Vietnamese Version of Diabetes Self‐Management Instrument: Development and Psychometric Testing

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In Vietnam, a small developing country in Southeast Asia, an estimated 6% of the population of 93 million are affected by diabetes (Pham & Eggleston, 2015). Annually, each Vietnamese person with diabetes pays 3,600,000 VND (equivalent to $162 US) more than the usual health costs for diabetes care (International Diabetes Federation, 2014). More than 95% of cases with diabetes in Vietnam are type 2. This health problem can cause complications including fluctuating blood glucose levels, diabetic ketoacidosis, foot ulcers, visual impairment, kidney diseases, cardiovascular disease, and stroke (Joslin et al., 2005).
Most adults with type 2 diabetes (T2DM) manage their diabetes outside healthcare settings, but primary diabetes care services are not available in many areas in Vietnam. Most Vietnamese adults with T2DM must visit a tertiary care setting for treatment. Also, in the Vietnamese culture, people consume white rice daily. This source of food is easily broken down into glucose and increases blood glucose levels faster than other types of food. These challenges require Vietnamese people to be more involved in their diabetes management.
With effective diabetes self‐management (DSM), adults with T2DM would improve their blood glucose control (Houle et al., 2015; Pal et al., 2014), reduce their treatment‐related costs (Lorig et al., 2001), and improve their health status (Cong, Zhao, Xu, Zhong, & Xing, 2012). There are no national statistics for blood glucose control or complications from diabetes among adults with T2DM in Vietnam, but in a recent study, 39% of patients with diabetes at Nhan Dan 115 hospital and 33% at Hoa Hao Medical Centre had hemoglobin A1c (HbA1c) levels greater than 8% (Yokokawa et al., 2010). This high level of blood glucose may lead to many complications for those with T2DM, and implies that adults with T2DM in Vietnam may not perform DSM effectively. Overall, however, knowledge about DSM among adults with T2DM in Vietnam is limited because of the lack of a valid Vietnamese instrument to measure this concept.
In a survey of available DSM measurements, it was found that because the concept has been defined differently, the measures of DSM differ (Lu, Xu, Zhao, & Han, 2015). Many researchers have measured DSM as patients’ compliance or adherence to recommended activities to control blood glucose and prevent complications from diabetes. In this scope of definition, several scales, for example, the Summary of Diabetes Self‐Care Activities (Choi et al., 2011; Toobert, Hampson, & Glasgow, 2000), and Diabetes Self‐Management Questionnaire (Schmitt et al., 2013), measure how often adults with T2DM follow each recommended activity for people with diabetes.
However, adults with T2DM have autonomy to manage their diabetes independently from healthcare professionals (Lin, Anderson, Chang, Hagerty, & Loveland‐Cherry, 2008). Adults deal with their health problems and make important decisions about disease management outside health care settings (Anderson & Funnell, 2000). Expecting them to comply with health care professionals’ recommendations may be unrealistic and may devalue patients’ roles in diabetes management (Anderson & Funnell, 2000; Redman, 2004). To optimize patients’ quality of life, diabetes management should be flexible and adapted to individual conditions (Anderson & Funnell, 2000). Therefore, a preferred definition of DSM is “an active, flexible process in which patients develop strategies for achieving desired goals by regulating their own actions, collaborating with their healthcare providers and significant people and performing preventive and therapeutic health‐related activities” (Lin et al., 2008, p. 371) .
The Diabetes Self‐Management Instrument (Lin et al., 2008; DSMI) is the only available scale that measures DSM as a process. The original instrument has 35 items. Originally, it was developed in English and translated into Chinese to be validated in Taiwan.

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