Development of reliable clinician-rated measures of diabetes self-care

OBJECTIVE: The purpose of this study was to use clinician judgements to develop reliable methods of assessing self-monitoring of blood glucose (SMBG) technique and healthy eating in people with diabetes mellitus. METHOD: Items for inclusion in the assessment tools were generated through a series of focus groups with certified diabetes educators (nurses, dietitians, a social worker and a psychologist). These items were used to develop a semi-structured interview with interview questions rated using empirical Likert scales. The resulting Nutrition Evaluation Tool was used to assess healthy eating during a clinical interview that probed each item and a 4-day food record. To determine the reliability of the scales, 3 nurses assessed SMBG in 6 patients and 2 dietitians rated 11 audiotaped nutrition interviews with reference to each patient's 4-day food record. The validity of the SMBG scale was assessed through examination of correlations between the SMBG scale and A 1 C and self-reported testing frequency. Scores on the Nutrition Evaluation Tool were compared to self-report of eating behaviour and computer analysis of the 4-day food record. RESULTS: The following aspects of SMBG were judged to be essential to behavioural competency: observed technique, obtaining a comparison reading from laboratory results and record keeping. The following factors were identified as essential considerations in healthy eating behaviour: meal spacing, meal irregularity, unnecessary snacking, meal balance, carbohydrate loading, fibre adequacy, sugar intake, fat intake, sodium intake, caloric intake, protein intake, nutritional adequacy of milk, fruits and vegetables, protein and starch, and alcohol intake. The SMBG scale and the Nutrition Evaluation Tool both demonstrated high inter-rater reliability. Ratings on the SMBG scale significantly correlated to self-reported testing frequency but not to A 1 C. Data from the Nutrition Evaluation Tool were significantly predictive of both self-report of eating behaviour and computer analysis of a 4-day food record, as well as with body mass index (BMI). CONCLUSION: In this study, the authors developed evidence-based tools to facilitate the reliable assessment of SMBG and healthy eating using clinician judgements. Clinician judgements predictably correlated with other measures of healthy eating. Scales such as those evaluated in this study will assist in the research of diabetes self-management providing a scientifically valid method to use clinical judgements.