title: Time cost of diabetes: Development of a questionnaire to assess time spent on diabetes self-care.
abstract: Methods to measure patient time spent on health-related activities are currently not well elaborated or standardized.
  
  
  
  The purpose of this study was to develop a recall questionnaire measuring patient time devoted to diabetes self-care and to examine its feasibility and validity under field conditions.
  
  
  
  The initial questionnaire was developed on the basis of instruments frequently used to assess self-care behavior in patients with diabetes, evaluated in two focus groups with patients with type 2 diabetes (N=15) and tested in a random sample of patients with type 2 diabetes (N=178). To assess the validity of the questionnaire, four hypotheses about expected differences in self-care time across various patient sub-groups were tested.
  
  
  
  The final questionnaire includes thirteen items estimating time spent on regular diabetes-related activities undertaken in the previous seven days. 78% of respondents completed the questionnaire without item non-response or other evident problems. As hypothesized, respondents receiving insulin treatment, those with poor self-rated health and those with diabetes-related emotional distress (PAID-5 score ≥8) reported spending more time on diabetes self-care than the rest of the sample. Contrary to our assumption, no differences in time spent on diabetes self-care between employed and retired individuals were detected by the questionnaire.
  
  
  
  The recall questionnaire measuring patient time devoted to a broad range of regular diabetes self-care activities was developed and its feasibility was proved under field conditions. Ideally, the questionnaire should be further validated within a variety of populations. Exploration of the convergent validity between the recall method and prospective diary may be also useful.
authors.affiliation: Heinrich-Heine-University Düsseldorf, Faculty of Medicine, Institute of Health Services Research and Health Economics, Mooren Straße 5, 40225 Duesseldorf, Germany. Electronic address: Nadja.Chernyak@uni-duesseldorf.de.
authors.forename: Nadja
authors.initials: N
authors.lastname: Chernyak
authors.affiliation: Heinrich-Heine-University Düsseldorf, Faculty of Medicine, Institute of Health Services Research and Health Economics, Mooren Straße 5, 40225 Duesseldorf, Germany. Electronic address: fabian-juelich@gmx.de.
authors.forename: Fabian
authors.initials: F
authors.lastname: Jülich
authors.affiliation: Heinrich-Heine-University Düsseldorf, Faculty of Medicine, Institute of Health Services Research and Health Economics, Mooren Straße 5, 40225 Duesseldorf, Germany. Electronic address: juliakasperidus@gmx.de.
authors.forename: Julia
authors.initials: J
authors.lastname: Kasperidus
authors.affiliation: Heinrich-Heine-University Düsseldorf, Faculty of Medicine, Institute of Health Services Research and Health Economics, Mooren Straße 5, 40225 Duesseldorf, Germany. Electronic address: astrid.stephan@uni-duesseldorf.de.
authors.forename: Astrid
authors.initials: A
authors.lastname: Stephan
authors.affiliation: German Diabetes Center at the Heinrich-Heine-University Duesseldorf, Institute of Biometrics and Epidemiology, Auf'm Hennekamp 65, 40225 Duesseldorf, Germany. Electronic address: Alexander.Begun@ddz.uni-duesseldorf.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Begun
authors.affiliation: Leverkusen, Germany. Electronic address: m.kaltheuner@web.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Kaltheuner
authors.affiliation: Heinrich-Heine-University Düsseldorf, Faculty of Medicine, Institute of Health Services Research and Health Economics, Mooren Straße 5, 40225 Duesseldorf, Germany; German Diabetes Center at the Heinrich-Heine-University Duesseldorf, Institute of Biometrics and Epidemiology, Auf'm Hennekamp 65, 40225 Duesseldorf, Germany; German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, Düsseldorf, Germany. Electronic address: Andrea.Icks@uni-duesseldorf.de.
authors.forename: Andrea
authors.initials: A
authors.lastname: Icks
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D003131:Combined Modality Therapy; D017281:Cost of Illness; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D017144:Focus Groups; D005858:Germany; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D010349:Patient Compliance; D012107:Research Design; D012189:Retrospective Studies; D057566:Self Report; D000073278:Self-Management; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Diabetes; Patient time; Recall questionnaire; Self-care; Time measurement