Summary of Diabetes Self-Care Activities (SDSCA)

Abstract

The Summary of Diabetes Self-Care Activities (SDSCA) is a widely utilized, brief self-report measure designed to assess the frequency of specific diabetes self-management behaviors over the preceding seven days. Developed primarily for use in clinical research and practice, the SDSCA evaluates adherence to recommended self-care regimens across several key domains, including Diet, Exercise, Blood Glucose Testing, Foot Care, and Smoking Status. The instrument is valuable for tracking patient progress, evaluating the effectiveness of educational interventions, and identifying specific behavioral barriers to optimal glycemic control. The refined 2000 version incorporated findings from multiple studies to enhance its psychometric properties and utility.

Keywords

Diabetes, Self-Care Activities, SDSCA, Adherence, Glycemic Control, Diet, Exercise, Blood Glucose Testing, Foot Care, Behavioral Assessment

Authors

Deborah T. Toobert, Sarah E. Hampson, Russell E. Glasgow

Purpose

The primary purpose of the Summary of Diabetes Self-Care Activities (SDSCA) scale is to provide researchers and healthcare providers with a reliable, standardized metric for quantifying patient adherence to the complex behavioral demands of diabetes management. The instrument specifically measures how frequently, on a daily or weekly basis, individuals engage in critical self-care behaviors necessary to prevent acute complications and long-term morbidity associated with the condition.

By focusing on the number of days per week an activity is performed, the SDSCA allows for a detailed, quantifiable assessment of treatment fidelity. This measure is essential for evaluating large-scale interventions, allowing for direct comparison of self-care adherence levels across different populations or treatment groups. Its brevity also makes it highly practical for routine clinical use, facilitating quick behavioral screening.

Construct

The SDSCA measures the behavioral construct of adherence to the prescribed diabetes treatment regimen. This construct is recognized as multi-faceted, encompassing distinct and semi-independent behavioral domains rather than a single unified dimension. The scale operationalizes self-care behaviors into specific, measurable frequencies (days per week), reflecting the immediate behavioral effort required by the patient.

The core components of the construct measured include adherence to dietary guidelines (general and specific), participation in physical activity, consistency in monitoring blood glucose levels, performing routine preventative foot care, and managing smoking status. The expanded version further incorporates adherence to medication schedules and specific recommendations provided by the healthcare team, providing a holistic view of self-management.

Validity

The validity of the SDSCA has been established through extensive empirical testing, notably the revision published in 2000 based on results from seven distinct studies. The instrument demonstrates strong content validity, as its items directly reflect internationally recognized clinical recommendations for effective diabetes self-management behaviors.

Construct validity is supported by the scale’s ability to differentiate between individuals based on their self-care practices and its expected correlation with clinical outcomes, such as HbA1c levels. The multidimensional structure of the scale is validated by factor analysis, confirming that the subscales measure distinct aspects of self-care, which is crucial given that patients often adhere strictly to one domain (e.g., medication) while struggling in another (e.g., diet).

Reliability

Reliability analyses of the SDSCA typically focus on internal consistency (Cronbach’s alpha) for the defined subscales, as well as test-retest reliability over short periods. The original development and subsequent revisions sought to optimize the reliability of the subscales, though the nature of measuring distinct behaviors means that inter-item correlations within the overall scale remain low, justifying the calculation of separate scores for each domain (Diet, Exercise, etc.).

For instance, the developers noted low inter-item correlations within the Specific Diet subscale, leading to the recommendation that individual items within this domain should often be analyzed separately rather than aggregating them into a single mean score. Overall, the subscales generally demonstrate acceptable to good reliability for self-report measures of behavioral frequency, making the SDSCA a dependable tool for tracking change over time.

Factor Analysis

Factor analysis of the SDSCA consistently supports a multi-factor structure, reflecting the distinct nature of the diabetes self-care regimen. The primary factors identified correspond to the main domains of self-care: Diet, Exercise, Blood-Glucose Testing, Foot Care, and Smoking Status. This factor structure is robust and confirms that the scale is not measuring a unidimensional construct of “general adherence.”

The revision process leading up to the 2000 publication involved confirmatory factor analysis across multiple datasets to ensure that the revised scale items loaded appropriately onto these theoretically derived factors. This rigorous approach ensured that each subscale provided a meaningful and independent measure of a specific self-care behavior.

Instrument

Test Type: Self-Report Behavioral Frequency Questionnaire

Format: Brief questionnaire utilizing a 7-day recall period (0 to 7 days per week response format).

Language Available: English (Numerous translations are available due to its widespread use globally).

Population Group: Individuals diagnosed with Type 1 or Type 2 Diabetes Mellitus.

Age Group: Adolescents and Adults (typically ages 18+ for the standard version, though adaptations exist for younger populations).

Population Details: Used across diverse clinical and non-clinical settings, including primary care, specialty diabetes clinics, and large epidemiological studies.

Test Methodology: Patients respond by indicating the number of days in the last seven (or the last month for some items) that they performed the specified self-care activity.

Keywords

Psychometrics, Behavioral Health, Chronic Disease Management, Health Behavior, Patient Compliance, Insulin, Dietary Adherence, Physical Activity, Smoking Cessation

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 Summary of Diabetes Self-Care Activities (SDSCA) is generally considered a public domain instrument intended for non-commercial research and clinical use, stemming from its publication in major academic journals. The core instrument and scoring instructions are frequently made available free of charge by the authors or through academic repositories. The critical revision and standardization of the expanded scale were published in the year 2000. Researchers should cite the primary Toobert, Hampson, and Glasgow (2000) reference when using the scale.

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 instrument and related scoring details can be found online at: https://www.researchgate.net/publication/12423077

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

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

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

Core Subscales of the Brief Version

The brief version focuses on five regimen areas:

• Diet:
  • How many of the last SEVEN DAYS have you followed a healthful eating plan?
  • On average, over the past month, how many DAYS PER WEEK have you followed your eating plan?
  • On how many of the last SEVEN DAYS did you eat five or more servings of fruits and vegetables?
  • On how many of the last SEVEN DAYS did you eat high fat foods such as red meat or full-fat dairy products?
• Exercise:
  • On how many of the last SEVEN DAYS did you participate in at least 30 minutes of physical activity? (Total minutes of continuous activity, including walking).
  • 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?
• Blood Sugar Testing:
  • On how many of the last SEVEN DAYS did you test your blood sugar?
  • On how many of the last SEVEN DAYS did you test your blood sugar the number of times recommended by your health care provider?
• Foot Care:
  • On how many of the last SEVEN DAYS did you check your feet?
  • On how many of the last SEVEN DAYS did you inspect the inside of your shoes?
• Smoking:
  • Have you smoked a cigarette- even one puff- during the past SEVEN DAYS?
  • 0. No
  • 1. Yes. If yes, how many cigarettes did you smoke on an average day? Number of cigarettes:

Additional Items for the Expanded Version

The expanded version includes questions regarding self-care recommendations, medications, and detailed foot care practices:

• Self-Care Recommendations (Example Items):
  • Which of the following has your health care team (doctor, nurse, dietitian, or diabetes educator) advised you to do? (Check all that apply for Diet, Exercise, and Blood Sugar Testing advice).
  • Which of the following medications for your diabetes has your doctor prescribed?
• Diet:
  • On how many of the last SEVEN DAYS did you space carbohydrates evenly through the day?
• Medications:
  • On how many of the last SEVEN DAYS, did you take your recommended diabetes medication?
  • OR
  • On how many of the last SEVEN DAYS did you take your recommended insulin injections?
  • On how many of the last SEVEN DAYS did you take your recommended number of diabetes pills?
• Foot Care:
  • On how many of the last SEVEN DAYS did you wash your feet?
  • On how many of the last SEVEN DAYS did you soak your feet?
  • On how many of the last SEVEN DAYS did you dry between your toes after washing?
• Smoking:
  • At your last doctor’s visit, did anyone ask about your smoking status?
  • 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?
  • When did you last smoke a cigarette?