Development and validation of a type 1 diabetes self-management scale for children

Ceran, Merve Aşkın; Bektas, Murat; Eklioğlu, Beray Selver

doi:10.1590/1806-9282.20252204

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Original Article • Rev. Assoc. Med. Bras. 72 (6) • 2026 • https://doi.org/10.1590/1806-9282.20252204 linkcopy

Development and validation of a type 1 diabetes self-management scale for children

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE: The aim of this study was to develop a type 1 diabetes mellitus self-management scale for children and to assess its psychometric properties.

METHODS: A methodological, descriptive, correlational, and cross-sectional study was conducted. The research sample comprised 212 children with diabetes aged 7–12 years. Content validity was evaluated by seven experts in pediatric endocrinology, pediatric nursing, public health nursing, and Turkish language. Descriptive statistics, correlation analyses, Cronbach's alpha, McDonald's omega, split-half reliability, and factor analyses were used.

RESULTS: The Cronbach's alpha for the overall scale was 0.893, and for the subscales, it ranged from 0.757 to 0.845. The item-total score correlations ranged from 0.408 to 0.660. Exploratory factor analysis revealed a four-factor structure that explained 57.730% of the total variance, with item loadings ranging from 0.380 to 0.863. Confirmatory factor analysis supported the four-factor structure, with factor loadings ranging from 0.52 to 0.87 and acceptable fit indices: χ²/df=1.461, goodness-of-fit index=0.901, comparative fit index=0.939, incremental fit index=0.941, Tucker–Lewis index=0.926, and root mean square error of approximation=0.066.

CONCLUSION: The validity and reliability analyses revealed that the scale is a valid and reliable measure in Turkish culture.

KEYWORDS:
Children; Type 1 diabetes mellitus; Self-management; Psychometric; Development; Scale

Items	Factor loads
Items	Factor 1 Care	Factor 2 Treatment	Factor 3 Nutrition	Factor 4 Exercise
I administer my insulin injections exactly as I was taught. (ÇDÖYÖ 7)		0.861
I can inject my insulin in a different place each time. (ÇDÖYÖ 8)		0.491
I adjust my insulin dose according to my blood sugar results, as recommended to me. (ÇDÖYÖ 10)		0.697
I know how to use the insulin pump/insulin pen prescribed for my treatment. (ÇDÖYÖ 11)		0.817
To prevent my blood sugar from rising, I can exercise regularly, as recommended by my diabetes team. (ÇDÖYÖ 17)				0.723
I adjust my exercise routine according to my blood sugar results. (ÇDÖYÖ 18)				0.862
I stick to my diet plan. (ÇDÖYÖ 19)			0.731
I never skip my main meals (breakfast, lunch, and dinner). (ÇDÖYÖ 20)			0.863
Even when I eat outside the home (at restaurants, school, or visiting friends/family), I stick to my diet. (ÇDÖYÖ 22)			0.612
I check my feet regularly (for cuts, scrapes, etc.) (ÇDÖYÖ 27)	0.742
I keep my toenails straight and short. (ÇDÖYÖ 28)	0.716
I wear loose-fitting and cotton socks. (ÇDÖYÖ 29)	0.779
I prefer shoes that fit my feet properly and don't squeeze them. (ÇDÖYÖ 30)	0.616
I go for regular check-ups with my doctor every 3 months for my diabetes. (ÇDÖYÖ 31)	0.536
I ask my nurse or doctor about any problems I think might be related to my diabetes. (ÇDÖYÖ 34)				0.380
I can achieve the goals I've set for keeping my diabetes under control. (ÇDÖYÖ 41)			0.609
Eigenvalue	6.579	1.723	1.405	1.157
Explained variance (%)	38.759	8.040	6.285	4.645
Explained total variance (%)	57.730
KMO	0.840
Bartlett χ²(p)	867.411 (p<0.001)

	X²	dfa	X²/df	RMSEAb	GFIc	CFId	IFIe	TLIf
Four Factor Model	143.154	98	1.461	0.066	0.901	0.939	0.941	0.926

Subscale	CR	AVE	MSV	MaxR (H)	1	2	3	4	ASV
Care	0.846	0.529	0.375	0.868	0.727				0.26
Treatment	0.818	0.532	0.415	0.842	0.386**	0.729			0.23
Nutrition	0.846	0.581	0.369	0.861	0.516***	0.345**	0.763		0.25
Exercise	0.786	0.555	0.415	0.828	0.612***	0.644***	0.608***	0.745	0.39

	Cronbach's alpha	Mcdonald omega	Split half analysis					M±SD
	Cronbach's alpha	Mcdonald omega	Part 1 Cronbach's alpha	Part 2 Cronbach's alpha	Spearman-Brown	Guttman split-half	Correlation Between Forms	M±SD
Scale total	0.893	0.895	0.817	0.767	0.936	0.935	0.879	62.11±10.11
Care subscale	0.845	0.852						20.04±4.02
Treatment subscale	0.813	0.820						16.49±3.04
Nutrition subscale	0.812	0.817						14.58±3.29
Exercise subscale	0.757	0.773						11.01±2.69

Items	Cronbach's alpha if item deleted	Corrected item-total correlation (r)*	Corrected item-subscale total score correlation (r)*
I1 (ÇDÖYÖ 7)	0.887	0.542	0.622
I2 (ÇDÖYÖ 8)	0.889	0.466	0.547
I3 (ÇDÖYÖ 10)	0.887	0.529	0.642
I4 (ÇDÖYÖ 11)	0.885	0.604	0.728
I5 (ÇDÖYÖ 17)	0.883	0.630	0.663
I6 (ÇDÖYÖ 18)	0.886	0.566	0.615
I7 (ÇDÖYÖ 19)	0.886	0.560	0.687
I8 (ÇDÖYÖ 20)	0.888	0.507	0.639
I9 (ÇDÖYÖ 22)	0.891	0.438	0.600
I10 (ÇDÖYÖ 27)	0.882	0.649	0.804
I11 (ÇDÖYÖ 28)	0.888	0.516	0.808
I12 (ÇDÖYÖ 29)	0.882	0.660	0.777
I13 (ÇDÖYÖ 30)	0.883	0.650	0.803
I14 (ÇDÖYÖ 31)	0.891	0.408	0.865
I15 (ÇDÖYÖ 34)	0.887	0.549	0.494
I16 (ÇDÖYÖ 41)	0.886	0.574	0.612

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[TFN1] KMO: Kaiser–Meyer–Olkin measure of sampling adequacy; ÇDÖYÖ: Type 1 Diabetes Self-Management Scale for Children original item code; χ²: chi-square.