Development of a Digitally Applicable Tool for Identifying Insulin Adherence Challenges Prior to Consultation

Adherence to insulin therapy is crucial for optimal glycemic control in people with diabetes. Yet, non-adherence is common, and identifying those struggling with adherence remains challenging. This study developed and validated a questionnaire designed to assess insulin adherence among people with insulin-treated diabetes. A 10-item questionnaire in Danish was developed based on a literature review, prior research on insulin use patterns, and expert evaluation. Content validity was evaluated by a panel of five domain experts who independently rated item relevance on a 4-point scale. Item-level Content Validity Index (I-CVI), Scale-level CVI (S-CVI/Ave), and modified kappa (κ*) were computed. All ten items were rated as relevant (scores 3-4) by all experts, resulting in I-CVI = 1.00 and κ* = 1.00 for all items. The overall scale (S-CVI/Ave) demonstrated excellent content validity. The insulin adherence questionnaire appears to comprehensively capture different aspects of insulin-taking behavior. The questionnaire holds promise for both clinical and educational use, particularly when administered digitally prior to consultations. This allows healthcare professionals to identify adherence challenges and tailor patient education and support.