Development of the Diabetes Index for Social Determinants of Health (DISDOH)

Social determinants of health (SDoH) are key risk factors impacting diabetes outcomes. The American Diabetes Association has identified five principal SDoH categories influencing diabetes outcomes: socioeconomic status, neighborhood and physical environment, food environment, healthcare, and social context. Currently, no concise and valid instruments exist to measure the burden of SDoH factors for individuals with diabetes. To fill this gap, we developed the Diabetes Index for Social Determinants of Health (DISDOH).

Participants with type 1 and type 2 diabetes were recruited from the regional Health Extension for Diabetes (HED) programme and a national crowdsourcing platform. Item development through a diabetes expert stakeholder group yielded a pool of 16 items, which were further refined through piloting with individuals living with diabetes. Principal component analysis was conducted with a sample of 440 HED participants, identifying a 5-factor solution. Confirmatory factor analysis supported this 5-factor solution using 215 individuals with type 1 and type 2 diabetes. Reliability and validity of DISDOH were also assessed.

The five DISDOH domains demonstrated acceptable internal consistency estimates: Domain 1, socioeconomic status (a=0.660); Domain 2, neighborhood and physical environment (a=0.812); Domain 3, food environment (a=0.801); Domain 4, health context (a=0.812); and Domain 5, social context (a=0.708). DISDOH showed strong convergent validity with related SDoH measures, and divergent validity was supported by weak or non-significant correlations with distinct constructs.

DISDOH is the first validated, diabetes-specific SDoH assessment designed for brief, practical use in clinical and community settings. Unlike existing instruments, which are often lengthy and not tailored to diabetes management, DISDOH offers a concise yet comprehensive approach to identifying social risk factors that impact diabetes self-care and outcomes.