Character Strengths Use in Diabetes Self-Management Scale (CSUDM)

Abstract

The Character Strengths Use in Diabetes Self-management Scale (SUDM), developed by Wang et al. (2023), is a specialized psychometric instrument designed to quantify an individual’s capacity for healthy cognitive, emotional, and behavioral functioning specifically within the context of diabetes self-management. The scale’s development followed a rigorous process including comprehensive literature reviews and expert validation, culminating in the final 12-item measure.

The psychometric properties of the SUDM were assessed using a convenience sample of Taiwanese adults diagnosed with Type 2 Diabetes (T2DM). The study confirmed a robust three-factor structure through factor analysis, demonstrated high internal consistency, and established validity through significant correlations with quality of life and predictive utility regarding haemoglobin A1c levels.

Keywords

Self-Management, Type 2 Diabetes, Character Strengths Use, Thinking Positively, Taking on Challenges, Learning Proactively.

Authors

Wang, Ruey-Hsia, Kao, Chia‐Chan, Su, Yi‐Ching, Chen, Shi‐Yu, Hsu, Hui‐Chun, Lu, Chieh‐Hua, Jone, Kuen‐Yung.

Purpose

The primary objective of the SUDM scale is to systematically assess the degree to which individuals with Type 2 Diabetes utilize their inherent positive psychological capacities, or character strengths, as active components of their daily self-management routines.

This measurement allows researchers and clinicians to gauge the behavioral and psychological resources available to patients for effectively coping with the demands and challenges associated with managing a chronic illness, thereby identifying targets for psychological intervention.

Construct

The SUDM scale is rooted in positive psychology and measures the application of character strengths within the specific domain of managing a chronic condition. It seeks to operationalize the capacity for healthy and productive engagement with diabetes care across three distinct latent factors.

These three core factors, identified through rigorous factor analysis, represent the specific ways positive psychological traits manifest in diabetes care adherence and coping behaviors:

• Learning proactively: The tendency to seek out and apply new information regarding diabetes management, demonstrating intellectual curiosity and openness.
• Taking on challenges: The display of resilience, persistence, and determination used to overcome obstacles inherent in daily self-care tasks.
• Thinking positively: The optimistic cognitive style applied to interpret events, maintain motivation, and address difficulties associated with the chronic disease.

Validity

Construct Validity: Support for the scale’s underlying structure was established through both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). These analyses confirmed the hypothesized three-factor model consisting of 12 items, demonstrating a robust and adequate fit to the empirical data collected from the patient sample.

Concurrent and Predictive Validity: The total SUDM score exhibited significant correlations with established health outcomes. The measure showed a strong positive correlation with self-reported diabetes-specific quality of life. Crucially, the SUDM demonstrated predictive utility by showing a significant negative correlation with both baseline and 9-month haemoglobin A1c (HbA1c) levels, suggesting that higher character strength use is associated with superior long-term glycemic control.

Reliability

Internal Consistency: The reliability of the SUDM scale was assessed via internal consistency measures. The coefficients for Cronbach’s α for the overall 12-item scale and its individual subscales were found to be highly robust, ranging consistently between .78 and .91. These high coefficients confirm that the items within the SUDM scale consistently measure the same underlying construct with high fidelity.

Factor Analysis

Exploratory Factor Analysis (EFA): Initial EFA, guided by Scree plot analysis, extracted three distinct factors. Following a process of item refinement and deletion, the final set of 12 items remained, which grouped coherently into these three factors. The cumulative variance explained by the 12-item SUDM was high, accounting for 69.44% of the total variance. The summary score for each factor ranges from 0 to 16.

Confirmatory Factor Analysis (CFA): The results of the CFA strongly supported the measurement model derived from the EFA. All 12 items were significantly loaded onto their corresponding factors, with factor loadings consistently greater than 0.46. The standard fit indices demonstrated a good model fit: χ2/df = 1.52, CFI = 0.97, NFI = 0.93, GFI = 0.92, and RMSEA = 0.06 (with a 95% confidence interval of 0.03–0.09). These results confirm the structural validity and integrity of the SUDM scale.

Instrument

Test Type: Original

Format: Each item is rated using a 5-point Likert scale, ranging from 0 (extremely disagree) to 4 points (extremely agree). There are no reverse-scored items. A higher total summary score obtained from the scale indicates a greater utilization of character strengths in diabetes self-management.

Language Available: Chinese (The development study was reported in English)

Population Group: Human; Male; Female

Age Group: Adulthood (18 years and older)

Population Details:

• Respondents: Patients with Type-2 Diabetes
• Location: Taiwan

Test Methodology: Test Validity, Concurrent Validity, Predictive Validity, Test Reliability, Internal Consistency, Factor Analysis, Confirmatory Factor Analysis, Exploratory Factor Analysis

Keywords

Self-Management, Type 2 Diabetes, Character Strengths Use, Thinking Positively, Taking on Challenges, Learning Proactively.

Authors

Author ORCID Identifier:

• Wang, Ruey-Hsia: http://orcid.org/0000-0001-9323-7389
• Kao, Chia‐Chan: http://orcid.org/0000-0003-2846-5590

Affiliation Email addresses:

• Wang, Ruey-Hsia: Kaohsiung Medical University, College of Nursing
• Kao, Chia‐Chan: School of Nursing, I-Shou University
• Su, Yi‐Ching: Kaohsiung Medical University, College of Nursing
• Chen, Shi‐Yu: Department of Internal Medicine, Tri-Service General Hospital Division of Endocrinology and Metabolism
• Hsu, Hui‐Chun: Lee’s Endocrinology Clinic
• Lu, Chieh‐Hua: Department of Internal Medicine, Tri-Service General Hospital Division of Endocrinology and Metabolism
• Jone, Kuen‐Yung: Kaohsiung Medical University, School of Psychology
• Correspondence Email: [email protected]

Correspondence Address:

• Wang, Ruey-Hsia: Kaohsiung Medical University, College of Nursing, No. 100 Shih-Chuan 1st Road, San-Min District, Kaohsiung City, Taiwan, Province of China, 80708, [email protected]

Permissions & Fee and Test Year

Permissions: Contact Corresponding Author

Commercial Use: No

Fee: No

Test Year: 2023

References

Wang, R.‐H., Kao, C.‐C., Su, Y.‐C., Chen, S.‐Y., Hsu, H.‐C., Lu, C.‐H., & Jone, K.‐Y. (2023). Character Strengths Use in Diabetes Self-management Scale: Development and psychometric testing. Journal of Advanced Nursing, 79(10), 4034–4043. https://doi.org/10.1111/jan.15723

Items of the Character Strengths Use in Diabetes Self-management Scale (SUDM)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

This measure consists of 12 items. No data is Available regarding the specific items of the scale.

Factors and Subscales:

• Learning proactively
• Taking on challenges
• Thinking positively