Introduction
The Diabetes Empowerment Scale-Short Form (DES-SF) is a critical tool for measuring diabetes-related psychosocial self-efficacy. Developed in 2003 by Anderson et al. and the Michigan Diabetes Research Center (MDRC) published it. The DES-SF assesses a patient’s confidence in managing their condition. Furthermore, its over 500 citations establish its influence in both clinical practice and research. The developers specifically designed the scale for adolescents (aged 12 and older) and adults with various types of diabetes, including Type 1, Type 2, and gestational diabetes. Consequently, it offers clinicians and researchers a streamlined method for evaluating the effectiveness of empowerment-based interventions.
This article provides a comprehensive overview of the DES-SF, detailing its features, scoring, applications, and psychometric properties.
Key Features of the Diabetes Empowerment Scale-Short Form (DES-SF)
Purpose and Use
The primary purpose of the DES-SF is to assess a patient’s confidence in key areas of diabetes management, including emotional coping, seeking support, and making informed self-care decisions. Furthermore, its unique strength lies in measuring psychosocial empowerment rather than just knowledge or skills, which makes it a powerful predictor of long-term self-care adherence.
Target Population
The DES-SF is validated for Patients with Type 1, Type 2, or gestational diabetes, including:
- Adolescents (13-17 years).
- Young Adults (18-24 years).
- Middle-Aged Adults (25-44 years).
- Older Adults (45-64 years).
- Seniors (65+ years).
Structure
Patients respond using a 5-point Likert scale. Crucially, the questionnaire is exceptionally brief, comprising just 8 items. Specifically, researchers selected each item because it has the highest correlation to one of the eight conceptual dimensions of the original, long-form scale. These dimensions cover:
- Assessing the need for change.
- Developing a plan.
- Overcoming barriers.
- Asking for support.
- Supporting oneself.
- Coping with emotion.
- Motivating oneself.
- Making appropriate diabetes care choices.
Scoring Method
The scoring process is straightforward and easy to implement.
- Response Scale: Responses are rated on a Likert scale from 1 (strongly disagree) to 5 (strongly agree).
- Overall Score Calculation: The total DES-SF score is calculated by summing the scores for all 8 items and then dividing by 8.
- Interpretation: Higher scores indicate a greater sense of diabetes-related empowerment. Importantly, there are no established clinical cut-off scores; the scale is primarily used to measure change over time.
Administration Format
The DES-SF offers excellent flexibility in its administration, as it can be completed via:
- Paper-based forms
- Digital (Online) platforms
- Interview (In-person)
- Phone/Video call
Because it is a self-administered tool, no specialized training is required for its implementation, also the entire questionnaire takes less than 5 minutes to complete, which makes it highly practical for busy settings.
Applications of the Diabetes Empowerment Scale
The DES-SF is a versatile instrument with wide-ranging applications in both clinical practice and academic research. Its primary uses include:
- Screening: Quickly identifying patients who may lack confidence in their ability to manage their diabetes.
- Monitoring: Tracking changes in patient empowerment over time, especially in response to educational or behavioral interventions.
- Treatment Planning: Helping clinicians tailor support and education plans to address specific areas where a patient feels less empowered.
- Research: Serving as a primary outcome measure in studies evaluating the effectiveness of diabetes self-management education and support (DSMES) programs.
Languages and Availability
The DES-SF is accessible to a global audience, with validated translations in many languages, including:
- English.
- Spanish.
- Portuguese.
- Turkish.
- Slovenian.
- And many others.
The questionnaire is freely available for non-commercial use. However, appropriate citation must be given to the authors.
Reliability and Validity
The DES-SF is a highly reliable and valid psychometric tool.
It demonstrates strong internal consistency, with a Cronbach’s alpha of 0.84, and good test-retest reliability, with an Intraclass Correlation Coefficient (ICC) ranging from 0.78 to 0.85.
In addition, the scale shows robust construct validity. For instance, it correlates with diabetes self-management behaviors (r = 0.63) and with HbA1c levels (r = −0.32), thus indicating that higher empowerment is associated with better self-care and glycemic control.
Limitations and Considerations
Despite its strengths, the DES-SF has a few limitations:
- Lack of Sensitivity to Change: The scale may not be sensitive enough to detect small but clinically meaningful changes in empowerment following some interventions.
- Self-report: Respondents may be influenced by social desirability bias or personal interpretation, which could potentially affect the accuracy of their responses.
- Cultural Bias: Although translated into several languages, cultural nuances may affect how questions are interpreted, which could impact validity across different populations.
Other Versions and Related Questionnaires
While the DES-SF is the most commonly used version, other adaptations exist:
- DES-28 (Long Form): The original 28-item scale from which the short form was derived.
- DES-SF-10: A 10-item variant that is rarely used.
Complementary Questionnaires
- Diabetes Self-Management Questionnaire (DSMQ): Measures the frequency and quality of self-care behaviors.
- Problem Areas in Diabetes (PAID) Scale: Assesses diabetes-related emotional distress.
Additional Resources
- A direct link to the Original Validation Study
- You can access the questionnaire as a PDF through this link.
- For inquiries, contact Shay Aboutawila at the University of Michigan via email.
- For additional DES-SF resources, consult the Michigan Diabetes Research Center website.
Frequently Asked Questions (FAQ)
- Who can use the DES-SF?
Clinicians, researchers, and healthcare providers use the DES-SF for patients aged 12 and older with Type 1, Type 2, or gestational diabetes. - How long does it take to complete the DES-SF?
Patients typically take less than 5 minutes to complete the DES-SF, which makes it highly feasible for use in clinical and research settings. - How is the DES-SF administered?
Healthcare teams can administer the questionnaire via paper, digital, or interview formats—offering excellent flexibility in usage. - Is there any cost to using the DES-SF?
The DES-SF is free for non-commercial use, as long as the developers are properly cited.
A Word from ResRef About Diabetes Empowerment Scale-Short Form (DES-SF)
The DES-SF unlocks critical insights into the psychological drivers of diabetes self-care, thereby making it an essential tool for clinicians and researchers aiming to transform patient outcomes beyond just HbA1c numbers. Moreover, its brevity and ease of use, combined with robust psychometric properties, allow for a quick yet powerful assessment of a patient’s confidence. Consequently, integrating the DES-SF into practice can lead to more personalized, effective, and empowering patient care.
References
- Anderson, R. M., Fitzgerald, J. T., Gruppen, L. D., Funnell, M. M., & Oh, M. S. (2003). The Diabetes Empowerment Scale-Short Form (DES-SF). Diabetes Care, 26(5), 1641–1642. Link.
- Maria Rui Sousa, Matilde Almeida, Helena Loureiro, Teresa Martins; Study of the Psychometric Properties of the Diabetes Empowerment Scale Short Form (DES-SF). Port J Public Health23 April 2020; 37 (2-3): 66–72. Link.
- Virtič Potočnik, T., Miroševič, Š., Mihevc, M., Zavrnik, Č., Lukančič, M. M., Poplas Susič, T., & Klemenc-Ketiš, Z. (2024). Psychometric properties of the Slovenian versions of the diabetes empowerment scale, long and short form, among the slovenian adults with type 2 diabetes. Primary Care Diabetes, 18(6), 660–668. Link.
