Elsevier

Primary Care Diabetes

Volume 3, Issue 1, February 2009, Pages 43-47
Primary Care Diabetes

Original research
Validation of the Diabetes Obstacles Questionnaire (DOQ) to assess obstacles in living with type 2 diabetes in a Belgian population

https://doi.org/10.1016/j.pcd.2009.02.003Get rights and content

Abstract

Aims

The aim of this study was to validate the Dutch version of the Diabetes Obstacles Questionnaire (DOQ) [H. Hearnshaw, K. Wright, J. Dale, J. Sturt, E. Vermeire, P. Van Royen, Development and validation of the Diabetes Obstacles Questionnaire (DOQ) to assess obstacles in living with Type 2 diabetes, Diabetic Med. 24 (2007) 878–882] assessing people living with type 2 diabetes’ obstacles to adhere to treatment recommendations. The goal is to have at one's disposal an instrument to identify obstacles to adhering to treatment recommendations for people living with type 2 diabetes in a Dutch speaking population.

Methods

Participants were recruited from a pragmatic sample of general practices in Flanders (Belgium). In accordance with the validation procedure in the UK [H. Hearnshaw, K. Wright, J. Dale, J. Sturt, E. Vermeire, P. Van Royen, Development and validation of the Diabetes Obstacles Questionnaire (DOQ) to assess obstacles in living with Type 2 diabetes, Diabetic Med. 24 (2007) 878–882], responders also completed the Dutch version of a quality of life questionnaire (ADDQoL) [C. Bradley, C. Todd, T. Gorton, E. Symonds, A. Martin, R. Plowright, The development of an individualised questionnaire measure of perceived impact of diabetes on quality of life: the ADDQoL. Qual. Life Res. 8 (1999) 79–91] and the Problem Areas in Diabetes (PAID) scale as golden standard [G. Welch, A.M. Jacobson, W.H. Polowsky, The Problem Areas in Diabetes (PAID) scale. An evaluation of its utility. Diabetes Care 20 (1997) 760–766]. Some biomedical variables such as HbA1c were collected also.

Results

Each scale showed sufficient reliability with Cronbach's alpha (>0.76). Each subscale had a factor structure of no more than 4, and a Kaiser–Meyer–Olkin measure of 0.75. Criterion validity was shown by significant correlation with the PAID and construct validity by a correlation with HbA1c. Construct validity has also been shown by significant correlations between ADDQoL and the DOQ Obstacles of Lifestyle changes scale.

Conclusions

The Dutch version of the DOQ is a feasible and valid instrument for the assessment of obstacles to adherence to treatment recommendations in people living with type 2 diabetes.

Introduction

Diabetes is one of the largest contributors to the number of chronically ill persons worldwide [4]. Its management requires comprehensive and complex health care services [5], along with health care systems that are adapted to delivering appropriate chronic care [6]. Usual medical care often fails to meet the needs of chronically ill patients, even in managed, integrated delivery systems [6]. Previous research suggests that tailored strategies may improve outcomes in these patients. The ideas of support, and of empowerment are cornerstones because the person living with a chronic condition is considered to be the principal caregiver [7], [8]. In addition a series of daily practical, social and psychological factors are challenges to adherence to regimens and barriers to self-care adaptation. Adherence to medical treatment and to lifestyle changes by people living with type 2 diabetes is considered an essential premise to reach improved metabolic control, but is difficult to achieve and to maintain though [9], [10]. Non-adherence to treatment recommendations may be considered a major health care problem [11]. Diabetes is a very demanding illness, not only on the medical but on the psychological and the behavioural level as well [9]. The daily confrontation, during many years, with self-care challenges may affect people's well being and may cause a series of psychological symptoms and even ‘diabetes burnout’ [12].

In order to be adherent to treatment recommendations many hurdles have to be taken and barriers have to be overcome [13], [14]. As a consequence, successful diabetes management presumes that health care providers and informal caregivers explore these phenomena in a particular patient. Some important themes are the perception of the course of the illness, and health beliefs in general concerning diabetes in particular [13]. Knowing and understanding these obstacles is very clarifying for all parties involved. Health beliefs, attitudes and obstacles to adhering should be elucidated to enable good diagnostic and follow-up procedures, to reach concordance about treatment goals and to arrive at tailored care [13].

The aim of this study was to validate the Dutch version of the DOQ in order to have at one's disposal an instrument to identify obstacles to adhering to treatment recommendations for people living with type 2 diabetes in a Dutch speaking population.

Section snippets

Questionnaire construction

The Diabetes Obstacles Questionnaire (DOQ) is based on a comprehensive search of the literature [9], [14], qualitative research using focus groups discussions with people living with type 2 diabetes in Flanders and in the UK [12], and the aggregated data from similar qualitative work in five other countries (Croatia, Estonia, France, Netherlands, Slovenia). The questionnaire development process and the validation of the English version of the DOQ have been described elsewhere [1]. This study in

Results

The efforts of the 197 GPs who were willing to participate resulted in 160 filled out questionnaires. Only one questionnaire was excluded because only 15% of the items were completed. Self-reported completion time of the questionnaires was approximately 60 min.

Participants were female (53%) and male (47%), native Dutch speaking people living with type 2 diabetes and aged between 33 and 87 years (mean age: 77.37). The mean time of illness duration since diagnosis was 6 years and the most frequent

Discussion

The DOQ is a valid and reliable instrument to inform health care providers’ questions about patients’ obstacles to adhere to proposed treatment regimens and advice in Dutch speaking people living with type 2 diabetes. In addition, it seems to be possible to use subscales – in combination or separately – depending on the specific needs or questions the professional or the individual person have. The subscales of this questionnaire are appropriate to identify more in detail the different medical

Conflicts of interest

None.

Acknowledgement

The authors want to thank Primary Care Diabetes for the research grant.

References (15)

  • E. Vermeire et al.

    Obstacles to adherence in living with type-2 diabetes. An international qualitative study using meta-ethnography (EUROBSTACLE)

    Primary Care Diabetes

    (2007)
  • H. Hearnshaw et al.

    Development and validation of the Diabetes Obstacles Questionnaire (DOQ) to assess obstacles in living with Type 2 diabetes

    Diabetic Med.

    (2007)
  • C. Bradley et al.

    The development of an individualised questionnaire measure of perceived impact of diabetes on quality of life: the ADDQoL

    Qual. Life Res.

    (1999)
  • G. Welch et al.

    The Problem Areas in Diabetes (PAID) scale. An evaluation of its utility

    Diabetes Care

    (1997)
  • C. Murray et al.

    The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Disease, Injuries and Risk Factors in 1990 and Projected to 2020

    (1996)
  • F.J. Snoek et al.

    Diabetes-related emotional distress in Dutch and US. Diabetic patients

    Diabetes Care

    (2000)
  • E.H. Wagner et al.

    Organizing care for patients with chronic illness

    Milbank Q

    (1996)
There are more references available in the full text version of this article.

Cited by (6)

  • A systematic review of patient-reported and economic outcomes: Value to stakeholders in the decision-making process in patients with type 2 diabetes mellitus

    2011, Clinical Therapeutics
    Citation Excerpt :

    Four articles were not obtained. Ultimately, 185 studies were included in the review.24–208 Each study could contain >1 outcome.

View full text