title: Development of a health status measure for older African-American women with type 2 diabetes.
abstract: OBJECTIVE
  To develop a health status measure in older African-American women with type 2 diabetes.
  
  
  METHODS
  African-American women, age > or =40 years with type 2 diabetes, were recruited from central North Carolina to participate in three sequential phases: 1) Seven focus groups were convened and transcripts evaluated to generate questions and identify plausible domains; 2) Ten one-on-one cognitive response interviews were performed to ensure clarity and cultural appropriateness of the questions; and 3) 217 women participated in psychometric evaluation to establish the internal consistency and validity of the instrument.
  
  
  RESULTS
  Three broad categories--mental, physical, and social well-being--captured important issues generated during the focus groups. "My diabetes" was added during the cognitive response interviews as a way of separating the impact of diabetes from coexisting issues that affect health status. The response option was changed from a six- to a four-point Likert scale to accommodate subject preference. Using principal components and subsequent promax rotation, we identified two hierarchical domains (mental and social well-being) and a physical symptom index. The internal consistency (Cronbach's alpha) of the mental and social well-being subscales are 0.83 and 0.93, respectively. A priori hypothesized correlations between subscales along with each subscale and glycated hemoglobin, diabetes duration, physical activity, and a perceived health competence scale helped establish the construct validity of the instrument.
  
  
  CONCLUSIONS
  A culturally appropriate disease-specific health status measure for older African-American women with type 2 diabetes has been developed. We have established the internal consistency, construct validity, and factor analytic properties of the measure. This measure should prove useful for investigators who seek a health status instrument that addresses issues germane to African-American women with type 2 diabetes.
authors.affiliation: School of Medicine, Vanderbilt University, Nashville, Tennessee, USA. tom.elasy@mcmail.vanderbilt.edu
authors.forename: T A
authors.initials: TA
authors.lastname: Elasy
authors.forename: C D
authors.initials: CD
authors.lastname: Samuel-Hodge
authors.forename: R F
authors.initials: RF
authors.lastname: DeVellis
authors.forename: A H
authors.initials: AH
authors.lastname: Skelly
authors.forename: A S
authors.initials: AS
authors.lastname: Ammerman
authors.forename: T C
authors.initials: TC
authors.lastname: Keyserling
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D001294:Attitude to Health; D044383:Black People; D003071:Cognition; D003151:Community Health Centers; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology* / Q000523:psychology*; D005260:Female; D006304:Health Status; D006801:Humans; D008603:Mental Health; D008875:Middle Aged