THE VALIDITY AND RELIABILITY OF THE DIABETES HEALTH PROFILE (DHP) IN NIDDM PATIENTS REFERRED FOR INSULIN THERAPY

Recently, a new diabetes-specific questionnaire, the Diabetes Health P rofile (DHP), has been developed to identify psychosocial dysfunctioni ng of insulin-requiring (NIDDM) and insulin-dependent diabetes mellitu s (IDDM) patients. The DHP comprises three dimensions: psychological d istress (PSY: 14 items), barriers to activity (BAR: 12 items) and disi nhibited eating (EAT: five items). This study investigates the psychom etric properties of the DHP in Dutch noninsulin-dependent diabetes mel litus (NIDDM) patients referred for insulin therapy. In addition, the relationship between patient characteristics and the DHP outcome was e xamined. The factor structure found was similar but not identical to f ormer studies, but construct validity was supported by high correlatio ns of our factor structure and the original factor outcome and Cronbac h's alpha. The three factors explained 32% of the variance, supporting earlier findings. It was shown that Cronbach's alpha was satisfactory (0.72, 0.72 and 0.79). Convergent validity showed strong and signific ant correlations between the PSY/BAR dimensions and predicted correspo nding scales of the RAND-36. However, the PSY/BAR dimensions also show ed, although less strong, significant correlations with the non-corres ponding RAND-36 scales. The EAT dimension showed only correlations wit h two of the RAND-36 dimensions, thus measuring a different trait. Reg ression analysis showed that older patients had less problems with ite ms of the EAT dimension and that no difference was found between men a nd women, supporting earlier findings. The hyperglycaemic complaint 'f atigue' gave a significantly lower score (more problems) on the PSY an d BAR dimensions. Younger age, the presence of hypertension and retino pathy resulted in a significantly lower score on the EAT dimension. DH P outcome was not significantly influenced by duration of diabetes, Hb A(1c) (indicator of glycemic control), serum total cholesterol, body m ass index, chronic diabetes complications and comorbidity. Overall, th e psychometric properties were good considering the small and diverse sample, suggesting that the DHP is promising for use in NIDDM patients , although more study is necessary in a larger sample.