THE VALIDITY AND RELIABILITY OF THE SUMMARY OF DIABETES SELF-

CARE ACTIVITIES QUESTIONNAIRE: AN INDONESIAN VERSION

Sugiharto, RN., Ph.D.1*, Yu-Yun Hsu, RN., Ph.D2, Deborah J. Toobert, Ph.D3, Shan-Tair Wang,
Ph.D4
1
University of Muhammadiyah Pekajangan Pekalongan, 2 National Cheng Kung University, Taiwan, 3
Oregon Research Institute, 1776 Millrace Drive Eugene, Oregon 97403, 4 National Cheng Kung
University, Taiwan
Email*: [email protected]/[email protected]

ABSTRACT

Introduction: Diabetes self-care activities is a complex regimen, that required an appropriate tools to asses. The
Summary of Diabetes Self-Care Activities (SDSCA) questionnaire is the most widely used tool for assess diabetes
self-care activities. The study aimed to testing validity and reliability of the Bahasa Indonesia version of the
SDSCA. Methods: The study applied a forward-backward translation strategy. A pretest and a validation study
were conducted. The Bahasa Indonesia version of the SDSCA was reviewed by an expert panel for conceptual
and content equivalence to the English version. Furthermore, forty-five and 125 patients with T2DM participated
in the pretest and the validation study, respectively. The psychometric properties were evaluated in terms of
internal consistency, content validity, concurrent validity, and construct validity. Results: The content validity
index (CVI) and the internal consistency (Cronbach’s alpha) were satisfactory, which are 0.98, and 0.72,
respectively. The exploratory factor analysis revealed that SDSCA-I are consistent with the original English
version. There are significant correlations between three subscales of SDSCA-I and the diabetes knowledge levels
namely general diet (r = 0.274, p = 0.002), physical activity (r = 0.269, p = 0.002), and foot care (r = 0.297, p =
0.001). SDSCA-I was significantly correlated with HbA1c values, in term of general diet (r = -0.205, p = 0.022)
and self-monitoring of blood glucose (r = -0.265, p = 0.003). Conclusions: The translation and psychometric
test of the SDSCA-I were satisfactory. The tool could assess the self-care activities of Indonesians with T2DM in
all settings.

Keywords: diabetes self-care activities questionnaire; forward-backward translation; psychometric properties;

type 2 diabetes mellitus (T2DM)

INTRODUCTION DM complications is 74.3% (National Institute

of Research and Development of Health, 2013).
The global prevalence of diabetes
Theoretically, these complications can be
mellitus (DM) has been predicted to increase
prevented by modifying lifestyle (Weber, Oza-
from 415 million in 2015 to 642 million in 2040
Frank, Staimez, Ali, & Venkat Narayan, 2012)
(International Diabetes Federation [IDF],
and implementing self-care activities
2015). Indonesia ranks second in the prevalence
(American Diabetes Association [ADA],
of DM in the Southeast Asia Region (World
2018).
Health Organization, 2016), with
Diabetes self-care activities are an
approximately ten million sufferers (IDF,
essential strategy that can prevent or delay
2015). The majority of these patients have type
diabetes complications by maintaining ideal
2 diabetes mellitus (T2DM) (National Institute
glycemic control (ADA, 2018; Coyle, Francis,
of Research and Development of Health, 2013).
& Chapman, 2013). Seven regimens of diabetes
Evidence shows that T2DM threatens DM-
self-care activities have been recommended,
related complications, such as macro- and
namely healthy eating, being active,
micro-vascular complications, whose rates are
monitoring, taking medications, problem-
27.2% and 53.5%, respectively (Litwak et al.,
solving, healthy coping, and reducing risks
2013). In Indonesia, the mortality rate due to
(American Association of Diabetes Educator,

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Jurnal INJEC Vol. 4 No. 1 June 2019: 25-36

2014). A study showed that self-care activities increase their knowledge and self-care
can improve HbA1c by 0.36% milligrams per activities related to DM. However, there is a
deciliter (Minet, Møller, Vach, Wagner, & lack of a valid tool for assessing diabetes self-
Henriksen, 2010). Empirically, the adherence care activities. Therefore, the present study
rate of self-care in developing countries is low aimed to translate SDSCA into the Indonesian
(Dal Santo Francisco Bonamichi et al., 2016). language and examine its psychometric
In line with this, in most Asian countries, the properties.
goal of self-care activities was unachievable
(Ramachandran, Snehalatha, Shetty, & METHODS
Nanditha, 2012).
A possible reason for the low Study design
adherence to self-care activities is the The SDSCA questionnaire was translated
complexity of the regimens. Moreover, the using a forward-backward translation
assessment of self-care performance is approach. There are six stages in the forward-
important for monitoring and determining self- backward translation process: translation,
care support. Several diabetes self-care synthesis, back translation, expert committee
assessment tools have been developed with review, pretesting, and submission and
good psychometrics, but most are in the English appraisal (Beaton, Bombardier, Guillemin, &
language. The Summary of Diabetes Self-Care Ferraz, 2000). A cross-sectional design was
Activities (SDSCA), developed by Toobert and applied to evaluate the psychometric properties
Glasgow, is the most widely used tool for of the SDSCA.
assessing diabetes self-care activities (Toobert Setting and Participants
& Glasgow, 1994). SDSCA revised version Two groups of participants were
contains 25 items related to diet, medication, recruited for this study. The first group was
foot care, physical activity, self-monitoring of recruited for a pretest, which was conducted to
blood glucose, smoking, and self-care assess the readability and clarity of the
recommendations from healthcare providers Indonesian version of SDSCA (SDSCA-I). The
(Toobert, Hampson, & Glasgow, 2000). participants in the first group were recruited
SDSCA has been recognized as a simple, valid, from “Ngesti Waluyo” diabetes club Parakan,
and reliable questionnaire (Adarmouch, Central Java. The participants of the second
Sebbani, Elyacoubi, & Amine, 2016; Toobert et group were recruited from community health
al., 2000). It has thus been translated into centers in Pekalongan, Central Java, to test the
several languages, including Chinese (Xu, psychometric properties of SDSCA-I. The
Savage, Toobert, Pan, & Whitmer, 2008), inclusion criteria of the participants were ≥ 18
Spanish (Vincent, McEwen, & Pasvogel, years of age, literate in Bahasa Indonesia, and
2008), Turkish (Kav et al., 2010), Korean (Choi diagnosed with T2DM. The exclusion criteria
et al., 2011), Malay (Jalaludin, Fuziah, Hong, included T2DM patients with physical or
Adam, & Jamaiyah, 2012), German (Kamradt psychological limitations for conducting self-
et al., 2014), Arabic (AlJohani, Kendall, & care, serious diabetes complications (e.g., renal
Snider, 2014), and Moroccan (Adarmouch et failure, acute myocardial infarction, or stroke),
al., 2016). The above studies have confirmed and severe psychiatric disorders. This study
that SDSCA is a valid and reliable scale for was conducted from October 2014 to October
assessing diabetes self-care activities for DM 2015.
patients across cultural backgrounds. Measurements
Since Indonesia has a high prevalence There are tree variables were measured
of DM, the Indonesian National Health included self-care activities, diabetes
Insurance recently provided a program namely knowledge, and HbA1c. The self-care activities
PROLANIS, for patients with T2DM to was assessed using the summary of diabetes

26
The Validity and Reliability of ... (Sugiharto, et.al)

self-care activities questionnaire. Diabetes Translation procedures

knowledge questionnaire was used to evaluate Permission to translate SDSCA was
the knowledge level of diabetes among the obtained from its creator (Dr. Toobert).
participants. And HbA1c was analyzed using Approval for the study was obtained from the
clover A1c mechine. Detail of these tree Ethical Committee at the Universitas
measurements are described below. Muhammadiyah Yogyakarta (407/EP-FKIK-
The Summary of Diabetes Self-Care UMY/IX/2015).
Activities Questionnaire The SDSCA questionnaire was
SDSCA is a self-reported questionnaire translated using a forward-backward translation
that assesses the frequency of performing model (Figure 1). The English version of
diabetes self-care in the preceding 7 days. The SDSCA was translated into Bahasa Indonesia
original SDSCA questionnaire consists of 25 independently by two bilingual nurses. Then,
items that distributed in the diabetes regimen the two translators met to synthesize the results
namely general diet, specific diet, exercise, and reach a consensus. The Indonesian version
blood-glucose testing, foot care, medication, of SDSCA was translated back into an English
and smoking (Toobert et al., 2000). The version by a bilingual nurse and an English
respondents score their adherence to the self- translator, independently. Finally, the
care activities within the past week, ranging Indonesian version of SDSCA was approved by
from 0 to 7 days. The SDSCA has been proven an English language center in Indonesia; both
to have good psychometric properties, with versions attained a linguistic consensus.
acceptable inter-item correlation (mean = 0.47), Nine healthcare professionals,
moderate test-retest correlations (mean = 0.40), including physicians, dietitians, pharmacists,
and low correlations among the five dimensions diabetes educator nurses, and clinical nurses,
(mean r = 0.23) (Toobert et al., 2000). participated in evaluating the content of
Diabetes Knowledge Questionnaire SDSCA-I related to diabetes care concepts,
The Diabetes Knowledge culture, and linguistic context. The content
Questionnaire (DKQ) is a self-report scale for evaluation was used a 1-4 scoring system (1 =
assessing one’s knowledge of diabetes not relevant to 4 = highly relevant). Qualitative
(Eigenmann, Skinner, & Colagiuri, 2011). comments were also collected.
There are 14 multiple-choice questions with the
following scoring system: 0 = incorrect, 1 = Figure 1. Translation Process
correct, and 0.5 = unsure. The internal
consistency of DKQ has been proven, with a Stage 1:
Cronbach’s alpha of 0.76 (Eigenmann et al., Two initial translation (T1 & T2) into
2011). DKQ was applied to assess the Bahasa Indonesia
concurrent validity of SDSCA because
knowledge of diabetes is coincident with self-
care performance (Kueh, Morris, & Ismail,
2017). Stage 2:
HbA1c Synthesize T1 & T2 into T12, gain
The HbA1c level of the participants consensus
was measured to serve as an indicator of
assessing concurrent validity. In this study,
HbA1c levels were measured using an analyze
machine with a drop of capillary whole blood.
The blood sample was drawn after the Stage 3:
participants had completed SDSCA-I. Back-translation from T12 into BT1 & BT2
Research procedures

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Jurnal INJEC Vol. 4 No. 1 June 2019: 25-36

1 or 2). The item-CVI (I-CVI) was computed as

the number of experts giving a rating of
relevant, divided by the total number of experts.
I-CVI was reflected by an inter-rater agreement
that a score of 0.78 is regarded as good (Pilot &
Stage 4: Beck, 2006). The score-CVI (S-CVI) was
Nine (9) expert committee review, produce calculated as the average proportion of items
pre-final version rated as relevant by the experts. There are no
criteria for S-CVI (Polit and Beck, 2006). Item
analysis was used to examine the homogeneity
of the items in the SDSCA-I. Cronbach’s alpha
was computed to examine the internal
consistency of SDSCA-I. Exploratory factor
Stage 5: analysis (EFA) with principal component
Pretesting/pilot study of the pre-final analysis and varimax rotation was applied to
version determine the factor structures of SDSCA-I,
45 T2DM patients and the absolute value was set of above 0.40.
Pearson’s correlation was used to examine the
Study procedures for pretest and SDSCA-I concurrent validity between SDSCA-I and
validation DKQ and between SDSCA-I and HbA1c levels.
Two waves of the study were
implemented. In the first wave, a pretest was RESULTS
conducted to assess the clarity and readability
of SDSCA-I. Forty-five patients with T2DM Characteristics of participants
were invited to fill out the SDSCA-I The pretest (Wave I) included 45
questionnaire and were interviewed regarding participants and the validation study (Wave II)
its content. According to Beaton et al. (2000), included 125 participants. The demographic
30-40 respondents are recommended in the characteristics of the two groups are shown in
pretesting stage. In the second wave, 125 Table 1. The average age of the participants in
participants with T2DM were recruited for Wave I was 55.24 years (standard deviation
evaluating the psychometric properties of [SD] = 8.27 years) and that in Wave II was
SDSCA-I. Because SDSCA is a well- 55.10 years (SD = 7.12 years). The average
established questionnaire, the sample size in duration of diabetes from diagnosis was 5.77
this study was acceptable and it could yield a years (SD = 5.16 years) in Wave I and 4.85
reliable result (Mundfrom, Shaw, & Ke, 2005; years (SD = 5.14 years) in Wave II. The
de Winter, Dodou, & Wieringa, 2009). majority of participants in both groups were
Participants signed informed consent forms female and had a low level of education. The
prior to enrolling in the study. They filled out majority of participants (> 82%) were being
the 25-item SDSCA-I and DKQ questionnaires. treated with an oral hypoglycemic agent. Just
Subsequently, blood samples were drawn from over half of the participants had never received
the participants to examine their HbA1c levels. any diabetes education (51.2%). Based on the
Data analysis participants’ report in Wave II, almost two-
The content validity of SDSCA-I was thirds (73.6%) had no DM complications. More
analyzed using the content validity index (CVI) than half (64.8%) in Wave II had a low level of
with a 4-point scoring system (from 1 = not income.
relevant to 4 = highly relevant). Furthermore,
the rating was dichotomized into “relevant”
(scores of 3 or 4) and “not relevant” (scores of

28
The Validity and Reliability of ... (Sugiharto, et.al)

Table 1. Characteristics of Participants

Sample Wave II (n =
Characteristic Sample Wave I (n = 45)
125)
mean (SD)
mean (SD)
Age 55.2 (8.3) 55.1 (7.1)
Year of diagnosed DM 5.8 (5.2) 4.9 (5.1)
n (%) n (%)
HbA1c
< 7% - 0 (0%
≥ 7% 125 (100%)
Gender
Male 17 (37.8) 41 (32.8)
Female 28 (62.2) 84 (67.2)
Education levels
No formal education - 39 (31.2)
Elementary 20 (44.4) 38 (30.4)
Senior High School 16 (35.6) 32 (25.6)
Higher Education 9 (20) 16 (12.8)
Treatment regimen
No treatment 8 (17.8) 17 (13.6)
OHA* 37 (82.2) 104 (83.2)
Insulin - 1 ( 0.8)
OHA + insulin - 3 ( 2.4)
Diabetes education received
Yes 30 (66.7) 61 (48.8)
No 15 (33.3) 64 (51.2)
Complication by participants’ report
No complication 92 (73.6)
1 complication 30 (24.0)
2 complication 3 ( 2.4)
National Health Insurance
Yes 91 (72.8)
No 34 (27.2)
Income (million Rupiahs)
<2 81 (64.8)
2–4 32 (25.6)
≥4 12 ( 9.6)
*OHA: Oral Hypoglycemic Agents
Content validity and participants’ feedback had difficulty understanding of meanings of
The I-CVI and S-CVI of SDSCA-I Items 3 and 5. “servings” of fruit and
were 0.99 and 0.88, respectively. In addition, vegetables and “exact serving amount” of
the experts suggested adding examples for Item carbohydrates were difficult to understand for
4 (i.e., high-fat foods such as red meat or full- the participants. The participants also suggested
fat dairy products) and Item 5A (i.e., space that items with similar regimens be grouped
carbohydrates evenly throughout the day). In into one subscale, which would aid the
the pretest, the qualitative feedback from the answering of questions.
participants was also collected. The participants

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Jurnal INJEC Vol. 4 No. 1 June 2019: 25-36

TableTable
2. The2.item
Theanalysis
item analysis
and reliability
and reliability
of theof
SDSCA-I
the SDSCA-I
(Continue)

12. Wash the

Dimension/Item 1.04Mean
± 0.542 Cronbach’s 0.569
Item-Total 0.677 Item-Total Cronbach’s
0.682
feet 2.28± SD Correlation α if item Correlation α if item
a a b
properly Deleted Deleted b
13. Soak
Overall scalethe 6.36 ± -0.523 0.759
0.72 -0.537 0.776
0.73
Generalfeet diet 1.58 0.86 0.86
14.
1. DryFollowed a 1.132.10 ± 0.518
0.617 0.679
0.665 0.525
0.623 0.687
0.672
between
healthful 2.35±
toes
eatingafter
plan 2.54
2. washing
Followed 2.02 0.583 0.669 0.599 0.675
Medication eating plan ± 0.48 0.48
15. Take 3.962.57
± 0.349 0.700 0.324 0.713
Specificdiabetes
diet 3.10 0.07
medication
3. Eat five 3.50 0.051 0.728 - -
16. Insulin
portion or 0.25± ± 0.401 0.701 0.351 0.714
injection
more 1.182.25
17. Take
vegetables 3.81 ± 0.402 0.692 0.405 0.703
number
and fruitsof 3.08
diabetes
4. Eat high-fat 5.81 -0.143 0.732 - -
pills
food ±
Smoking 1.40
18. Are
5. Spread you 0.10 ±
0.55 -0.286
0.606 0.722
0.683 -- --
smoker
carbohydrate 0.30±
SDSCA-I: the Summary of1.48 Diabetes Self-Care Activities-Indonesian version; a: crude analysis
b
of Exercise
18 items; : analysis if item 3, 4, 5, and 18 were deleted
0.88 0.88
6. Participate in 3.26 0.343 0.699 0.348 0.710
at least 30 ±
min of 2.67
physical
activity
7. Participate in 2.31 0.193 0.718 0.175 0.734
a specific ±
exercise 2.73
session
Blood glucose 0.73 0.73
testing
8. Test blood 0.54 0.361 0.703 0.348 0.714
sugar ±
1.24
9. Test blood 0.38 0.325 0.706 0.339 0.716
sugar as ±
recommended 1.08
Foot care 0.79 0.79
10. Check the 0.86 0.351 0.698 0.354 0.709
Item analysisfeet and internal consistency
± SDSCA-I had a Cronbach’s alpha of 0.72.
Item analysis showed that the internal
2.07 However, the subscale of a specific diet (i.e.,
consistency for the
11. Inspect the original
0.43 25 items
0.306 of Items 3,4 and 5)
0.704 had a very low
0.345 Cronbach’s
0.712
inside of ±
shoes 1.53 30
The Validity and Reliability of ... (Sugiharto, et.al)

alpha of 0.07. The results of item-deleted

Cronbach’s alpha indicated that when Items 3,
4, and 5 were deleted, the internal consistency
of SDSCA-I did not increase significantly
(0.73). Accordingly, we decided to retain Items
3, 4, and 5. The final version of SDSCA-I has a
Cronbach’s alpha of 0.72; the highest
Cronbach’s alpha (0.88) is for the subscale of
physical activity and the lowest Cronbach’s
alpha (0.07) is for the subscale of specific diet
(Table 2).
Construct validity
The Kaiser-Meyer-Olkin (KMO) value
was 0.697, and the Bartlett’s test of sphericity
value was X2 = 1105.763 (df = 136, p < 0.001).
Both KMO and Bartlett’s test results indicate
that the data had sampling adequacy and could
be analyzed using EFA (Dixon, 2013). EFA
revealed six factors, namely general diet (4
items), specific diet (2 items), physical activity
(2 items), self-monitoring of blood glucose (2
items), foot care (5 items), and medication (2
items) (Table 3). The factor loadings for each
item ranged from 0.444 to 0.966. The
cumulative percentage of the total variance in
the six factors reached 74%.
Concurrent validity
Concurrent validity was confirmed
because there were significant correlations
between three subscales of SDSCA-I and DKQ:
general diet (r = 0.274, p = 0.002), physical
activity (r = 0.269, p = 0.002), and foot care (r
= 0.297, p = 0.001). Furthermore, two subscales
of SDSCA-I had significant correlations with
HbA1c value: general diet (r = - 0.205, p =
0.022) and self-monitoring of blood glucose (r
= -0.265, p = 0.003).

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Table 3. Exploratory factor analysis (EFA) test of the final SDSCA-I

Item General Foot Medication SMBG Physical Specific

diet care Activity diet
1. Followed a healthful 0.585
eating plan
2. Followed eating 0.519
plan
3. Eat five or more 0.444
servings of fruits
and vegetables?
4. Eat high-fat foods, 0.828
such as red meat or
full-fat dairy
products?
5. Space carbohydrates 0.832
evenly through the
day?
6. Participate in at 0.939
least 30 min of
physical activity
7. Participate in a 0.927
specific exercise
session
8. Test blood sugar 0.824
9. Test blood sugar as 0.811
recommended
10. Check your feet 0.761
11. Inspect the inside of 0.681
shoes
12. Wash feet properly 0.600
13. Soaking your feet -0.708
14. Dry between toes 0.645
after washing
15. Take recommended 0.966
diabetes medication
16. Insulin injection 0.873
17. Take recommended 0.954
number of diabetes
pills
Initial Eigenvalues:
% of variance 16.818 15.309 11.980 11.685 10.914 7.425
Cumulative % 16.818 32.127 44.107 55.793 66.707 74.131
SDSCA-I: the Summary Diabetes Self-Care Activities Indonesian version; SMBG: Self-
Monitoring Blood Glucose
DISCUSSIONS The initial English version of the 25-
item SDSCA was translated into SDSCA-I

32
The Validity and Reliability of ... (Sugiharto, et.al)

using a forward and backward approach. The physical activity, and foot care, but the
SDSCA-I has satisfactory psychometric subscales of specific diets, self-monitoring and
properties, as proven through a series of taking medicine were not associated with the
reliability and validity tests. The final version knowledge of T2DM. The non-significant
of SDSCA-I has satisfactory internal associations may be due to cultural-economic
consistency with Cronbach’s alpha of 0.72. factors, such as the financial burden of buying
These results are consistent with those for the meat or a blood sugar detector and paternalism
Malay version (Jalaludin et al., 2012) and the in medical adherence. In Indonesia, many
Arabic version (Aljohani et al., 2014). patients with diabetes cannot afford to buy a
Three items related to the specific diet blood sugar detector to perform self-
subscale (i.e., fruit and vegetable consumption; monitoring. In this study, more than half of the
high-fat food consumption; and spacing participants had a low level of income < 2
carbohydrates throughout the day) had a very million Rupiah per month. Paternalism in
low-reliability score. Even though our experts medical adherence refers to patient follow a
agreed that a specific diet is relevant in the physician’s recommendation for taking
context of diabetes care and is linguistically medication without adequate knowledge of
sound, the participants did not fully understand diabetes care. The level of diabetes knowledge
the meaning of the specific diet. A possible is associated with diabetes self-care practice
reason is that the specific diet items may not be (Sharma & Bhadari, 2017; Sugiharto et al.,
well understood culturally among Indonesian 2017). Concurrent validity was also
patients with T2DM. For example, “servings of demonstrated by the subscales of diet and self-
fruits and vegetables” in Item 3 is ambiguous. monitoring being significantly associated with
It can be referred to fruits and vegetable HbA1c levels. These findings are consistent
consumption independently or both are with previous studies, in which adherence to
together. In the future, patients with diabetes diet and self-monitoring of blood glucose were
need to be taught the concepts of diet regimen, significant factors in determining glycemic
specific diet, servings, and spacing control (Khattab, Khader, Al-Khawaldeh, &
carbohydrates. Ajlouni, 2010). Additionally, frequent self-
Another issue is related to the items monitoring of blood glucose can help T2DM
that required reverse scoring, namely Item 4 patients adjust their self-care activities (Houle
(“high-fat food consumption”) and Item 13 et al., 2015).
(“soaking of feet”). Both items need to be The EFA analysis showed that the 17
reversed before scoring. However, the two items of self-care activities are loaded into their
items had negative item-total correlations and relevant factors, which is consistent with the
low internal consistency (Table 2). Similar English version of SDSCA, except for Item 5
findings were found for the Spanish version (spacing carbohydrates) and Item 16 (insulin
(Vincent et al., 2008) and the Malay version injection), which are loaded into the general
(Jalaludin et al., 2012). To adjust for the low diet factor. Inconsistent factor loading has been
internal consistency, Vincent et al. (2008) reported for the Chinese version of SDSCA,
suggested that the two items should not be where a diet item was loaded into the subscale
reversed. These items were retained because of of medication (Xu et al., 2008). In the present
the significance of these items on the DM study, a possible reason is that the term
regimen. “carbohydrates” is identic with diet and only
The concurrent validity of SDSCA-I 3.2% of the study participants had received
was confirmed via its significant association insulin injection. The insulin injection performs
with DKQ. The levels of self-care activity are before the meal time.
reflected in the knowledge of T2DM, Several limitations of this study should
particularly in the knowledge of general diet, be taken into account. First, the study did not

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include patients with type 1 DM (T1DM). measure. Journal of Diabetes Research,

Accordingly, the results cannot be generalized 2016, 1-6. doi:10.1155/2016/5479216.
to such patients. Future studies should assess AlJohani, K. A., Kendall, G. E., & Snider, P. D.
the psychometric properties of SDSCA-I for (2014). Psychometric evaluation of the
patients with T1DM. The study was conducted summary of diabetes self-care activities–
in a rural area of Java Island. Since Indonesia Arabic (SDSCA-Arabic) translation and
has a multi-ethnic population, future analysis process. Journal of
investigations in different settings (urban areas, Transcultural Nursing, 27(1), 65-72.
different islands) and with different ethnicities doi:1043659614526255.
are recommended. Finally, in the present study, American Association of Diabetes Educators.
the concurrent validity of SDSCA-I was (2014). AADE7 position statement:
examined using a diabetes knowledge AADE7 self-care behaviors. Retrieved
questionnaire and HbA1c levels instead of any from http://www.diabeteseducator.org.
diabetes self-care scales. This is due to the lack American Diabetes Association [ADA].
of diabetes self-care scales in Indonesia. (2018). Standards of medical care in
diabetes-2018. Diabetes Care, 41 (Suppl.
CONCLUSIONS 1): S7-S12. doi:10.2337/dc18-S001.
Beaton, D. E., Bombardier, C., Guillemin, F., &
This study approves that the SDSCA-I Ferraz, M. B. (2000). Guidelines for the
is a valid and reliable scale and it has process of cross-cultural adaptation of
satisfactory psychometric properties. SDSCA-I self-report measures. Spine, 25(24),
is a simple tool and requires 5-10 minutes to 3186-3191. doi: 10.1097/00007632-
complete. Thus, SDSCA-I can be used by 200012150-00014.
healthcare providers to assess the self-care Choi, E. J., Nam, M., Kim, S. H., Park, C. G.,
activities of patients with T2DM in Indonesia in Toobert, D. J., Yoo, J. S., & Chu, S. H.
outpatient departments in hospitals or (2011). Psychometric properties of a
community settings, and it can be used as a Korean version of the summary of
research instrument. diabetes self-care activities measure.
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experts for their participation in the cross- 2010.08.007.
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Utami, Saiful Bakhtiar, I Made Sukma Wijaya, (2013). Self-management activities in
Nuniek Nizmah Fajriyah, Nurul Hidayati, Eko diabetes care: A systematic review.
Julianto, Sujodo, Retno Tri Probowati, Ferry Australian Health Review, 37(4), 513-
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Conflict of interests statement Camargo, L., Ksyvickis dos Louros, M.,
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