The purpose of the MEA-D is to assess a person’s experience with diabetes. This assessment may be useful for informing strategies to improve diabetes care. The evaluation of programs intended for people living with DM demands a reliable and valid measure of empowerment. We developed the MEA-D to address this need. It was validated in partnership with primary care clinicians and patients living with diabetes.
Background: Diabetes Mellitus (DM) is a prevalent chronic condition that poses a major burden for patients and the healthcare system. Evidence suggests that patient engagement in self-care improves DM control and reduces the risk of complications. According to Diabetes Canada, patient empowerment is an important factor in self-care and diabetes control. To provide effective interventions that help empower patients with diabetes, a comprehensive, valid and reliable measure of empowerment is needed. The present details the development of the McGill Empowerment Assessment – Diabetes (MEA-D), a questionnaire for measuring the empowerment of people living with diabetes, and its construct validation using a representative sample of Canadians living with DM.
Methods: The development and validation of the MEA-D questionnaire comprised three steps (item generation, face validity and factorial content validity). The first version was created by a group of expert clinicians and researchers. They generated items inductively and combined these with items from existing instruments identified in the scientific literature. They mapped these items to a conceptual framework (Zimmerman 1995, Christens 2002) with four domains: 1) Attitude, 2) Knowledge, 3) Behavior, and 4) Relatedness. Semi-structured interviews were conducted with 21 adults living with diabetes to assess the initial questionnaire’s face validity (i.e. the clarity, relevance, specificity and representativeness of the items). Using the responses, the wording of the questionnaire items was revised by a participatory research team (including clinicians, researchers and patient-partners), and redundant items were removed. Subsequently, factorial content validation was performed to determine the internal consistency of the MEA-D.
Results: The final version of the MEA-D contained 28 items. A sample of 300 Canadian people living with diabetes (type 1 or type 2) completed the MEA-D. A moderately good item-domain correlation was found between the individual items within the four domains. Cronbach’s Alpha was 0.81 (95% CI: 0.78 to 0.85) for Attitude; 0.73 (95% CI: 0.67 to 0.79) for Knowledge; 0.84 (95% CI: 0.81 to 0.87) for Behaviour; and 0.81 (95% CI: 0.77 to 0.84) for Relatedness.
Conclusions: The evaluation of programs intended for people living with DM demands a reliable and valid measure of empowerment. We developed the MEA-D to address this need. It was validated in partnership with primary care clinicians and patients living with diabetes. In addition to DM, the MEA-D may be adapted to measure patients’ empowerment regarding other chronic health conditions.