Diabulimia Knowledge Level Scale

Abstract

The Diabulimia Knowledge Level Scale (DKLS), developed by Çetinkaya Özdemir, Semerci, and Sönmez Sarı in 2023, is a specialized 19-item instrument designed to quantify the professional knowledge level of nurses concerning the complex condition known as diabulimia (the non-compliance with insulin regimens for weight control in individuals with Type 1 diabetes). The scale’s content was rigorously formulated following a comprehensive literature review, drawing upon established sources to ensure relevance and clinical accuracy.

Following content generation, the instrument underwent extensive psychometric analyses, including factor analysis, reliability testing, and validity assessment, using a sample of Turkish nurses. The DKLS serves as a crucial educational and diagnostic tool aimed at enhancing awareness and knowledge among healthcare professionals, thereby improving the quality of care provided to affected patients.

Keywords

Diabulimia Knowledge Levels, Nurses, Behaviors, Psychological Effects, Physiological Effects, General Information

Authors

Çetinkaya Özdemir, Serap, Semerci, Vahide, Sönmez Sarı, Ebru

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Purpose

The primary objective of the DKLS is to accurately assess the depth and breadth of nurses’ knowledge regarding the identification, symptoms, and management of diabulimia. By quantifying knowledge deficits, the scale allows researchers and administrators to pinpoint specific educational needs within the professional group.

Ultimately, the scale serves as a foundational tool for developing targeted educational interventions aimed at increasing professional awareness and knowledge within the nursing cohort, which is essential for timely recognition and appropriate referral of patients managing this dangerous comorbidity.

Construct

The Diabulimia Knowledge Level Scale is designed to measure the cognitive construct of professional knowledge specifically related to diabulimia, which is defined as an eating disorder behavior observed in individuals with Type 1 diabetes. The scale operationalizes knowledge across four distinct sub-domains, ensuring a holistic assessment of the respondent’s understanding of the condition’s multifaceted nature:

• General Information regarding diabulimia.
• Specific Behaviors associated with the condition.
• The Psychological effects on the patient.
• The Physiological effects and complications resulting from insulin restriction.

Validity

The validity of the DKLS was established through detailed content and construct analyses.

Content Validity: Content validity was rigorously evaluated through expert review and quantification using the Content Validity Index (CVI). The results demonstrated high levels of concordance across critical aspects: 0.97 for item-construct relationships, 0.92 for simplicity, and 0.95 for clarity. These robust CVI values confirm that the final item pool is highly representative and clinically relevant to the domain of diabulimia knowledge.

Construct Validity: Support for construct validity was demonstrated through the successful application of factor analysis, confirming that the items appropriately load onto the hypothesized underlying theoretical dimensions (General Information, Behaviors, Psychological Effects, and Physiological Effects).

Reliability

The reliability of the DKLS was assessed through measures of internal consistency and temporal stability.

Internal Consistency: The internal consistency of the Diabulimia Knowledge Level Scale was evaluated using Cronbach’s alpha coefficient. The resulting values ranged from .70 to .92 across the total scale and its subscales, indicating acceptable to excellent homogeneity among the items measuring the intended construct.

Test-Retest Reliability: Temporal stability was assessed using a test-retest methodology over a three-week interval on a sub-sample of nurses. The test-retest correlations for the factor and total scores ranged from 0.44 to 0.76. A paired samples t-test confirmed that there was no statistically significant difference between the first and second applications (p = 0.154), suggesting good temporal stability for the instrument.

Factor Analysis

The latent structure of the scale was determined through a combination of exploratory and confirmatory techniques.

Exploratory Factor Analysis (EFA): Exploratory Factor Analysis was performed using the principal components method with varimax rotation. This analysis successfully identified a robust four-factor structure, which collectively accounted for 68.53% of the total variance in the data. A comprehensive item reduction process was necessary, leading to the exclusion of 17 initial items due to insufficient loading, cross-loading onto multiple factors (e.g., items 8 and 24), or belonging to factors with minimal item representation. This process resulted in the final 19-item, four-factor scale.

Confirmatory Factor Analysis (CFA): The hypothesized four-factor structure was further tested using Confirmatory Factor Analysis (CFA). The model fit indices provided support for the structure, with reported values including χ2 = 448.853, df = 146, p = 0.000, and a relative chi-square (χ2/df) of 3.074. Other key indices were NFI = 0.82, CFI = 0.87, RMSEA = 0.104, RMR = 0.07, GFI = 0.78, RFI = 0.79, IFI = 0.87, and TLI = 0.85.

Instrument

Test Type: Original Inventory/Questionnaire

Format: The scale uses a 5-point Likert-type scale, with response options ranging from 1 = Strongly disagree, 2 = Disagree, 3 = Undecided, 4 = Agree, to 5 = Strongly agree.

Language Available: Turkish (Original language of administration). The documentation used for validation and description is available in English.

Population Group: Human (Male and Female).

Age Group: Adulthood (18 years & older).

Population Details: The validation study utilized registered nurses working in clinical settings in Turkey.

Test Methodology: The development and validation involved several key methodologies: Test Validity (including Construct Validity and Content Validity), Test Reliability (including Internal Consistency and Test-Retest Reliability), and Factor Analysis (including Confirmatory Factor Analysis, Exploratory Factor Analysis, and Principal Component Analysis).

Keywords

Behaviors, Diabulimia Knowledge Levels, General Information, Nurses, Physiological Effects, Psychological Effects

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Authors

Author ORCID Identifier:

• Çetinkaya Özdemir, Serap: http://orcid.org/0000-0001-7706-4748
• Semerci, Vahide: http://orcid.org/0000-0003-3481-9500
• Sönmez Sarı, Ebru: http://orcid.org/0000-0001-7337-4853

Affiliation Email addresses:

• Çetinkaya Özdemir, Serap (Sakarya University): [email protected]
• Semerci, Vahide (Bayburt University): No data is Available
• Sönmez Sarı, Ebru (Bayburt University): No data is Available

Correspondence Address: Çetinkaya Özdemir, Serap: Sakarya University, Faculty of Health Sciences, Department of Internal Medicine Nursing, Sakarya, Turkey, 54050, [email protected]

Permissions & Fee and Test Year

Permissions: The scale may be used freely for academic, research, and teaching purposes.

Commercial Use: No.

Fee: No fee is required for its non-commercial use.

Test Year: 2023.

Reference’s

Çetinkaya Özdemir, S., Semerci, V., & Sönmez Sarı, E. (2023). Development of the Diabulimia Knowledge Level Scale. Archives of Psychiatric Nursing, 46, 139–145. DOI: https://doi.org/10.1016/j.apnu.2023.09.003

Hoffmann, M. (2019). No data is Available

Markowitz, L. A., & Friedman, J. D. (2010). No data is Available

Ruth-Sahd, L. A., & Power, S. (2009). No data is Available

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Items of the Diabulimia Knowledge Level Scale

This is a 19-item scale.

Factors and Subscales: The scale is structured around four subscales:

• General information
• Behaviors
• Psychological effects
• Physiological effects

The specific items comprising the scale are available in Table 5, Page 144 of the source reference: Çetinkaya Özdemir, S., Semerci, V., & Sönmez Sarı, E. (2023). Development of the Diabulimia Knowledge Level Scale. Archives of Psychiatric Nursing, 46, 139–145.

Items

1. Individuals with diabulimia intentionally skip insulin doses
2. Diabulimia occurs among type 1 diabetics
3. Diabulimia is more common during adolescence
4. Individuals with diabulimia skip meals to lose weight
5. Individuals with diabulimia may use laxatives (medications causing bowel movements) to lose weight
6. Individuals with diabulimia may intentionally induce vomiting to lose weight
7. Individuals with diabulimia are not satisfied with their bodies
8. Individuals with diabulimia care very much about their appearances
9. Individuals with diabulimia may display depressive behaviors
10. The self-esteem of individuals with diabulimia is low
11. Individuals with diabulimia may display obsessive behaviors
12. Lack of concentration can be observed in individuals with diabulimia
13. The moods of individuals with diabulimia change constantly
14. Diabulimia can cause growth deficiency in adolescents
15. Individuals with diabulimia have weakness/fatigue
16. Urinary tract infections can be seen in individuals with diabulimia
17. Muscle loss can be seen in individuals with diabulimia
18. Individuals with diabulimia may have osteoporosis (bone resorption) in the long term
19. Menstrual irregularities can be seen in women with diabulimia

Note. Items are rated from 1=Strongly disagree to 5=Strongly agree.