Psychometric Properties of the Treatment Self-Regulation Questionnaire in Patients with Type II Diabetes
DOI:
https://doi.org/10.61838/kman.pdmd.3.3.14Keywords:
Treatment self, regulation, Type II Diabetes, Factor Structure, Reliability, ValidityAbstract
Background and Objective: The current research aimed to explore the psychometric properties of the Treatment Self-Regulation Questionnaire (TSRQ) in patients with type II diabetes.
Methods and Materials: The research adopted a developmental approach and fell within the scope of descriptive and test validation studies. The participants were type 2 diabetes patients from Mashhad, collected during the autumn of 2012. Two separate groups, one with 201 and another with 283 subjects, were assembled through convenience sampling. They were asked to fill out several instruments, including the TSRQ, Perceived Competence Scale (PCS), Subjective Vitality Scale (SVS), Satisfaction With Life Scale (SWLS), and Kessler's Psychological Distress Scale (K6). Data analysis was performed using exploratory and confirmatory factor analyses, as well as multiple regression and multivariate analysis of variance, with the aid of SPSS 27 and Amos 24.
Findings: Analysis revealed that the TSRQ is bifactorial, comprising autonomous and controlled regulation factors. The variance was 81.58% in medication adherence and glycemic control and 85.40% in dietary adherence and physical activity. Confirmatory factor analysis provided further validation of this structure. Reliability was confirmed through Cronbach's alpha and split-half reliability tests. Predictive validity was established for perceived competence, subjective vitality, life satisfaction, and psychological distress. No significant correlation was found between fasting blood sugar levels and the self-regulation dimensions of diabetes treatment (P<0.05). Additionally, significant variances in self-regulation were observed across variables such as duration of diabetes, gender, age, marital status, educational background, and employment status (P<0.01).
Conclusion: The TSRQ appears to possess robust psychometric qualities for patients with type 2 diabetes, making it a valuable tool for assessing and enhancing their self-management and regulatory capabilities.
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References
Abdollahi, F., Bikdeli, H., Zeabadi, S. M., Sepasi, R. R., Kalhor, R., & Motalebi, S. A. (2022). Predicting role of illness
perception in treatment self-regulation among patients with type 2 diabetes. Journal of Preventive Medicine and
Hygiene, 63(4), 604-610. https://doi.org/10.15167%2F2421-4248%2Fjpmh2022.63.4.2727
Allen, D. D., & Wilson, M. (2006). Introducing multidimensional item response modeling in health behavior and health
education research. Health Education Research, 21, 73-84. https://doi.org/10.1093/her/cyl086
Barzoui, M. (2023). Investigating the Effect of Health Education on Changing the Nutritional Awareness and Behaviors of
Elementary School Students in Lordegan City. Journal of Psychological Dynamics in Mood Disorders (PDMD), 2(1), 40
47. https://doi.org/10.22034/pdmd.2023.185626
Deci, E. L., & Ryan, R. M. (1985). Conceptualizations of intrinsic motivation and self-determination. In Intrinsic motivation
and self-determination in human behavior (pp. 11-40). Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-2271
7_2
Diener, E. D., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The satisfaction with life scale. Journal of personality
assessment, 49(1), 71-75. https://doi.org/10.1207/s15327752jpa4901_13
Hazrati‐Meimaneh, Z., Zamanian, H., Shalchi Oghli, S., Moradnejad, S., Karkehabadi, F., Pourabbasi, A., & Amini‐Tehrani,
M. (2022). Treatment self‐regulation questionnaire across three self‐care behaviours: An instrument validation study in
Iranian patients with type 2 diabetes mellitus. Nursing Open, 9(4), 2084-2094. https://doi.org/10.1002/nop2.1219
Ishii, K., Morita, K., & Sumita, H. (2022). Reliability and validity of the Japanese treatment self-regulation questionnaire for
Japanese workers. BMC Public Health, 22(1), 1892. https://doi.org/10.1186/s12889-022-14281-8
Jafarvand, E., Ataey, A., & Edalati, S. (2021). Epidemiology and Death Trends Due to Diabetes in Iran. The Horizon of Medical
Sciences, 27 (2), 198-213 (In Persian). http://dx.doi.org/10.32598/hms.27.2.2764.1
Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, S. L., ... & Zaslavsky, A. M. (2002). Short
screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological
medicine, 32(6), 959-976. https://doi.org/10.1017/S0033291702006074
Kessler, R. C., Green, J. G., Gruber, M. J., Sampson, N. A., Bromet, E., Cuitan, M., ... & Lara, C. (2010). Screening for serious
mental illness in the general population with the K6 screening scale: results from the WHO World Mental Health (WMH)
survey initiative. International journal of methods in psychiatric research, 19(S1), 4-22. https://doi.org/10.1002/mpr.310
Khajevandi, M., Kazemzadeh, Y., Ghorbani, S., Chahar Baghi, Z., & Mirzayan Shanjani, S. (2024). Meta-Analysis of the Effect
of Home-Based Aerobic Exercises on Some Psychological Indicators in Patients with Asthma. Journal of Psychological
Dynamics in Mood Disorders (PDMD), 3(2), 1-9. https://doi.org/10.22034/pdmd.2024.457282.1093
Khamseh, M. E., Sepanlou, S. G., Hashemi-Madani, N., Joukar, F., Mehrparvar, A. H., Faramarzi, E., ... & Malekzadeh, R.
(2021). Nationwide prevalence of diabetes and prediabetes and associated risk factors among Iranian adults: analysis of
data from PERSIAN cohort study. Diabetes Therapy, 12(11), 2921-2938. https://doi.org/10.1007/s13300-021-01152-5
Levesque, C. S., Williams, G. C., Elliot, D., Pickering, M. A., Bodenhamer, B., & Finley, P. J. (2007). Validating the theoretical
structure of the Treatment Self-Regulation Questionnaire (TSRQ) across three different health behaviors. Health education
research, 22(5), 691-702. https://doi.org/10.1093/her/cyl148
Lima, L., Bastos, C., Santos, C., Barroso, C., Rocha, A. L., Regufe, V., & Martins, T. (2020). Evaluation of the psychometric
properties of the Treatment Self-Regulation Questionnaire for chronic diseases. Revista de Enfermagem Referencia, 5(2),
1-7. https://doi.org/10.12707/riv19069
MacCallum, R. C., Widaman, K. F., Zhang, S., & Hong, S. (1999). Sample size in factor analysis. Psychological methods, 4(1),
84. https://psycnet.apa.org/doi/10.1037/1082-989X.4.1.84
Marentes-Castillo, M., Zamarripa, J., & Castillo, I. (2019). Validation of the grit scale and the treatment self-regulation
questionnaire (TSRQ) in the Mexican context. Revista Latinoamericana de Psicología, 51(1), 9-18.
https://doi.org/10.14349/rlp.2019.v51.n1.2
Martela, F., & Riekki, T. J. (2018). Autonomy, competence, relatedness, and beneficence: A multicultural comparison of the
four pathways to meaningful work. Frontiers in psychology, 9, 327587. https://doi.org/10.3389/fpsyg.2018.01157
Martin, H., van Wijngaarden, E., Seplaki, C. L., Stringer, J., Williams, G. C., & Dozier, A. M. (2022). Breastfeeding motivation
predicts infant feeding intention and outcomes: evaluation of a novel adaptation of the treatment self-regulation
questionnaire. Journal of Human Lactation, 38(2), 236-247. https://doi.org/10.1177/08903344211032128
Mata, J., Silva, M. N., Vieira, P. N., Carraça, E. V., Andrade, A. M., Coutinho, S. R., ... & Teixeira, P. J. (2011). Motivational
“spill-over” during weight control: Increased self-determination and exercise intrinsic motivation predict eating self
regulation. Sport, Exercise, and Performance Psychology, 1, 49-59. https://psycnet.apa.org/doi/10.1037/2157-3905.1.S.49
Matin, H., Sarbakhsh, P., & Shaghaghi, A. (2022). Psychometric analysis of the Treatment Self-Regulation Questionnaire
Persian (TSRQ-P) version: autonomous regulation appraisal among the Iranian type 2 diabetes patients.
https://doi.org/10.21203/rs.3.rs-2108615/v1
Meyers, L. S., Gamst, G., & Guarino, A. J. (2016). Applied multivariate research: Design and interpretation. Sage publications.
URL: https://uk.sagepub.com/en-gb/mst/applied-multivariate-research/book246895
Miežienė, B., Šinkariova, L., & Adomavičiūtė, E. (2015). The importance of perceived autonomy support for autonomous
motivation in type 1 diabetes behaviour self-regulation. Tarptautinis psychologists žurnalas biopsichosocialinis požiūris= International Journal of Psychology: a biopsychosocial approach. Kaunas: Vytauto Didžiojo universitetas, 2015, [Nr.]
17, 17, 57-78. https://doi.org/10.7220/2345-024x.17.4
Murray, C. J., Aravkin, A. Y., Zheng, P., Abbafati, C., Abbas, K. M., Abbasi-Kangevari, M., ... & Borzouei, S. (2020). Global
burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease
Study 2019. The Lancet, 396(10258), 1223-1249. https://doi.org/10.1016/S0140-6736(20)30752-2
Nouwen, A., Ford, T., Balan, A. T., Twisk, J., Ruggiero, L., & White, D. (2011). Longitudinal motivational predictors of dietary
self-care and diabetes control in adults with newly diagnosed type 2 diabetes mellitus. Health Psychology, 30(6), 771.
https://psycnet.apa.org/doi/10.1037/a0024500
Okati-Aliabad, H., Nazri-Panjaki, A., Mohammadi, M., Nejabat, E., & Ansari-Moghaddam, A. (2024). Determinants of
diabetes self-care activities in patients with type 2 diabetes based on self-determination theory. Acta Diabetologica, 61(3),
297-307. https://doi.org/10.1007/s00592-023-02186-w.
Richards, D. K., Morera, O. F., & Field, C. A. (2021). The psychometric properties of a version of the Treatment Self-Regulation
Questionnaire for assessing motivations for responsible drinking. Journal of American College Health, 69(7), 742-749.
https://doi.org/10.1080/07448481.2019.1706536
Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development,
and well-being. American psychologist, 55(1), 68. https://doi.org/10.1037//0003-066x.55.1.68
Ryan, R. M., & Deci, E. L. (2020). Intrinsic and extrinsic motivation from a self-determination theory perspective: Definitions,
theory, practices, and future directions. Contemporary educational psychology, 61, 101860.
https://doi.org/10.1016/j.cedpsych.2020.101860
Ryan, R. M., & Frederick, C. (1997). On energy, personality, and health: Subjective vitality as a dynamic reflection of well
being. Journal of personality, 65(3), 529-565. https://doi.org/10.1111/j.1467-6494.1997.tb00326.x
Ryan, R. M., Deci, E. L., Vansteenkiste, M., & Soenens, B. (2021). Building a science of motivated persons: Self-determination
theory’s empirical approach to human experience and the regulation of behavior. Motivation Science, 7(2), 97-110.
https://psycnet.apa.org/doi/10.1037/mot0000194
Ryan, R.M., & Connell, J.P. (1989). Perceived locus of causality and internalization: Examining reasons for acting in two
domains. Journal of Personality and Social Psychology, 57, 749-761. https://psycnet.apa.org/doi/10.1037/0022
3514.57.5.749
Saeedi, P., Petersohn, I., Salpea, P., Malanda, B., Karuranga, S., Unwin, N., ... & IDF Diabetes Atlas Committee. (2019). Global
and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International
Diabetes Federation Diabetes Atlas. Diabetes research and clinical practice, 157, 107843.
https://doi.org/10.1016/j.diabres.2019.107843
Sallay, V., Klinovszky, A., Csuka, S. I., Buzás, N., & Papp-Zipernovszky, O. (2021). Striving for autonomy in everyday diabetes
self-management—qualitative exploration via grounded theory approach. BMJ open, 11(12), e058885.
https://doi.org/10.1136/bmjopen-2021-058885
Samadieh, H., Kareshki, H., Aminyazdi, S. A., & Hejazi, E. (2024). Development and Validation of the Students' Sense of
Belonging to University Scale. Quarterly of Educational Measurement, 14(55), 38-71.
https://doi.org/10.22054/jem.2024.74464.3474
Samadieh, H., Kareshki, H., Amin Yazdi, S. A., & Hejazi, E. (2024). Motivational Antecedents of Students' Sense of Belonging
to University: The Role of Autonomy, Competence, Relatedness and Individual Interest. Education Strategies in Medical
Sciences, 17(1), 33-44. http://edcbmj.ir/article-1-2667-en.html
Sariçam, H. (2016). Examining the Relationship between Self-rumination and Happiness: The Mediating and Moderating Role
of Subjective Vitality. Universitas Psychologica, 15(2), 383-396. https://psycnet.apa.org/doi/10.11144/Javeriana.upsy15
2.errh
Shigaki, C., Kruse, R. L., Mehr, D., Sheldon, K. M., Ge, B., Moore, C., & Lemaster, J. (2010). Motivation and diabetes self
management. Chronic illness, 6(3), 202-214. https://doi.org/10.1177/1742395310375630
Stamp, K. D., Dunbar, S. B., Clark, P. C., Reilly, C. M., Gary, R. A., Higgins, M., & Ryan, R. M. (2016). Family partner
intervention influences self-care confidence and treatment self-regulation in patients with heart failure. European Journal
of Cardiovascular Nursing, 15(5), 317-327. https://doi.org/10.1177%2F1474515115572047
Tanhaye Reshvanloo, F., & Kimiaei, S. A. (2020). Construct Validity and Item-Response Characteristics of the Satisfaction
with Relationship Status Scale (ReSta). Journal of Modern Psychological Researches, 15(58), 140-156 (In Persian).
https://dorl.net/dor/20.1001.1.27173852.1399.15.58.9.9
Tanhaye Reshvanloo, F., Kareshki, H., Amani, M., Esfandyari, S., & Torkamani, M. (2020). Psychometric Properties of the
Kessler psychological distress scale (K6) based on classical test theory and Item-response theory. Razi Journal of Medical
Sciences, 26(11), 20-33 (In Persian). http://rjms.iums.ac.ir/article-1-5208-en.html
Tanhaye Reshvanloo, F., Keramati, R., Kareshki, H., & Torkamani, M. (2018). Factor Structure and Gender Invariance of
Subjective Vitality Scale in students. Journal of Applied Psychological Research, 9(3), 1-14 (In Persian).
https://doi.org/10.22059/japr.2018.69108
Tanhaye Reshvanloo, F., Samadieh, H., & Goli, B. (2024). Psychometric Properties of the Sense of Belonging Instrument
Among University Students: Testing the Theory of Human Relatedness. Social Psychology Research, 14(53), 17
32. https://10.22034/spr.2024.419090.1869
Vafaey Moghaddam, M., Haji Alizadeh, K., Zarei, E., & Amirfakhraei, A. (2024). Investigating the Structural Relationships
of Rumination with the Mediation of Body Image on the Anxiety of People with Bulimia Nervosa Disorder. Journal of
Psychological Dynamics in Mood Disorders (PDMD), 2(4), 10-20. https://doi.org/10.22034/pdmd.2024.444564.1050
Williams, G. C., & Deci, E. L. (1996). Internalization of biopsychosocial values by medical students: A test of self
determination theory. Journal of Personality and Social Psychology, 70(4), 767-779.
https://psycnet.apa.org/doi/10.1037/0022-3514.70.4.767
Williams, G. C., Cox, E. M., Kouides, R., & Deci, E. L. (1999). Presenting the facts about smoking to adolescents: effects of
an autonomy-supportive style. Archives of pediatrics & adolescent medicine, 153(9), 959-964.
https://doi.org/10.1001/archpedi.153.9.959
Williams, G. C., Freedman, Z. R., & Deci, E. L. (1998). Supporting autonomy to motivate patients with diabetes for glucose
control. Diabetes care, 21(10), 1644-1651. https://doi.org/10.2337/diacare.21.10.1644
Williams, G. C., Grow, V. M., Freedman, Z. R., Ryan, R. M., & Deci, E. L. (1996). Motivational predictors of weight loss and
weight-loss maintenance. Journal of personality and social psychology, 70(1), 115.
https://psycnet.apa.org/doi/10.1037/0022-3514.70.1.115
Wilson, P. M., Blanchard, C. M., Nehl, E., & Baker, F. (2006). Predicting physical activity and outcome expectations in cancer
survivors: an application of Self‐Determination Theory. Psycho‐Oncology: Journal of the Psychological, Social and
Behavioral Dimensions of Cancer, 15(7), 567-578. https://doi.org/10.1002/pon.990
Życińska, J., Januszek, M., Jurczyk, M., & Syska-Sumińska, J. (2012). How to measure motivation to change risk behaviors
from the self-determination perspective? The Polish adaptation of the Treatment Self-Regulation Questionnaire (TSRQ)
among patients with chronic diseases. Polish Psychological Bulletin, 4(43), 261-271. https://doi.org/10.2478/v10059-012-0029-y
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