Development and validity testing of the revised diabetes self-care inventory for children and adolescents

Recently, self-care in children and adolescents with type 1 diabetes has changed with regard to both adherence to treatment and self-management. Only one diabetes self-care scale for children and adolescents is used in Japan which lacks reflection on flexible regimens. The aims of this study were to modify and subsequently test the validity of the revised diabetes self-care inventory (R-DSCI) for children and adolescents, and to construct the diabetes self-care model on the R-DSCI, HbA1c, duration of diabetes and age. Based on qualitative secondary analysis of the self-care framework for teenagers and a literature review of diabetes self-care instruments, the items concerning insulin injection and meal planning were modified from the original DSCI and new items concerning negotiation with parents and others were added. The participants in the validity testing were 122 children and adolescents with type 1 diabetes, 50.8% were girls, aged 9-18 years, mean HbA1c of 7.9%. The final version of the R-DSCI was composed of 41 items. Eight factors, which explained 40.9% of the variance, were identified using the varimax method; Cronbach's alpha for the 41 items was 0.79. The diabetes self-care model showed a negative direct effect of "diabetes self-care practice" on HbA1c (P = 0.004), and the negative indirect effect of "support and perception of life with diabetes" on HbA1c through "diabetes self-care practice" (P = 0.002; estimated effect - 0.21). In addition, "independent self-care behavior" was directly affected by age (P < 0.001). The R-DSCI should be useful for clinicians and researchers to assess the self-management in children and adolescents.