574.

Items of the Appraisal of Diabetes Scale (ADS)

People differ in their thoughts and feelings about having diabetes. We would like to know how you feel about having diabetes. Therefore, please circle the answer to each question which is closest to the way you feel. Please give you honest feelings

– we are interested in how you feel, not what your doctor or family may think.

1. How upsetting is having diabetes for you?

2. How much control over your diabetes do you have?

3. How much uncertainty do you currently experience in your life as a result of being diabetic?

4. How likely is your diabetes to worsen over the next several years?

(Try to give an estimate based on your personal feeling rather than based on a rational judgment.)

5. Do you believe that achieving good diabetic control is due to your efforts as compared to factors which are beyond your control?

6. How effective are you in coping with your diabetes?

7. To what degree does your diabetes get in the way of your developing life goals?

Scoring the ADS is easy:

1. Reverse score items # 2 and 6:

ADS2R = 5 – ADS2 ADS6R = 5 – ADS6

2. Then sum all items, using the reversed scored items 2 and 6:

Total score = ADS1 + ADSR2 + ADS3 + ADS4 + ADS5 + ADSR6 + ADS7

Interpretation is straightforward: The smaller the total score, the more positive the appraisal strategy. Thus, lower scores are better.