Construction and validation of an educational tool on insulin therapy for adults with diabetes mellitus

Miranda, Luiz Henrique Diniz; Reis, Janice Sepúlveda; Oliveira, Suelen Rosa de

doi:10.1590/1413-81232023285.09502022EN

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FREE THEMES • Ciênc. saúde coletiva 28 (05) • May 2023 • https://doi.org/10.1590/1413-81232023285.09502022EN copy

Construction and validation of an educational tool on insulin therapy for adults with diabetes mellitus

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The insulin therapy used to treat Diabetes Mellitus (DM) lacks educational tools to assist self-care. Thus, we aimed to develop and validate an educational tool for the relationship between glycemic variation and insulin therapy for adults with type 1 and 2 DM. The study was developed in three stages: i) elaboration of the educational tool; ii) validation of content and display by a panel of judges; iii) pre-test with a target audience. Ten judges participated in the second stage, and 12 insulin-dependent adults with type 1 or 2 DM participated in the third stage. The Content Validity Index (CVI) was used to evaluate the adequacy of the material by the judges. The percentages of the agreement by item were calculated for validation by the target audience. The My Treatment Diary (MTD) educational tool was then developed. It obtained a mean CVI of 99.6% and a percentage of agreement of 99%. The results demonstrated that the content and display of the MTD tool were validated and culturally appropriate for the population of adults with type 1 and 2 DM.

Key words:
Self-care; Diabetes Mellitus; Validation Study; Insulin; Health Education

Page content	Page evaluation parameter	Page	Evaluators										CVI
Page content	Page evaluation parameter	Page	01	02	03	04	05	06	07	08	09	10
Cover and authors	Clarity\| text	02	4	4	4	4	4	4	4	4	4	4	1
Cover and authors	Relevance\|text	02	3	4	4	4	4	4	4	4	4	4	1
Opening text and guidance to educators	Clarity\|text	03	4	4	4	4	4	4	4	4	4	4	1
Opening text and guidance to educators	Relevance\|text	03	4	4	4	4	4	4	4	4	3	4	1
MTD kit presentation	Clarity\|text and image	04	4	4	3	4	4	4	4	4	4	4	1
MTD kit presentation	Relevance\|text and image	04	4	4	3	4	4	4	4	4	4	4	1
Image of the inner side of the leaflet (scales)	Clarity\|text and image	05	4	4	4	4	3	4	4	4	4	4	1
Image of the inner side of the leaflet (scales)	Relevance\|text and image	05	4	4	4	4	4	4	4	4	4	4	1
Identification of MTD subscales	Clarity\|text	06	4	3	4	4	4	4	4	4	4	4	1
Identification of MTD subscales	Relevance\|text	06	4	4	4	4	4	4	4	4	4	4	1
Identification of MTD scales	Clarity\|text	07	4	4	3	4	4	4	4	4	4	4	1
Identification of MTD scales	Relevance\|text	07	4	4	4	4	4	4	4	4	4	4	1
Illustrative therapeutic plan for the educator	Clarity\|text and image	08	4	4	4	4	4	4	4	4	4	4	1
Illustrative therapeutic plan for the educator	Relevance\|text and image	08	4	4	4	4	4	4	4	4	4	4	1
Inner side of the leaflet with the completed insulin therapy scales	Clarity\|text	09	4	4	4	4	4	4	4	4	4	4	1
	Relevance\|text	09	4	4	4	4	4	4	4	3	4	4	1
Illustrative food plan for educators	Clarity\|text and image	10	4	4	3	4	4	4	4	4	4	4	1
Illustrative food plan for educators	Relevance\|text and image	10	4	4	4	4	4	4	4	4	4	4	1
Inner side of the leaflet with the completed meal scale	Clarity\|text	11	4	4	3	4	4	4	4	3	4	4	1
Inner side of the leaflet with the completed meal scale	Relevance\|text	11	4	4	4	4	4	4	4	4	4	4	1
Description of the sticking technique of the MTD scales	Clarity\|image	12	4	3	4	4	4	4	4	3	4	4	1
Description of the sticking technique of the MTD scales	Relevance\|image	12	4	4	4	4	4	4	4	4	4	4	1
Image of self-adhesive label flyers	Clarity\|text and image	13	4	3	3	4	4	4	4	4	4	3	1
Image of self-adhesive label flyers	Relevance\|text and image	13	4	4	4	4	4	4	4	4	4	4	1
Criteria for using colors and illustrations of MTD stickers (insulin therapy)	Clarity\|text and image	14	4	4	3	4	4	4	4	2	4	3	0.9
	Relevance\|text and image	14	4	3	4	4	4	4	4	3	4	4	1
Criteria for using colors/illustrations on MTD stickers (meals)	Clarity\|text and image	15	4	4	4	4	4	4	4	4	4	4	1
	Relevance\|text and image	15	4	4	4	4	4	4	4	3	4	4	1
Basal insulin recording template	Clarity\|text and image	16	4	4	3	4	4	4	4	3	4	4	1
Basal insulin recording template	Relevance\|text and image	16	4	4	4	4	4	4	4	4	4	4	1
Meal log template	Clarity\|text and image	17	4	4	4	4	4	4	4	3	4	4	1
Meal log template	Relevance\|text and image	17	4	4	4	4	4	4	4	3	4	4	1
Insulinization log template for food boluses	Clarity\|text and image	18	4	4	4	4	4	4	4	4	4	4	1
Insulinization log template for food boluses	Relevance\|text and image	18	4	4	4	4	4	4	4	4	4	4	1
Inner side of the leaflet with the completed scales (insulin therapy and meals)	Clarity\|text	19	4	4	3	4	4	4	4	4	4	4	1
	Relevance\|text	19	4	4	4	4	4	4	4	4	4	3	1
Patient tool interpretation guidelines	Clarity\|text	20	4	3	4	4	4	4	4	4	4	4	1
Patient tool interpretation guidelines	Relevance\|text	20	4	3	4	4	4	4	4	4	4	4	1
Description of the content on the outer side of the leaflet	Clarity\|text and image	21	4	4	4	4	4	4	4	3	3	4	1
Description of the content on the outer side of the leaflet	Relevance\|text and image	21	4	4	4	4	4	4	4	4	3	4	1
Image of the outer side of the leaflet	Clarity\|text and image	22	4	4	4	4	4	4	4	3	4	4	1
Image of the outer side of the leaflet	Relevance\|text and image	22	4	4	4	4	4	4	4	4	4	3	1
Chromatic modules for completing the meals’ scale	Clarity\|text and image	23	4	4	4	4	4	4	4	3	4	4	1
Chromatic modules for completing the meals’ scale	Relevance\|text and image	23	4	4	4	4	4	4	4	4	4	4	1
Chromatic modules for completing the basal insulin therapy scale	Clarity\|text and image	24	4	4	4	4	4	4	4	3	4	4	1
	Relevance\|text and image	24	4	4	4	4	4	4	4	4	4	4	1
Color modules for completing the insulin therapy scale for food boluses	Clarity\|text and image	25	4	4	4	4	4	4	4	3	4	4	1
	Relevance\|text and image	25	4	4	4	4	4	4	4	4	4	2	0.9
Mean CVI	Clarity												0.996
Mean CVI	Relevance												0.996

Variable		Frequency	%
Age (years)
	18-20	2	16.67
	21-44	7	58.33
	45-59	3	25.0
Sex
	Male	5	41.67
	Female	7	58.33
Marital status
	With a companion	7	58.33
	Without a companion	5	41.67
Schooling
	Incomplete Elementary School	2	16.67
	Incomplete High School	2	16.67
	Incomplete Higher Education	2	16.67
	Higher Education	6	50.0
Diabetes Mellitus Type
	DM1	7	58.33
	DM2	4	33.34
	Wolfram’s syndrome	1	8.33
Comorbidities and complications
	Cardiovascular complications	3	25
	Retinopathy	3	25
	Nephropathy	2	16.67
	Severe hypoglycemia	3	25
	Severe hyperglycemia	2	16.67
	Ketoacidosis	2	16.67

MTD items		Agreement*
Question 1: MTD general aspects		1
Questions 2 and 3: Understanding the yellow scale	Conceptual meaning	1
Questions 2 and 3: Understanding the yellow scale	Graphic meaning	1
Questions 4 and 5: Understanding the red scale	Conceptual meaning	1
Questions 4 and 5: Understanding the red scale	Graphic meaning	1
Questions 6 and 7: Understanding the blue scale	Conceptual meaning	0.9
Questions 6 and 7: Understanding the blue scale	Graphic meaning	1
Question 8: MTD relevance assessment		1
Question 9: MTD indication assessment		1
Total agreement percentage		0.99

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[1] Chief editors:

Romeu Gomes, Antônio Augusto Moura da Silva