InDiMa SIP Group

1. STAGE 1: TECHNICAL PSYCHOMETRIC CHARACTERISTICS OF THE ‘InDiMa’ COMMUNICATION SYSTEM (ICS)

 1.1 EXCELLENT DISTRIBUTIONAL AND DISCRIMINATION CHARACTERISTICS OF ICS

 

  • Each item’s frequency distribution was examined. All items showed adequate distributional characteristics (please see Appendix # from Hans Stam, InDiMa Service Center). Many items showed excellent characteristics of having full discrimination due to having good spread across the response options.
  • 9 items (35R1), 58, 64, 71R1), 81, 120, 125, 254) out of 158 items add little quality and have been removed in the final version in order to improve the internal consistency of the scales (see Table 1).
  • R = ‘Reverse’

 

 1.2 VERY GOOD INTERNAL CONSISTENCY SCORES FOR ICS: SCALE MEANS AND STANDARD DEVIATION

 

  • Below are the scales, their internal consistency reliability, what if any changes that could be made, the scale mean and standard deviation.
  • The Cronbach’s Alpha Scores are very good, ranging from Alpha = .71 up to .93.

 

 1.3 VERY GOOD INTERNAL CONSISTENCY SCORES FOR ‘I-D-E-A’

 

  • The four factors of the ‘I-D-E-A Interaction & Communication Styles’ (‘ICS’) – ‘Introspective, Driver, Expressive, Analytic’ – have been confirmed.
  • All four factors show a high internal consistency and reliability (Cronbach’s Alpha) from Alpha = .74 to Alpha .92:
    • ‘Social Initiative’: Alpha = .88 (Dimension I) and
    • ‘Social Style’: Alpha = .92 (Dimension II)

are of high relevance, since the ‘Interaction & Communication Styles’ (‘ICS’) are determined by these two dimensions.

1.4 MEASURING SCALES BY MEANS (OF SCALE SCORES) FOR INTERPRETATIONS

 

  • By using means instead of sums for the scales, interpretation can be made across scales with varying number of items.
  • In addition, using means increases the sample size because those patients who omit a few items can still receive meaningful scale scores. For example patients on average agree more with not coping with diabetes scale items than diabetes in the health care system scale items.

TABLE 1: PSYCHOMETRIC CHARACTERISTICS OF THE SCALES (n = 1000)

 

Scale # Items Cronbach’s

Alpha

Comments Mean (SD)
Experiences about Diabetes Treatment and Self-Care (13 – 28):

Mean from 1 (disagree) to 5 (agree)

Difficult living with diabetes and need for help 5 .82 All items needed 2.5 (1.0)
Diabetes in the health care system 6 .88 All items needed 1.9 (0.9)
Confidence in health care system 5 .73 All items needed 3.5 (0.8)
PSP: Psychological & Social Profile (29 – 93):

Mean from 1 (disagree) to 5 (agree)

I.1    Open and trusting communication 5 .85 All items needed 4.2 (0.8)
I.2    Successful coping with diabetes 5 .73 / .75 Alpha = .75 if remove 35R 4.0 (0.7)
I.3    Anxiety and need for support 5 .80 All items needed 2.7 (0.9)
I.4    Admit failures and talk about it 5 .82 All items needed 2.5 (0.9)
I.5    Positive motivation for self-management 5 .86 All items needed 4.2 (0.8)
I.6    Ability and energy to change 5 .78 Alpha = .88 if remove 58 3.8 (0.8)
I.7    Willingness to learn and cooperate with doctor and other HCP’s Team 5 .77 All items needed 3.9 (0.8)
I.8    Inner resistance against change, tipping points of patients 5 .70 / .71 Alpha = .71 if remove 64 2.1 (0.8)
I.9    Support needed to combine health and quality of life 5 .67 / .74 Alpha = .74 if remove 71R 3.6 (0.8)
I.10  Need for help and guidance 5 .80 All items needed 3.2 (0.9)
II.1   Social condition (tipping point 7) 5 .64 / .70 Alpha = .70 if remove 81 3.2 (0.8)
II.2   No Support (tipping point 6) 5 .92 All items needed 2.1 (1.1)
II.3   External pressure (tipping point 7) 5 .88 All items needed 2.0 (0.9)
‘I-D-E-A Interaction & Communication Styles’ (94 – 115):

Mean from 1 (not at all) to 7 (very much so)

Social Initiative (Dimension I) 7 .88 All items needed 4.7 (1.2)
Social Style (Dimension II) 7 .92 All items needed 5.3 (1.2)
Social Flexibility (Scale III) 4 .74 All items needed 4.8 (1.1)
Self-Steering (Scale IV) 4 .87 All items needed 5.0 (1.1)
Support and Guidance for Your Diabetes Care (116 – 127):

Mean from 1 (disagree) to 5 (agree)

Adequate coping with diabetes 4 .83 All items needed 3.3 (1.0)
Wish for clarity 4 .79 /.84 Alpha = .84 if remove 120 3.6 (0.9)
Need for support 4 .69 / .81 Alpha = .81 if remove 125 3.8 (0.7)
Satisfaction with Your Health Care Providers (222 – 229):

Mean from 1 (no) to 5 (yes)

Satisfaction with your HCP 8 .92 All items needed 4.0 (0.9)
Diabetes Self Management, Health, and Quality of Life (230 – 247)
Evaluation of your health and diabetes self-therapy: Mean = 0 (negative) – 10 (positive) 9 .92 All items needed 6.4 (2.0)
Your opinion on areas that need improvement: Mean = 0 (no need to improve) to 10 (great need to improve) 9 .93 All items needed 5.0 (2.4)
Individualized Support in Cooperation with my Doctor / Health Care Providers (248 – 254):

Mean from 0 (disagree) to 5 (agree)

Individualized support in cooperation with my HCP 7 .79 / .81 Alpha = .81 if remove 254 3.9 (0.7)

Next Action: 8 items (35R, 58, 64, 71R, 81, 120, 125, 254) will be removed in the final ICS-version.

One hundred and fifty eight items comprise 27 scales and 7 construct groupings. Of those 158 items, only 8 of them could be eliminated. For the purpose of the rest of the report, these 8 items will remain part of the scales as originally intended. No scale lacked sufficient internal consistency reliability to warrant the exclusion of items.

The factor analysis of the 27 scales resulted in 5 factors. The smallest factor (number 5) had the 4 ‘I-D-E-A’ communication style scales as the only loadings. These have been documented to function reliably as a set of scales.  These 4 scales were removed and the 23 scales were re-analyzed.

The factor analysis of the 23 scales resulted in 4 factors with ‘Eigenvalues’ (Eigenwerte) greater than 1.0, explaining 65% of the scale variance.

Factor scores for these four factors were generated and used in the stage 2 and 3 analyses. Below are the factor loadings. A possible interpretation for Factor I is ‘(Realistic) Self Evaluation and Coping with Diabetes’. Factor II represents the ‘Negative External Factors and Tipping Points’; Factor III represents ‘Accept Clarity and Guidance: Willingness to Learn’; and Factor IV represents ‘Adaptive Living with Diabetes Type II’. Negative loadings imply the reverse of the scale.

One hundred and fifty eight items comprise 27 scales and 7 construct groupings. Of those 158 items, only 8 of them could be eliminated. For the purpose of the rest of the report, these 8 items will remain part of the scales as originally intended. No scale lacked sufficient internal consistency reliability to warrant the exclusion of items.

The factor analysis of the 27 scales resulted in 5 factors. The smallest factor (number 5) had the 4 ‘I-D-E-A’ communication style scales as the only loadings. These have been documented to function reliably as a set of scales.  These 4 scales were removed and the 23 scales were re-analyzed.

The factor analysis of the 23 scales resulted in 4 factors with ‘Eigenvalues’ (Eigenwerte) greater than 1.0, explaining 65% of the scale variance.

Factor scores for these four factors were generated and used in the stage 2 and 3 analyses. Below are the factor loadings. A possible interpretation for Factor I is ‘(Realistic) Self Evaluation and Coping with Diabetes’. Factor II represents the ‘Negative External Factors and Tipping Points’; Factor III represents ‘Accept Clarity and Guidance: Willingness to Learn’; and Factor IV represents ‘Adaptive Living with Diabetes Type II’. Negative loadings imply the reverse of the scale.

1.5 HYPOTHETICAL CONCLUSION FOR THE ICS DEVELOPMENT (DR. MARTIN MUELLER-WOLF)

So, the final ICS version will consist of ICS Questionnaire

  • Part 1 (‘Personal Psychological Profile’ = ‘PPP’) and Part 2 (‘Social Environment Profile’ = ‘SEP’) with 150 items for Parts 1 and 2, comprising 23 scales and 4 factors.
  • Part 3 of the ICS Questionnaire is the ‘I-D-E-A’ Interaction & Communication Styles with 4 ‘Dimensions or ‘Scales’.

TABLE 2: FINAL ICS VERSION: (I) 150 ICS-items and (II) ‘I-D-E-A’ Interaction & Communication Styles (4scales)

 

PART 1and 2: 150 Items (23 Scales, 4 Factors) Scales ‘Personal and Social Profile’ (‘PSP’):

Part 1 (‘PPP’) and 2 (‘SEP’) of Questionnaire

6 scales

6 scales

6 scales

5 scales

Factor I:          ‘(Realistic) Self Evaluation and Coping with Diabetes’

( Persons Coping with Diabetes)

Factor II:        ‘Negative External Factors and Tipping Points’

( Obese Younger Type II Patients)

Factor III:       ‘Accept Clarity and Guidance: Willingness to Learn’

( Successful Persons with Diabetes)

Factor IV:       ‘Adaptive Living with Type II Diabetes’

( Senior Type II Patients)

Total: 23 scales 4 Factors explaining 65% of variance.
PART 3: ‘I-D-E-A’ Interaction & Communication Styles’ (ICS): Part 3 of Questionnaire (‘Introspective – Driver – Expressive – Amiable’) 1 Factor Scale
Scale I

Scale II

Scale III

Scale IV

Dimension I:    ‘Social Initiative’

Dimension II:  ‘Social Style’

Scale III:            ‘Social Flexibility’

Scale IV:            ‘Self-Steering’

 

‘Secondary’ Factors

The four factors of the Part I ‘Personal and Social Profile’ (PSP) as well as the one factor of Part II ‘have the quality of ‘basic’ or ‘Secondary Factors’, underlying the structure of ‘Primary Factors’.

Primary Factors and ’Scales’ / Dimensions

In psychological research for example, two dimensions have been well established:

  • ‘Dominance / Pro-Active’ vs. ‘Passivity / Observation / Reactive’: ‘Social Initiative’ in I-D-E-A / ICS;
  • ‘Introversion / Control / Reserved’ vs. ‘Extroversion / Intuition / Open’: ‘Social Style’ in I-D-E-A / ICS.

So, also the other ‘scales’ or ‘dimensions’ could be considered to be the ‘Primary Factors’ for the underlying ‘Four Secondary Factors’ of Part 1 ‘PPP’ (‘Personal and Psychological Profile) and Part 2 ‘SEP’ (‘Social Environment Profile’).

FactorsPersonalSocialProfile

  • There are two ‘main factors’:

Factor I:      ‘(Realistic) Self Evaluation and Coping with Diabetes’ indicating ‘Persons Coping with Diabetes’ and

Factor II:    ‘Negative External Factors and Tipping Points’ indicating ‘Obese Younger Type II Patients’, often in a phase of ‘denial’.

  • Factor III: ‘Accept Clarity and Guidance: Willingness to Learn’ is a personality related ‘didactic’ factor for the acquisition of knowledge and guidance.
  • Factor IV: ‘Adaptive Living with Diabetes Type II’ is related to an ‘adaptive lifestyle’ of apparently ‘Senior Type II PwD’s’, not changing their habits and satisfied with the doctor’s treatment.

TABLE 4: FACTOR LOADINGS FOR 27 SCALES (23 ICS Scales plus 4 Scales of ‘I-D-E-A’)

Scale Factor I Factor II Factor III Factor IV
 

(I) (REALISTIC) SELF EVALUATION AND COPING WITH DIABETES

 

Evaluation of your health and diabetes self-therapy: .74
Adequate coping with diabetes .71
I.6    Ability and energy to change .66
Your opinion on areas that need improvement -.64
I.9    Support needed  to combine health and quality of life .63
I.5    Positive motivation for self-management .58
 

(II) NEGATIVE EXTERNAL FACTORS AND ‘TIPPING POINTS’

 

II.3   External pressure (tipping point 7) .79
I.8    Inner resistance against change, tipping points of patients .78
II.2   No support (tipping point 6) .67
Diabetes in the health care system .64
I.4    Admit failures and talk about it .56
II.1   Social conditioning (tipping point 7) .55
 

(III) ACCEPT CLARITY AND GUIDANCE: WILLINGNESS TO LEARN

 

I.7    Willingness to learn and cooperate with HCP’s Team .82
I.10  Need for help and guidance .77
Wish for clarity .77
Need for support .73
Individualized support in cooperation with my HCP .63
I.3    Anxiety and need for support .55
 

(IV) ADAPTIVE LIVING WITH DIABETES TYPE II

 

Confidence with the health care system .72
I.1    Open and trusting communication .71
Satisfaction with your HCP .70
Difficult living with diabetes and need for help -.55
I.2    Successful coping with diabetes .52