Background
Methods
Instrument development
Title of the tool | Author-year | Dimensions of the questionnaire | Face validity | Content validity | Factor analysis | Convergence Validity | internal consistency | stability |
---|---|---|---|---|---|---|---|---|
36 item short form survey (SF-36) [24] | Ware and Sherbourne- 1992 | PF,1 RP,2 BP,3 GH,4 VT,5 SF,6 RE,7 MH,8 | – | – | – | – | – | – |
World Health Organization Quality Of Life Bref (WHO-QOL Bref) [25] | World health organization-1992 | Physical health, psychological, social relationship, environment | – | – | – | – | – | – |
Audit of Diabetes Dependent QoL (ADDQOL) [16] | Bradley-1999 | 13 item | – | – | 3 factor | – | – | – |
diabetes quality of life brief clinical inventory [26] | Burroughs-2004 | Self care behaviors, satisfaction with diabetes control | – | – | – | – | 0.77 | 0.72 |
diabetes-specific quality-of-life (D-QOL) scale [17] | Lee-2012 | Emotional sufferinge, Social functioninge, Adherence to the treatment regimene, Diabetes-specific symptoms | – | Qualitative validity | 4 factor with 70% variance | moderate and significant relationship between the D-QOL and SF-36 | 0.92% | – |
Diabetic Clients Quality Of Life (DCQOL) [18] | Darvishpoor-2005 | Physical, psycological, Social, Economic, Disease and treatment | – | – | 5 factor with 52% variance | significant relationship between the DCQOL and SF-36 | 0.88–0.93 | 0.86–0.90 |
Personal Diabetes Questionnaire [27] | Stetson-2011 | Diet knowledge and skills Dietary decision making Eating problems Diet barriers Problems in medication used Medication barriers Monitoring barriers Exercise barriers | – | – | – | – | – | 0.65–0.83 |
Diabetes Management Self –Efficacy Scale [28] | Bijl-1999 | physical exercise, blood sugar, nutrition general and medical treatment, nutrition specific and weight | – | – | 4 factor with 55% variance | – | 0.81 | 0.79 |
Diabetes Knowledge Questionnaire [29] | Garcia-2001 | 24 Item | – | – | – | – | 0.73–0.84 | – |
Adherence in Diabetes Questionnaire [30] | Kristensen-2012 | 19 Item | – | – | 1 factor | Predictive validity with HbA1C | 0.82–0.86 | – |
Psychological Predictors of Therapeutic success in Diabetes (PPTD) questionnaire [31] | Rotella-2014 | 19 Item | – | – | – | Predictive validity with HbA1C | 0.63 | – |
Psychometric properties of the instrument
Face validity
Content validity
Exploratory factor analysis
Convergence validity
Reliability
Statistical analysis
Ethical considerations
Results
Development of a primary questionnaire
I prefer to eat something I shouldn’t, rather than tell someone that I have diabetes [26] | |
I’m worried about whether I will miss work [26] | |
I feel diabetes limits my career [26] | |
I feel satisfied with my blood glucose control [28] | |
Recording your blood glucose levels in your chart/diabetes diary when your health care personnel asks you to [30] | |
I adjust insulin dose based on my blood glucose [30] | |
My diet is repetitious and not diversified [38] | |
Gestational diabetes has caused me not to enjoy my pregnancy [39] | |
I feel that my pregnancy is an abnormal pregnancy [40] |
Face validity
Characteristics | Face validity (n = 10) | Factor analysis And Known group validity (n = 165) | Convergence validity (n = 85) | Internal consistency (n = 30) | Stability (n = 15) |
---|---|---|---|---|---|
Age (years) | |||||
Mean (SD) | 29.6 (4.69) | 31.79 (5.30) | 29.87 (5.33) | 28.20 (5.88) | 28.40 (5.91) |
Range | 23–38 | 19–44 | 19–40 | 19–39 | 20–38 |
Gestational age (weeks) | |||||
Mean (SD) | 30.80 (3.76) | 31.00 (3.52) | 30.40 (3.74) | 31.33 (3.72) | 31.2 (3.70) |
Range | 27–36 | 26–39 | 26–39 | 26–37 | 26–36 |
Level of education | |||||
Elementary | 6 (60%) | 67 (40.6%) | 21 (24.7%) | 12 (40%) | 7 (46%) |
High school | 2 (20%) | 60 (36.4%) | 36 (42.4%) | 10 (33.3%) | 5 (33%) |
College/university | 2 (20%) | 31 (18.8%) | 23 (27.1%) | 8 (26.7%) | 3 (20%) |
postgraduate | 0 (0%) | 7 (4.2%) | 5 (5.9%) | 0 (0%) | 0 (0%) |
Employment status | |||||
Employment | 8 (80%) | 18 (10.9%) | 12 (14.1%) | 4 (13.3%) | 2 (13.3%) |
Housekeeper | 2 (20%) | 147 (89.1%) | 73 (85.9%) | 26 (86.7%) | 13 (86.7%) |
Economic status | |||||
Poor | 4 (40%) | 64 (38.8%) | 23 (27.1%) | 12 (40%) | 6 (40%) |
Moderate | 5 (50%) | 79 (47.9%) | 48 (56.5%) | 15 (50%) | 9 (60%) |
good | 1 (10%) | 22 (13.3%) | 14 (16.5%) | 3 (10%) | 0 (0%) |
Gravida | |||||
nuliparus | 4 (40%) | 49 (29.7%) | 37 (43.5%) | 10 (33.3%) | 2 (13.3%) |
multiparus | 6 (60%) | 116 (70.3%) | 48 (56.5%) | 20 (66.6%) | 13 (86.7%) |
Hospitalization | |||||
Yes | 3 (30%) | 63 (38.2%) | 28 (32.9%) | 11 (36.7%) | 4 (26.7%) |
no | 7 (70%) | 102 (61.8%) | 57 (67.1%) | 19 (63.3%) | 11 (73.3%) |
Treatment | |||||
Diet | 7 (70%) | 79 (47.9%) | 47 (55.3%) | 17 (56.7%) | 11 (73.3%) |
Medical treatment | 3 (30%) | 86 (52.1%) | 38 (44.7%) | 13 (43.3%) | 4 (26.7%) |
Content validation
Factor analysis
Component | Initial Eigenvalues | Extraction Sums of Squared Loadings | Rotation Sums of Squared Loadings | ||||||
---|---|---|---|---|---|---|---|---|---|
Total | % of Variance | % Cumulative | Total | % of Variance | % Comulative | Total | % of Variance | % Comulative | |
1 | 8.49 | 22.96 | 22.96 | 8.49 | 22.96 | 22.96 | 5.51 | 14.90 | 14.90 |
2 | 2.57 | 6.95 | 29.91 | 2.57 | 6.95 | 29.91 | 3.62 | 9.78 | 24.69 |
3 | 2.49 | 6.74 | 36.65 | 2.49 | 6.74 | 36.65 | 2.86 | 7.73 | 32.42 |
4 | 2.03 | 5.49 | 42.14 | 2.03 | 5.49 | 42.14 | 2.68 | 7.26 | 39.68 |
5 | 1.67 | 4.53 | 46.68 | 1.67 | 4.53 | 46.68 | 2.58 | 6.99 | 46.68 |
Raw | Item | Factor load | ||||
---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | ||
1 | I’m concerned about premature birth of my baby | 0.846 | ||||
2 | I’m concerned about the loss of fetal movement | 0.795 | ||||
3 | I’m concerned about the fetal death | 0.775 | ||||
4 | I’m concerned about fetal abnormalities | 0.765 | ||||
5 | I’m concerned about my baby’s blood sugar drop after birth | 0.655 | ||||
6 | I have to visit doctors with different specialties | 0.601 | ||||
7 | I’m concerned about poor weight gain | 0.572 | ||||
8 | I’m concerned that diabetes would be transmitted to my baby | 0.558 | ||||
9 | I have to visit the doctor frequently | 0.554 | ||||
10 | I’m concerned about fetal and baby weight gain | 0.524 | ||||
11 | I’m concerned about delayed wound healing | 0.436 | 0.439 | |||
12 | My diet is repetitious and not diversified | 0.721 | ||||
13 | I faced constraints on my favorite foods and fruits | 0.705 | ||||
14 | My food is separated from the family meal | 0.612 | ||||
15 | The family basket has changed due to my diet | 0.524 | ||||
16 | To measure fasting blood sugar, I should fast for a long time and endure hunger | 0.518 | ||||
17 | My sexual activity has decreased due to GDM | 0.480 | ||||
18 | I use fruits and food with low and determined amounts | 0.457 | ||||
19 | I go less often to the party and restaurants due to GDM | 0.401 | ||||
20 | I have feelings of thirst and dry mouth | 0.731 | ||||
21 | I repeatedly go to the bathroom | 0.695 | ||||
22 | I have blood sugar drop | 0.628 | ||||
23 | I get angry soon | 0.580 | ||||
24 | I feel depressed | 0.579 | ||||
25 | My mind is obsessed with the disease | 0.414 | 0.465 | |||
26 | Insulin injection is difficult for me at specific times of the day | 0.760 | ||||
27 | Insulin injections for several times is difficult and time consuming for me | 0.755 | ||||
28 | Frequent blood glucose test is difficult for me | 0.510 | ||||
29 | I’m concerned about drug side effects on my fetus | 0.508 | ||||
30 | I adjust insulin dose based on my blood glucose | 0.499 | ||||
31 | People’s empathy helps me to tolerate the disease | 0.678 | ||||
32 | My spouse mental and emotional support helps me tolerate the disease easier | 0.671 | ||||
33 | The information from healthcare workers about the disease has helped me | 0.605 | ||||
34 | The positive experience of the people around me about the disease has helped me | 0.594 | ||||
35 | The information I receive about the disease from the media and the Internet has helped me | 0.560 | ||||
36 | Prayer with God has helped me tolerate the disease | 0.431 |
Convergence validity
Subscales of questionnaire | Diabetes Clients Quality Of Life questionnaire (DCQOL) | |||||
---|---|---|---|---|---|---|
Physical | Psychological | Social | Economic | Disease and treatment | ||
Gestational Diabetes Mellitus Quality Of Life-36 Item (GDMQ-36) | concerns about high-risk pregnancy | 0.04 | 0.14 | −0.04 | 0.06 | 0.39** |
perceived constraints | −0.02 | 0.10 | −0.18 | −0.006 | 0.67** | |
GDM complications | 0.14 | 0.65** | 0.11 | 0.21* | −0.13** | |
medication and treatment | 0.10 | −0.01 | 0.005 | −0.05 | 0.46** | |
support | 0.06 | 0.005 | − 0.43** | −0.06 | 0.04 |
Reliability
subscales | Cronbach’s alpha | intra-class correlation coefficient (ICC) |
---|---|---|
concerns about high-risk pregnancy | 0.90 | 0.98 |
perceived constraints | 0.80 | 0.95 |
GDM complications | 0.85 | 0.90 |
medication and treatment | 0.77 | 0.85 |
support | 0.84 | 0.92 |
Total | 0.93 | 0.95 |
After Gestational Diabetes Mellitus | strongly disagree | disagree | have no idea | agree | strongly agree | |
---|---|---|---|---|---|---|
1 | I’m concerned about premature birth of my baby | |||||
2 | I’m concerned about the loss of fetal movement | |||||
3 | I’m concerned about the fetal death | |||||
4 | I’m concerned about fetal abnormalities | |||||
5 | I’m concerned about my baby’s blood sugar drop after birth | |||||
6 | I have to visit doctors with different specialties | |||||
7 | I’m concerned about poor weight gain | |||||
8 | I’m concerned that diabetes would be transmitted to my baby | |||||
9 | I have to visit the doctor frequently | |||||
10 | I’m concerned about fetal and baby weight gain | |||||
11 | I’m concerned about delayed wound healing | |||||
12 | My diet is repetitious and not diversified | |||||
13 | I faced constraints on my favorite foods and fruits | |||||
14 | My food is separated from the family meal | |||||
15 | The family basket has changed due to my diet | |||||
16 | To measure fasting blood sugar, I should fast for a long time and endure hunger | |||||
17 | My sexual activity has decreased due to GDM | |||||
18 | I use fruits and food with low and determined amounts | |||||
19 | I go less often to the party and restaurants due to GDM | |||||
20 | I have feelings of thirst and dry mouth | |||||
21 | I repeatedly go to the bathroom | |||||
22 | I have blood sugar drop | |||||
23 | I get angry soon | |||||
24 | I feel depressed | |||||
25 | My mind is obsessed with the disease | |||||
26 | Insulin injection is difficult for me at specific times of the day | |||||
27 | Insulin injections for several times is difficult and time consuming for me | |||||
28 | Frequent blood glucose test is difficult for me | |||||
29 | I’m concerned about drug side effects on my fetus | |||||
30 | I adjust insulin dose based on my blood glucose | |||||
31 | People’s empathy helps me to tolerate the disease | |||||
32 | My spouse mental and emotional support helps me tolerate the disease easier | |||||
33 | The information from healthcare workers about the disease has helped me | |||||
34 | The positive experience of the people around me about the disease has helped me | |||||
35 | The information I receive about the disease from the media and the Internet has helped me | |||||
36 | Prayer with God has helped me tolerate the disease |
Scoring procedure
Domains | Score range | Adjusted score |
---|---|---|
Concerns about high-risk pregnancy | 11–55 | (acquired raw score/maximum possible score)*100 |
Perceived constraints | 8–40 | |
Complications of GDM | 8–30 | |
Medication and treatment | 5–25 | |
Support | 6–30 | |
Total | 36–180 |