The Validity and Reliability of The Summary of Diabetes Self-Care Activities Questionnaire: An Indonesian Version

Sugiharto Sh, Yu Yun Hsu, Deborah J. Toobert, Shan Tair Wang

Abstract views = 1673 times | views = 359 times


Introduction: Diabetes self-care activities is a complex regimen, that required an appropriate tools to asses. The Summary of Diabetes Self-Care Activities (SDSCA) questionnaire is the most widely used tool for assess diabetes self-care activities. The study aimed to testing validity and reliability of the Bahasa Indonesia version of the SDSCA. Methods:  The study applied a forward-backward translation strategy. A pretest and a validation study were conducted. The Bahasa Indonesia version of the SDSCA was reviewed by an expert panel for conceptual and content equivalence to the English version. Furthermore, forty-five and 125 patients with T2DM participated in the pretest and the validation study, respectively. The psychometric properties were evaluated in terms of internal consistency, content validity, concurrent validity, and construct validity. Results:  The content validity index (CVI) and the internal consistency (Cronbach’s alpha) were satisfactory, which are 0.98, and 0.72, respectively. The exploratory factor analysis revealed that SDSCA-I are consistent with the original English version. There are significant correlations between three subscales of SDSCA-I and the diabetes knowledge levels namely general diet (r = 0.274, p = 0.002), physical activity (r = 0.269, p = 0.002), and foot care (r = 0.297, p = 0.001). SDSCA-I was significantly correlated with HbA1c values, in term of general diet (r = -0.205, p = 0.022) and self-monitoring of blood glucose (r = -0.265, p = 0.003). Conclusions:  The translation and psychometric test of the SDSCA-I were satisfactory. The tool could assess the self-care activities of Indonesians with T2DM in all settings.



diabetes self-care activities questionnaire; forward-backward translation; psychometric properties; type 2 diabetes mellitus (T2DM)

Full Text:



Adarmouch, L., Sebbani, M., Elyacoubi, A., & Amine, M. (2016). Psychometric properties of a Moroccan version of the summary of diabetes self-care activities measure. Journal of Diabetes Research, 2016, 1-6. doi:10.1155/2016/5479216.

AlJohani, K. A., Kendall, G. E., & Snider, P. D. (2014). Psychometric evaluation of the summary of diabetes self-care activities–Arabic (SDSCA-Arabic) translation and analysis process. Journal of Transcultural Nursing, 27(1), 65-72. doi:1043659614526255.

American Association of Diabetes Educators. (2014). AADE7 position statement: AADE7 self-care behaviors. Retrieved from

American Diabetes Association [ADA]. (2018). Standards of medical care in diabetes-2018. Diabetes Care, 41 (Suppl. 1): S7-S12. doi:10.2337/dc18-S001.

Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25(24), 3186-3191. doi: 10.1097/00007632-200012150-00014.

Choi, E. J., Nam, M., Kim, S. H., Park, C. G., Toobert, D. J., Yoo, J. S., & Chu, S. H. (2011). Psychometric properties of a Korean version of the summary of diabetes self-care activities measure. International Journal of Nursing Studies, 48(3), 333-337. doi: 10.1016/j.ijnurstu. 2010.08.007.

Coyle, M. E., Francis, K., & Chapman, Y. (2013). Self-management activities in diabetes care: A systematic review. Australian Health Review, 37(4), 513-522. doi: 10.1071/AH13060

Dal Santo Francisco Bonamichi, B., Caracik de Camargo, L., Ksyvickis dos Louros, M., Bonamichi dos Santos, R., Maria Scalissi A, N., & Eduardo Nunes Salles, J. (2016). Management of type 2 diabetes mellitus patients and prevalence of complications in a reference center. Integrative Obesity and Diabetes, 2(2). doi:10.15761/iod.1000146.

de Winter, J., Dodou, D.,& Wieringa, P.A. (2009). Exploratory factor analysis with small sample sizes. Multivariate Behavior Research, 44, 147-181. doi: 10.108000027317.

Dixon, JK. (2013). Exploratory Factor Analysis. In Plichta & Kelvin (6th Eds.), Munro’s statistical methods for health care research (pp. 371-398). China: Lippincott Williams & Wilkins.

Eigenmann, C., Skinner, T., & Colagiuri, R. (2011). Development and validation of a diabetes knowledge questionnaire. Practical Diabetes International, 28(4), 166-170d. doi: 10.1002/pdi.1586.

Houle, J., Beaulieu, M. D., Chiasson, J. L., Lespérance, F., Côté, J., Strychar, I., ... & Lambert, J. (2015). Glycaemic control and self‐management behaviours in Type 2 diabetes: Results from a 1‐year longitudinal cohort study. Diabetic Medicine, 32(9), 1247-1254. doi: 10.1111/dme.12686.

International Diabetes Federation. (2015). IDF Diabetes Atlas (6th Ed.). Retrieved from

Jalaludin, M., Fuziah, M., Hong, J., Adam, B. M., & Jamaiyah, H. (2012). Reliability and validity of the revised summary of diabetes self-care activities (SDSCA) for Malaysian children and adolescents. E-Journal of Malaysian Family Physician, 7(2-3), 10-20. Retrieved from

Kamradt, M., Bozorgmehr, K., Krisam, J., Freund, T., Kiel, M., Qreini, M., Ose, D. (2014). Assessing self-management in patients with diabetes mellitus type 2 in Germany: Validation of a Germany version of the summary of diabetes self-care activities measure (SDSCA-G). Health Quality Life Outcomes, 12(185), 1-10. doi:10.1186/s12955-014-0185-1

Kav, S., Akman, A., Dogan, N., Tarakei, Z., Bulut, Y., & Hanoglu, Z. (2010). Turkish validity and reliability of the summary of diabetes self-care activities measure for patients with type 2 diabetes mellitus. Journal of Clinical Nursing, 19, 2933-2935. doi:10.1111/j.1365-2702.2010. 03329.x.

Khattab, M., Khader, Y. S., Al-Khawaldeh, A., & Ajlouni, K. (2010). Factors associated with poor glycemic control among patients with type 2 diabetes. Journal of Diabetes Complications, 24(2), 84-89. doi:10.1016/j.jdiacomp.2008.12.008.

Kueh, Y. C., Morris, T., & Ismail, A.-A.-S. (2017). The effect of diabetes knowledge and attitudes on self-management and quality of life among people with type 2 diabetes. Psychology, Health & Medicine, 22(2), 138-144.

Minet, L., Møller, S., Vach, W., Wagner, L., & Henriksen, J. E. (2010). Mediating the effect of self-care management intervention in type 2 diabetes: A meta-analysis of 47 randomized controlled trials. Patient Education and Counseling, 80(1), 29-41. doi:10.1016/j.pec.2009.09.033.

Mundfrom, D.J., Shaw, D.G., & Ke, T. L.(2005). Minimum sample size recommendations for conducting factor analyses. International Journal of Testing, 5(2), 159-168.

National Institute of Research and Development of Health. (2013). Riset Kesehatan Dasar 2013. Retrieved from

Polit, D. F., & Beck, C. T. (2006). The content validity index: are you sure you know what's being reported? Critique and recommendations. Research and Nursing Health, 29(5), 489-497. doi:10.1002/nur.20147.

Ramachandran, A., Snehalatha, C., Shetty, A. S., & Nanditha, A. (2012). Trends in prevalence of diabetes in Asian countries. World J Diabetes, 3(6), 110-117. doi:10.4239/wjd.v3.i6.110.

Sharma, S., & Bhadari, S. D. (2017). Knowledge and Practice regarding Self-Care among the patients with type II Diabetes of Kapan, Kathmandu. Journal of Advanced Academic Research, 1(2), 85-91.

Sugiharto, S., Stephenson, M., Hsu, Y.-Y., & Fajriyah, N. N. (2017). Diabetes self-management education training for community health center nurses in Indonesia: a best practice implementation project. JBI Database of Systematic Reviews and Implementation Reports, 15(9), 2390-2397.

Toobert, D. J., & Glasgow, R. E. (1994). Assessing diabetes self-management: The Summary of Diabetes Self-Care Activities Questionnaire. In Bradly C. (Ed), Handbook of Psychology & Diabetes (pp. 351-375). New York: Psychology Press.

Toobert, D. J., Hampson, S. E., & Glasgow, R. (2000). The summary of diabetes self-care activities measure: Results from 7 studies and a revised scale. Diabetes Care, 23(7), 943-950. doi: 10.2337/diacare.23.7.943.

Vincent, D., McEwen, M. M., & Pasvogel, A. (2008). The validity and reliability of a Spanish version of the summary of diabetes self-care activities questionnaire. Nursing Research, 57(2), 101-106. doi: 10.1097/01.NNR.0000313484.18670.ab.

Weber, M. B., Oza-Frank, R., Staimez, L. R., Ali, M. K., & Venkat Narayan, K. (2012). Type 2 diabetes in Asians: prevalence, risk factors, and effectiveness of behavioral intervention at individual and population levels. Annual review of nutrition, 32, 417-439.

World Health Organization. (2016). Diabetes. Retrieved from factsheets/fs312/en/.

Xu, Y., Savage, C., Toobert, D., Pan, W., & Whitmer, K. (2008). Adaptation and testing of instruments to measure diabetes self-management in people with type 2 diabetes in mainland China. Journal of Transcultural Nursing, 19(3), 234-242. doi: 10.1177/1043659608319239.


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This journal is indexed by:



Creative Commons License

Copyright of Indonesian Nursing Journal of Education and Clinic (INJEC) (e-ISSN:2527-8819, p-ISSN:2527-8800).

View My Stats