Measure of Psychological Adjustment to Diabetes (ATT19)

Abstract

The Measure of Psychological Adjustment to Diabetes (ATT19) is a specialized psychometric instrument designed to assess how individuals cope with and perceive their life affected by diabetes. Derived from the longer 39-item version (ATT39) developed by Welch and colleagues in the early 1990s, the ATT19 focuses on capturing the complexity of the patient’s emotional, cognitive, and behavioral responses to managing a chronic illness. The scale is structured around six distinct subscales—including diabetes stress, coping, and illness conviction—to provide a nuanced profile of the respondent’s overall style of psychological adjustment.

Keywords

Diabetes, Psychological Adjustment, Chronic Illness, Coping, Diabetes Stress, Illness Conviction, Psychometrics, ATT19, ATT39.

Authors

G. Welch, R. B. W. Smith, F. H. Walkey, S. M. Dunn, L. J. Beeney.

Purpose

The primary purpose of the ATT19 is to measure the diverse styles and facets of an individual’s psychological adjustment specifically related to living with diabetes. Unlike scales focused solely on adherence or distress, the ATT19 aims to categorize the respondent’s overall attitude toward the disease, encompassing both negative reactions (e.g., stress, guilt, alienation) and positive coping mechanisms.

This instrument is crucial for researchers and clinicians seeking to understand the psychological barriers and facilitators influencing effective self-management and quality of life among people with Type 1 or Type 2 diabetes. Identifying specific areas of poor adjustment allows for targeted psychological and behavioral interventions designed to improve long-term health outcomes.

Construct

The ATT19 measures the overarching construct of Psychological Adjustment to Diabetes, conceptualized as a multi-dimensional process rather than a single stable state. The scale operationalizes this construct through six primary dimensions or subscales, reflecting different ways individuals internalize and react to their chronic condition. These dimensions capture how the illness impacts identity, social interaction, perceived control, and emotional state.

The six subscales measured are:

• Diabetes Stress: Measuring the perceived burden and emotional strain associated with managing the condition.
• Coping: Assessing active strategies and positive outlooks used to manage the daily demands of diabetes.
• Guilt: Reflecting feelings of self-blame or responsibility regarding the onset or management failures of the illness.
• Alienation/Cooperation: Capturing the extent to which the individual feels isolated by their condition versus cooperating with treatment and healthcare providers.
• Illness Conviction: Reflecting the stability and certainty of the individual’s belief about their diagnosis and its implications.
• Ambiguity Tolerance: Measuring the ability to cope with the uncertainty and unpredictable nature of diabetes control and symptoms.

Validity

Initial validation studies for the parent instrument, the ATT39, established strong construct validity through its clear differentiation of various psychological profiles in individuals with diabetes. The factor structure (which defines the six subscales) demonstrated that the components measure distinct yet related aspects of adjustment.

The scale has also shown evidence of criterion validity, correlating significantly with other measures of psychological distress, quality of life, and self-care behaviors, confirming its relevance in predicting key health outcomes related to chronic illness management. Studies utilizing the ATT framework support its utility in assessing the psychological impact of living with a demanding chronic condition.

Reliability

The reliability of the ATT scale has been typically assessed using internal consistency measures. The original ATT39 demonstrated acceptable to good internal consistency (e.g., Cronbach’s alpha values often ranging from .70 to .90 across the various subscales), indicating that items within each subscale reliably measure the same underlying dimension. While specific reliability metrics for the ATT19 version are context-dependent, its direct derivation from the psychometrically sound ATT39 suggests it retains adequate reliability for research and clinical screening purposes.

Factor Analysis

The development of the ATT scales relied heavily on Factor Analysis to identify the underlying structure of psychological adjustment styles. The original analysis on the ATT39 utilized techniques like Principal Components Analysis, which consistently yielded the six primary factors that define the scale’s subscales: stress, coping, guilt, alienation/cooperation, illness conviction, and ambiguity tolerance. The 19 items of the ATT19 are those that loaded most strongly onto these core factors, ensuring the abbreviated version maintains structural integrity and factor purity.

Instrument

Test Type: Self-report questionnaire / Psychometric scale.

Format: Likert Scale response format, typically ranging from “I disagree completely” to “I agree completely.” The specific number of points on the scale (e.g., 5 or 7 points) may vary depending on the administration protocol.

Language Available: Primarily English (original development language), with use documented in various international research settings.

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

Age Group: Typically used with adolescents and adults capable of self-reporting complex psychological states.

Population Details: Used in clinical and research settings to assess the psychological impact of chronic illness and inform treatment planning.

Test Methodology: Respondents indicate their level of agreement with 19 statements. Scoring involves calculating subscale scores based on the six identified factors, with specific items requiring reverse scoring to maintain scale directionality.

The original PDF containing details of this instrument can be downloaded here: http://vuir.vu.edu.au/15507/1/Andreassen2009.pdf

Keywords

ATT19, Diabetes Management, Chronic Disease, Emotional Adjustment, Psychosocial Factors, Health Psychology, Self-Care, Likert Scale.

Authors

Author ORCID Identifier: Not specified in source content.

Affiliation Email addresses: Not specified in source content.

Correspondence Address: Not specified in source content.

Permissions & Fee and Test Year

The scale was initially developed based on work published in 1992 (ATT39) and formally detailed in 1994 (ATT39). While the ATT19 version is widely used in research, specific licensing requirements should be checked with the copyright holders (Welch, Dunn, Beeney, et al.). Researchers often use this scale without fee for non-commercial academic purposes, but formal permission is generally required due to its publication in copyrighted academic texts.

Test Year: 1994 (ATT39 publication detailing the constructs).

Reference’s

• Welch, G., Smith, R. B. W., & Walkey, F. H. (1992). Styles of psychological adjustment in diabetes: A focus on key psychometric issues and the ATT39. Journal of Clinical Psychology, 48(5), 648-658.
• Welch, G., Dunn, S. M., & Beeney, L. J. (1994). The ATT39: A measure of psychological adjustment to diabetes. In C. Bradley (Ed.), Handbook of Psychology and Diabetes (pp. 223-245). Australia: Harwood Academic Publishers.
• Weinger, K., Butler, H. A., Welch, G. W., & La Greca, A. M. (2005). Measuring diabetes self-care: A psychometric analysis of the self-care inventory-revised with adults. Diabetes Care, 28(6), 1346-1352.
• Andreassen, Hege Kristine. (2009). Separation-Individuation and its Effect on Diabetes Management and Diabetes Control in Young Women with Type 1 Diabetes. Other Degree thesis, Victoria University.

Items of the Measure of Psychological Adjustment to Diabetes (ATT19)

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

1. If I did not have diabetes I think I would be quite a different person.
2. I dislike being referred to as “a diabetic”.
3. Diabetes is the worst thing that has happened to me.
4. Most people would find it difficult to adjust to ha‎ving diabetes.
5. I often feel embarrassed about ha‎ving diabetes.
6. There is not much I seem to be able to do to control my diabetes.
7. There is little hope of leading a normal life with diabetes.
8. The proper control of diabetes involves a lot of sacrifice and inconvenience.
9. I try not to let people know about my diabetes.
10. Being told you have diabetes is like being sentenced to a life time of illness.
11. My diabetic diet does not really spoil my life.
12. In general‚ doctors need to be a lot more sympathetic in their treatment of people with diabetes.
13. ha‎ving diabetes over a long period changes the personality.
14. I often find it difficult to decide whether I feel sick or well.
15. Diabetes is not really a problem because it can be controlled.
16. There is really nothing you can do if you have diabetes.
17. There is really no-one I feel I can talk to openly about my diabetes.
18. I believe I have adjusted well to ha‎ving diabetes.
19. I often think it is unfair that I should have diabetes when other people are so healthy.