Development of a health status measure for older African-American women with type 2 diabetes

OBJECTIVE - To develop a health status measure in older African-American wo men with type 2 diabetes. RESEARCH DESIGN AND METHODS - African-American women, age greater than or e qual to 40 years with type 2 diabetes, were recruited from central North Ca rolina to participate in three sequential phases: 1) Seven focus groups wer e convened and transcripts evaluated to generate questions and identify pla usible domains; 2) Ten one-on-one cognitive response interviews were perfor med to ensure clarity and cultural appropriateness of the questions; and 3) 217 women participated in psychometric evaluation to establish the interna l consistency and validity of the instrument. RESULTS - Three broad categories-mental, physical, and social well-being-ca ptured important issues generated during the focus groups. "My diabetes" wa s added during the cognitive response interviews as a way of separating the impact of diabetes from coexisting issues that affect health status. The r esponse option was changed from a six- to a four-point Likert scale to acco mmodate subject preference. Using principal components and subsequent proma x rotation, we identified two hierarchical domains (mental and social well- being) and a physical symptom index. The internal consistency (Cronbach's o r) of the mental and social well-bring subscales are 0.83 and 0.93, respect ively. A priori hypothesized correlations between subscales along with each subscale and glycated hemoglobin, diabetes duration, physical activity, an d a perceived health competence scale helped establish the construct validi ty of the instrument. CONCLUSIONS - A culturally appropriate disease-specific health status measu re for older African-American women with type 2 diabetes has been developed . We have established the internal consistency construct validity, and fact or analytic properties of the measure. This measure should prove useful for investigators who seek a health status instrument that addresses issues ge rmane to African-American women with type 2 diabetes.