Instrumentations
Acceptance of Illness Scale (AIS)
AIS was improved by Felton and Revenson [14]. The scale has 5-point
likert type and consist of 8 items. The 6th item of the scale is scored
inversely. The total point that is collected changes between 8-40. Low
scores indicate the lack of acceptance of the illness and high score
indicate presence of acceptance of the illness. The Cronbach’s α value
of the scale is 0.83, and it was found 0.70 in this study.
Problem Areas in Diabetes (PAID) Scale
The PAID Scale is designed to reduce the spread of emotional responses
to DM and to provide taking clinical and research screening measures in
DM and consists of 20 items [15]. The scale is a 5-point Likert type
and is scored between 0 (no problem) and 4 (serious problem). The scores
obtained from the scale are added up, multiplied by 1.25 and converted
into 0-100 points. High scores in the scale indicate emotional distress
[16]. The cut-off point was determined as ≥33 [17]. The
Cronbach’s α value of the scale is 0.95 [15], and it was found 0.87
in this study.
Beck Depression Scale (BDS)
BDS was developed by Beck et al. [18] to determine the level of
depression. The scale consists of 21 items. Depression-related behaviors
and symptoms are defined in sentences and these sentences are scored
between 0 and 3 using a 4-point likert type. Thus, each item consists of
sentences from 0-3, from mild to severe form. The total score on the
scale ranges from 0-63. The scale; 10-16 = mild, 17-29 = moderate, 30-63
= severe depression [19, 20]. In this study, Cronbach’s α value was
found 0.84.
SF-36
SF-36 is one of the most widely used general health measures in quality
of life studies with proven validity and reliability [21]. Designed
by Ware and Sherbourne [22] to be used in clinical practice and
research, health policy evaluations, and general population studies, the
SF-36 is a 36-item scale that evaluates eight health concepts. These
eight subcomponents; physical function (10 items), social functionality
(2 items), usual role difficulties due to physical health problems (4
items), role difficulties due to emotional problems (3 items), mental
health (5 items), energy/vitality (4 items) item), pain (2 items) and
general perception of health (5 items) [22]. The scale gives a
separate total score for each subcomponent, and the subcomponents
evaluate health between 0-100. It indicates poor health status as 0 and
good health status as 100, and it is understood that the quality of life
is good as the score increases. Also, physical function, physical role
difficulty, pain, and general health perception can be evaluated as
physical component summary (PCS); energy/vitality, social functionality,
emotional role difficulty, and mental health can be evaluated as mental
component summary (MCS) [23].
Healthy Eating Index-2010 (HEI-2010)
Food consumption was measured by 24-hour diet recall. Energy and
nutrient intake was calculated using the Computer Aided Nutrition
Program, Nutrition Information System (BeBiS) program [24]. All food
groups, energy and nutrient intakes were created from diet records using
this program.The HEI-2010 is a measure for assessing whether a range of
foods comply with the Dietary Guidelines for Americans (DGA). HEI-2010
consists of 12 items. The amounts for the points to be obtained from
these items are determined as maximum and minimum [25]. These 12
components are, respectively; total fruit, whole fruit, total
vegetables, dark green leafy vegetables and legumes, whole grains, dairy
group, total protein foods, seafood and vegetable proteins, fatty acids,
refined grains, sodium and empty energy sources (i.e. energy from fats,
alcohol and added sugars). The last 3 components are groups that should
be consumed in moderation, and lower intakes of these components result
in higher score intake. Thus, higher scores for all components reflect
better dietary quality [26]. In HEI-2010, component scores are added
up to obtain a total score [25]. In this scale, which scored between
0 and 100 in total, ≤50 was determined as ”bad diet”,
>50-≤80 as ”diet quality required to be improved” and
>80-100 as ”good diet” quality [26].