Terrence Steyer, M.D.
Chair, Department of Family Medicine
K. Meadows, N. Steen, E. McColl, M. Eccles, C. Shiels, J. Hewison, and A. Hutchinson (1996)
The DHP-1 was developed specifically for insulin-dependent diabetics (type 1) following in-depth interviews with patients, reviews of relevant literature, and discussions with health care professionals. Initially, a 43-item version was tested, but, after a factor analysis, 11 items with high cross-factor loading or low single factor loadings were dropped. Factor analysis of the resulting 32-item survey resulted in the identification of three subscales: Psychological Distress, Barriers to Activity, and Disinhibited Eating. The internal reliabilities of these subscales (as measured by Cronbach's alpha) were good (0.86, 0.82, and 0.77, respectively). Discriminant validity was assessed by comparing scores between men and women. Women younger than 40 scored significantly higher on the Psychological Distress subscale and women younger than 65 scored significantly higher on the Disinhibited Eating subscale. Convergent validity was measured by comparisons with individual dimensions of the Hospital Anxiety and Depression scale (HAD) and the SF-36. Strong correlations were found between these scales and the Psychological Distress and Barriers to Activity subscales.
The DHP-18 is a modified scale developed for use withn type 2 diabetics (Meadows et al. 2000). It was translated into Danish for a cross-cultural comparison. The 18 items in this scale remained after elimination of items from the DHP-1 deemed inappropriate for type 2 diabetics (e.g. insulin therapy questions) and items with low response rates for some answer categories. Factor analysis confirmed the identification of the same three subscales. Reliability of the three subscales remaind good (Cronbach's alpha 0.71 to 0.88). Discriminant validity was tested through the comparison of treatment type (insulin, tablet, or diet). In the UK population insulin-treated patients had significantly higher Psychological Distress and Barriers to Activity scores than other patients.
No assessment has been conducted specifically in elderly populations.
No assessment has been conducted specifically in minority populations, although a Danish translation (the DHP-18) has been tested.
No reports of subsequent studies using this measure have been published.
In a review of health outcome measures for diabetes Garratt et al. (2002) state that both of these instruments have good evidence for reliability, and internal and external construct validity. The three subscales measure psychosocial attributes not generally found in other scales. No validation studies with independent outcome measures (e.g. glycaemic control) have been performed. No test-retest validation studies have been performed.
Dr. Keith A. Meadows
Health and Survey Research Unit, The Applied Statistics Centre
University of Hull, Hull HU6 7RX, UK
Garratt, A.M., L. Schmidt, and R. Fitzpatrick (2002) Patient-assessed health outcome measures for diabetes: a structured review. Diabetic Med., 19, 1-11.
Meadows, K., N. Steen, E. McColl, M. Eccles, C. Shiels, J. Hewison, and A. Hutchinson (1996) The diabetes health profile (DHP): A new instrument for assessing the psychosocial profile of insulin requiring patients -- Development and psychometric evaluation. Qual. Life Res. 5, 242-254.
Meadows, K., S. Abrams, A. Sandback (2000) Adaptation of the Diabetes Health Profile (DHP-1) for use with patients with type 2 diabetes mellitus: psychometric evaluation and cross-cultural comparison. Diabet. Med. 17, 572-580.