Patient Interpretation of Neuropathy (PIN) questionnaire: an instrument for assessment of cognitive and emotional factors associated with foot self-care.
OBJECTIVE
Using the common-sense model of illness behavior, we developed and validated a self-report instrument for assessment of patients' cognitive and emotional representations of diabetic peripheral neuropathy (DPN) influencing foot self-care.


METHODS
The Patient Interpretation of Neuropathy (PIN) questionnaire, generated from discussions with clinicians and interviews with patients with DPN, was administered to patients with DPN attending U.K. (n = 325) and U.S. (n = 170) diabetes centers. Psychometric tests of the PIN questionnaire comprised factor analysis, internal consistency, and test-retest reliability. Partial correlations and multivariate regressions established construct and criterion-related validity. The associations of PIN scales to past foot ulceration and foot self-care behaviors were compared with those using a generic measure of illness perception and emotion, the Revised Illness Perception Questionnaire (IPQ-R), which was adapted to neuropathy.


RESULTS
Factor analysis of the PIN questionnaire produced 11 scales, which explained 69% of item variance. Nine factors measured patients' common-sense beliefs about DPN and their levels of understanding of DPN-related medical information. Two factors assessed the emotions of worry about potential consequences and anger at practitioners. Most scales demonstrated adequate internal (Cronbach's alpha = 0.62-0.90) and test-retest reliability (Pearson's r = 0.51-0.64). Partial correlations between the PIN and IPQ-R scales in corresponding domains were significant but modest (rp = 0.15-0.26). Finally, PIN scales showed significant associations with past foot ulceration and foot self-care behaviors, thereby confirming criterion validity.


CONCLUSIONS
The 39-item PIN questionnaire is a reliable and valid measure of patients' cognitive and emotional representations of neuropathy affecting foot self-care.
Vileikyte
Loretta
L
Department of Medicine, University of Manchester, Oxford Road, Manchester M13 WL9, U.K. lvileikyte@med.miami.edu
Gonzalez
Jeffrey S
JS
Leventhal
Howard
H
Peyrot
Mark F
MF
Rubin
Richard R
RR
Garrow
Adam
A
Ulbrecht
Jan S
JS
Cavanagh
Peter R
PR
Boulton
Andrew J M
AJ
D000368:Aged; D003071:Cognition; D003922:Diabetes Mellitus, Type 1 / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology; D017719:Diabetic Foot / Q000517:prevention & control; D003929:Diabetic Neuropathies / Q000523:psychology*; D004522:Educational Status; D004644:Emotions; D005260:Female; D005528:Foot; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D012648:Self Care; D011795:Surveys and Questionnaires