ANDIAB2 2010: Quality Assurance of Patient Practices and Diabetes Centre Care

Self Assessment of Health Status Form, Diabetes Distress Data Questionnaire

Page last updated: 16 May 2012

Self Assessment of Health Status

[1] Listed below are 2 potential problem areas that people with diabetes may experience. Consider the degree to which each of the 2 items may have distressed or bothered you DURING THE PAST MONTH and circle the appropriate number.

Please note that we are asking you to indicate the degree to which each item may be bothering you in your life, NOT whether the item is merely true for you. If you feel that a particular item is not a bother or a problem for you, you would circle "1". If it is very bothersome to you, you might circle "6".
Not a Problem
A Slight Problem
A Moderate Problem
Somewhat Serious Problem
A Serious Problem
A Very Serious Problem
1. Feeling overwhelmed by the demands of living with diabetes.
1
2
3
4
5
6
2. Feeling that I am often failing with my diabetes routine.
1
2
3
4
5
6
[2] We would like you to indicate on this scale, how good or bad your own health state is today, in your opinion. Please do this by drawing a line from the box on the right, to whichever point on the scale indicates how good or bad your health state is today.
This scale states how good or bad your own health state is, from 0 being 'Worst imaginable health state' and 100 being 'Best imaginable health state'

Name _________________________________________________________

Date __________________________________

DDS

DIRECTIONS: Living with diabetes can sometimes be tough. There may be many problems and hassles concerning diabetes and they can vary greatly in severity. Problems may range from minor hassles to major life difficulties. Listed below are 17 potential problem areas that people with diabetes may experience. Consider the degree to which each of the 17 items may have distressed or bothered you
DURING THE PAST MONTH and circle the appropriate number.

Please note that we are asking you to indicate the degree to which each item may be bothering you in your life, NOT whether the item is merely true for you. If you feel that a particular item is not a bother or a problem for you, you would circle "1". If it is very bothersome to you, you might circle "6".


Not a Problem
A Slight Problem
A Moderate problem
Somewhat Serious Problem
A Serious Problem
A Very Serious Problem
1. Feeling that my doctor doesn't
know enough about diabetes and
diabetes care.
1
2
3
4
5
6
2. Feeling that diabetes is taking
up too much of my mental and
physical energy every day.
1
2
3
4
5
6
3. Not feeling confident in my
day-to-day ability to manage
diabetes.
1
2
3
4
5
6
4. Feeling angry, scared and/or
depressed when I think about
living with diabetes.
1
2
3
4
5
6
5. Feeling that my doctor doesn't
give me clear enough directions on
how to manage my diabetes.
1
2
3
4
5
6
6. Feeling that I am not testing my
blood sugars frequently enough.
1
2
3
4
5
6
7. Feeling that I will end up with
serious long-term complications,
no matter what I do.
1
2
3
4
5
6
8. Feeling that I am often failing
with my diabetes routine.
1
2
3
4
5
6
9. Feeling that friends or family
are not supportive enough of
self-care efforts (e.g. planning
activities that conflict with my
schedule, encouraging me to
eat the "wrong" foods).
1
2
3
4
5
6
10. Feeling that diabetes controls
my life.
1
2
3
4
5
6
11. Feeling that my doctor doesn't
take my concerns seriously
enough.
1
2
3
4
5
6
12. Feeling that I am not sticking
closely enough to a good meal
plan.
1
2
3
4
5
6
13. Feeling that friends or family
don't appreciate how difficult
living with diabetes can be.
1
2
3
4
5
6
14. Feeling overwhelmed by the
demands of living with diabetes.
1
2
3
4
5
6
15. Feeling that I don't have a
doctor who I can see regularly
enough about my diabetes.
1
2
3
4
5
6
16. Not feeling motivated to keep
up my diabetes self management.
1
2
3
4
5
6
17. Feeling that friends or family
don't give me the emotional
support that I would like.
1
2
3
4
5
6

DDS17 SCORING SHEET

INSTRUCTIONS FOR SCORING:

The DDS17 yields a total diabetes distress scale score plus 4 sub scale scores, each addressing a different kind of distress. To score, simply sum the patient’s responses to the appropriate items and divide by the number of items in that scale. The letter in the far right margin corresponds to that item’s subscale as listed below. We consider a mean item score of 3 or higher (moderate distress) as a level of distress worthy of clinical attention. Place a check on the line to the far right if the mean item score is ≥ 3 to highlight an above-range value.

We also suggest reviewing the patient’s responses across all items, regardless of mean item scores. It may be helpful to inquire further or to begin a conversation about any single item scored 3 or higher.

Total DDS Score:

a. Sum of 17 item scores.
b. Divide by:
c. Mean item score:

______________
______17______
______________ ≥ 3 ____

A. Emotional Burden:

a. Sum of 5 items (2, 4, 7, 10, 14)
b. Divide by:
c. Mean item score:

_______________
_______5_______
_______________ ≥ 3 ____

B. Physician Distress:

a. Sum of 4 items (1, 5, 11, 15)
b. Divide by:
c. Mean item score:

______________
_______4______
______________ ≥ 3 ____

C. Regimen Distress:

a. Sum of 5 items (6, 8, 3, 12, 16)
b. Divide by:
c. Mean item score:

______________
_______5______
______________ ≥ 3 ____

D. Interpersonal Distress:

a. Sum of 3 items (9, 13, 17)
b. Divide by:
c. Mean item score:

______________
_______3______
______________ ≥ 3 ____

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