Psychometric Properties of the Persian Version of the Diabetes Self‑Management Questionnaire for Patients with Type 2 Diabetes in Iran

Mehran Nakhaeizadeh, Ali Khalooei


Background: Diabetes self‑management questionnaire (DSMQ) is among the relatively new tools with comprehensive structure measuring various dimensions of self‑care behaviors in diabetic patients. This study was carried out to evaluate psychometric properties of Persian version of DSMQ. Methods: A cross‑sectional study was carried out from January to March 2017 among patients with type 2 diabetes mellitus (T2DM) referred to urban health centers, in Kerman, southeastern Iran. Data were collected from 589 patients using DSMQ. The DSMQ was translated into Persian by forward and backward translation method. Cronbach’s alpha method and intraclass correlation coefficient  (ICC) were used to measure internal consistency and test‑retest reliability, respectively. In addition, construct validity was assessed by confirmatory factor analysis and exploratory factor analysis (EFA). Results: The sum‑scale Cronbach’s α of DSMQ was equal to 0.82 for 30 participants. The mean inter‑item correlation and mean item‑total correlation of “Sum Scale” (SS) were equal to 0.21 (standard deviation (SD) = 0.22) and 0.53 (SD = 0.19), respectively. All items had item‑total correlations higher than 0.30 except items 7, 11, and 15. For “SS,” ICC was obtained as 0.93. EFA revealed a four‑factor model accounting for 62.5% of the total variance. All indices were acceptable for the modified DSMQ with four factors (χ2 = 134.33, degrees of freedom = 89, P = 0.001, comparative fit index  =  0.97, root mean square error of approximation  =  0.044, Tucker‑Lewis index  =  0.96, and normal fit index =  0.92). Conclusions: The Persian version of DSMQ was found to have acceptable reliability and validity for assessing self‑management among patients with T2DM.


Diabetes mellitus; psychometric; self-care; self-management; validity and reliability

Full Text:



Shrivastava SR, Shrivastava PS, Ramasamy J. Role of self‑care

in management of diabetes mellitus. J Diabetes Metab Disord


Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U,

Guariguata L, Cho NH, et al. IDF diabetes atlas: Global

estimates for the prevalence of diabetes for 2015 and 2040.

Diabetes Res Clin Pract 2017;128:40‑50.

Esteghamati A, Larijani B, Aghajani MH, Ghaemi F,

Kermanchi J, Shahrami A, et al. Diabetes in Iran: Prospective

analysis from first nationwide diabetes report of National

program for prevention and control of diabetes (NPPCD‑2016).

Sci Rep 2017;7:13461.

Huang D, Refaat M, Mohammedi K, Jayyousi A, Al Suwaidi J,

Abi Khalil C. Macrovascular complications in patients with

diabetes and prediabetes. Biomed Res Int 2017;11:9.

Peimani M, Abrishami Z, Nasli‑Esfahani E, Bandarian F,

Ghodsi M, Larijani B. Iran diabetes research roadmap (IDRR)

study; analysis of diabetes comorbidity studies in iran: A review

article. Iran J Public Health 2017;46:39‑46.

Chong S, Ding D, Byun R, Comino E, Bauman A, Jalaludin B.

Lifestyle changes after a diagnosis of type 2 diabetes. Diabetes

Spectr 2017;30:43‑50.

De Man J, Aweko J, Daivadanam M, Alvesson HM, Delobelle P,

Mayega RW, et al. Diabetes self‑management in three different

income settings: Cross‑learning of barriers and opportunities.

PLoS One 2019;14:e0213530.

Schmitt A, Reimer A, Hermanns N, Huber J, Ehrmann D,

Schall S, et al. Assessing diabetes self‑management with the

diabetes self‑management questionnaire (DSMQ) can help

analyse Behavioural problems related to reduced Glycaemic control. PLoS One 2016;11:e0150774.

Laxy M, Mielck A, Hunger M, Schunk M, Meisinger C,

Rückert I‑M, et al. The association between patient‑reported

self‑management behavior, intermediate clinical outcomes, and

mortality in patients with type 2 diabetes: Results from the

KORA‑A study. Diabetes Care 2014;37:1604‑12.

Xu Y, Savage C, Toobert D, Pan W, Whitmer K. Adaptation and testing

of instruments to measure diabetes self‑management in people with

type 2 diabetes in mainland China. J Transcult Nurs 2008;19:234‑42.

Lu Y, Xu J, Zhao W, Han H‑R. Measuring self‑care in persons

with type 2 diabetes: A systematic review. Eval Health Prof


Schmitt A, Reimer A, Hermanns N, Huber J, Ehrmann D, Schall S,

et al. The Diabetes self‑management questionnaire (DSMQ):

Development and evaluation of an instrument to assess diabetes

self‑care activities associated with glycaemic control. Health

Qual Life Outcomes 2013;11:e0150774.

Bukhsh A, Lee SW, Pusparajah P, Schmitt A, Khan TM. Psychometric

properties of the Diabetes self‑management questionnaire (DSMQ) in

Urdu. Health Qual Life Outcomes 2017;15:200.

Babatunde S, Onu R. Psychometric performance of the Diabetes

self‑management questionnaire (DSMQ) among individuals

attending a referral hospital in Port Harcourt, Nigeria. SM J

Public Heal Epidemiol 2018;4:1047.

Thojampa S, Mawn B. Psychometric evaluation of the Thai

translation of the Diabetes self‑management questionnaire in

type 2 diabetes. Int J Nurs Sci 2017;4:236‑8.

Tahmasebi R, Noroozi A. Cross cultural validation of the

diabetes self management scale in Iranian patients. HealthMed


Moradi Y, Baradaran HR, Khamseh ME. Psychometric Properties

of the Iranian Version of the Diabetes Numeracy Test-15. Int

J Prev Med. 2016;7:43 Isfahan, IRAN. doi: 10.4103/20087802.177862. PMID: 27076881; PMCID: PMC4809128. [Last

accessed on 2020 Sep 10].

García‑Alcaraz JL, Oropesa‑Vento M, Maldonado‑Macías AA.

Kaizen Planning, Implementing and Controlling. Springer; 2017.

Koo TK, Li MY. A guideline of selecting and reporting intraclass

correlation coefficients for reliability research. J Chiropr Med


Hooper D, Coughlan J, Mullen MR. Structural equation

modelling: Guidelines for determining model fit. Electron J Bus

Res Methods 2008;6:53‑60.

Streiner DL. Starting at the beginning: An introduction to

coefficient alpha and internal consistency. J Pers Assess


Benrazavy L, Khalooei A. Medication adherence and its

predictors in type 2 diabetic patients referring to Urban primary

health care centers in Kerman City, Southeastern Iran. Shiraz

E‑Med J 2019;20:e84746.

Zolnierek KBH, DiMatteo MR. Physician communication and

patient adherence to treatment: A meta‑analysis. Med Care


Huizinga MM, Elasy TA, Wallston KA, Cavanaugh K, Davis D,

Gregory RP, et al. Development and validation of the Diabetes

numeracy test (DNT). BMC Health Serv Res 2008;8:96.

Alghodaier H, Jradi H, Mohammad NS, Bawazir A.

Validation of a diabetes numeracy test in Arabic. PloS One