Abstract
Noncommunicable diseases (NCDs) such as heart attacks and stroke, cancers, chronic respiratory illness and diabetes are a major source of disability, death and despair across the globe. According to the World Health Organization (WHO), this is especially so in low- and middle-income countries where over 31 million, or three-quarters of all NCD deaths occur. More local to this author’s jurisdiction, NCDs account for 80% of the disease burden in the European Union (EU) and are the leading causes of avoidable premature death. This is indeed a startling figure and represents a significant socioeconomic and personal cost in terms of reduced years of life and life in years. But more than simply startling, the sad fact is that many of these deaths are avoidable, or at the very least potentially preventable. The chronic nature of most NCDs means there is ample opportunity over perhaps many years for intervention, amelioration, stabilisation and possible recovery. Certainly, reducing the burden of NCDs requires a holistic and whole system approach including activities that promote health and prevent disease, which can, according to the EU, account for a reduction of up to 70%.
This paper examines the validity and reliability of the Indonesian version of the Diabetes Mellitus Self-Efficacy Scale (DMSES-I). Setting the context for the study, the authors note the increasing prevalence of Type II Diabetes Mellitus (T2DM) in Indonesia and its establishment as the third leading cause of death in this jurisdiction. They contend that while nurses are well placed to offer self-management education to patients with T2DM, a pre-requisite for successful self-management education is determining the patients’ level of self-efficacy. However, currently there is no reliable and rigorous tool in Indonesia to do this.
Using a cross-sectional design, the authors recruited two groups of volunteers from two private hospitals to, respectively, pre-test and pilot (n = 36), and psychometrically test (n = 227) the adapted DMSES scale (Van Der Bijl et al., 1999). Noting that the DMSES is already adapted to other countries with good internal consistency, the authors describe a rigorous process of forward–backward translation based on the guidelines of Beaton et al. (2000), review by an interdisciplinary expert panel, pre-testing and finally psychometric testing of the scale. The inclusion of an interdisciplinary panel comprising specialist endocrinologists, experienced nurses, suitably qualified educators, nutritionists and linguists is particularly commendable and reflective of the holistic and whole system approach needed to best treat this condition.
The authors employed both the item-content and scale-content validity indexes to determine validity of content, and both exploratory and confirmatory factor analyses to determine validity of construct. The final three factor 14-item scale (which differs from the original four factor 20-item scale) was found to have a Cronbach’s alpha of 0.928. One caveat to the overall reliability and validity of the DMSES-I, however, is a limitation recognised by the authors themselves – the fact that the scale was developed using responses gained solely from patients of private hospitals. It is possible that these respondents have access to better healthcare and economic resources, have better social support structures and have higher self-efficacy than those who cannot afford private healthcare. Further validation of the scale will be required through broader sampling strategies that better reflect the target population, as acknowledged by the authors.
Nurses, as the first and sometimes only healthcare professional that patients encounter (World Health Organization, 2020) are well positioned to educate and empower patients as active partners in healthcare (Bulto and Hendriks, 2024). Indonesia has invested in its nursing workforce over the last three decades, bringing the number of nurses from 6.24 per 10,000 in 1992 (third lowest of 41 countries) to 41.73 per 10,000 in 2022 or 40th of 60 countries (https://www.who.int/data/gho/data/themes/topics/health-workforce). But more than mere numbers, we also need to enable nurses to work to the top of their license (WHO, 2020). Certainly, before we can empower others, we must empower ourselves. Low-cost solutions include providing nurses with valid and reliable tools to help them better assess, better educate and better care for the patients and populations they serve. The scale developed by these authors intends to do this, which will by extension help enhance a health model of care for patients with T2DM in Indonesia and ultimately contribute to the attainment of Sustainable Development Goal 3.4 (United Nations, 2016).