Development and validation of a questionnaire for assessing the characteristics of diet and physical activity in patients with type 2 diabetes

  1. Rubén Martín Payo 1
  2. Xana González Méndez
  3. Cristina Papín Cano
  4. Javier Suárez Alvarez 1
  1. 1 Universidad de Oviedo

    Universidad de Oviedo

    Oviedo, España



ISSN: 0214-9915

Year of publication: 2018

Volume: 30

Issue: 1

Pages: 116-122

Type: Article

More publications in: Psicothema


Background: The aim ofthis study was to explore the psychometric properties of the Motiva.Diaf-DM2 questionnaire, which assesses adherence to a healthy diet and physical activity in patients with Type 2 Diabetes (T2D). Method: Participants were 206 patients who attended primary care services, with a mean age of 69.63 years (SD = 11.05), with 39.3% of the participants being women. To assess the test-retest reliability of the measure, a random subsample (n = 40) of patients who had another appointment scheduled was selected to fi ll in the questionnaire once again two weeks after the initial administration. Results: The reliability of the scores was found to be appropriate both in terms of internal consistency (αfi rst factor = .756; αsecond factor = .821) and temporal stability (r fi rst factor = .604; r second factor = .638). The structure of the test is two-dimensional. The scores for the second dimension (adherence to physical activity) are in agreement with the scores for basic psychological needs (r physical activity = .281), resilience (r = .216), and glycated haemoglobin (r = -.182). Conclusions: The Motiva.Diaf-DM2 test was shown to have the appropriate relia-bility and validity to assess adherence to a healthy diet and physical activity in patients diagnosed with T2D.

Bibliographic References

  • American Diabetes Association (2014). Diagnosis and classification of diabetes mellitus. Diabetes Care, 40 (Suppl 1), S11-S24. doi: 10.2337/ dc14-S081
  • Bradshaw, B.G., Richardson, G.E., Kumpfer, K., Carlson, J., Stanchfi eld, J., Overall, J., et al. (2007). Determining the efficacy of a resiliency training approach in adults with T2D. The Diabetes Educator, 33(4), 650-659.
  • De Feo, P., & Schwarz, P. (2013). Is physical exercise a core therapeutical element for most patients with T2D? Diabetes Care, 36 (Suppl 2):S149S154. doi: 10.2337/dcS13-2024
  • Deci, E., & Ryan, R.M. (1985). The general Causality Orientations Scale: Self-Determination in personality. Journal of Research in Personality, 19(2), 109-134.
  • Deci, E.L., & Ryan, R.M. (2012). Self-determination theory in health care and its relations to motivational interviewing: A few comments. The International Journal of Behavioral Nutrition and Physical Activity, 9, 24. doi: 10.1186/1479-5868-9-24
  • Duncan, L.R., Hall, C.R., Wilson, P.M., & Jenny, O. (2010). Exercise motivation: A cross-sectional analysis examining its relationships with frequency, intensity, and duration of exercise. The International Journal of Behavioral Nutrition and Physical Activity, 7, 7. doi: 10.1186/1479-5868-7-7
  • Evert, A.B., Boucher, J.L., Cypress, M., Dunbar, S.A., Franz, M.J., MayerDavis, E.J., et al. (2014). Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care, 37 (Suppl. 1), S120-S143. doi: 10.2337/dc14-S120
  • Federación Española de Diabetes (2013). Tengo diabetes tipo 2 ¿Qué puedo hacer? [I have T2D. What can I do?]. Retrieved from http://
  • Fleming, S.E., Boyd, A., Ballejos, M., Kynast-Gales, S.A., Malemute, C.L., Armstrong Shultz, J., et al. (2013). Goal setting with T2D: A hermeneutic analysis of the experiences of diabetes educators. The Diabetes Educator, 39(6), 811-819. doi: 10.1177/0145721713504471
  • García, J.M., Cox, D., & Rice, D.J. (2017). Association of physiological and psychological health outcomes with physical activity and sedentary behavior in adults with T2D. BMJ Open Diabetes Research & Care, 5(1), e000306. doi: 10.1136/bmjdrc-2016-000306
  • Gourlan, M., Trouilloud, D., & Boiché, J. (2016). Motivational profiles for physical activity practice in adults with T2D: A self-determination theory perspective. Behavioral Medicine, 42(4), 227-237. doi: 10.1080/08964289.2014.1001810
  • Huang, X.L., Pan, J.H., Chen, D., Chen, J., Chen, F., & Hu, T.T. (2016). Efficacy of lifestyle interventions in patients with T2D: A systematic review and meta-analysis. European Journal of Internal Medicine, 27, 37-47. doi: 10.1016/j.ejim.2015.11.016
  • Hurkmans, E.J., Maes, S., de Gucht, V., Knittle, K., Peeters, A.J., Ronday, H.K., et al. (2010). Motivation as a determinant of physical activity in patients with rheumatoid arthritis. Arthritis Care & Research, 62(3), 371-377. doi: 10.1002/acr.20106
  • International Diabetes Federation (2015). IDF Diabetes Atlas 7TH Edition. Retrieved from
  • Juul, L., Maindal, H.T., Zoffmann, V., Frydenberg, M., & Sandbaek, A. (2011). A cluster randomised pragmatic trial applying Selfdetermination theory to T2D care in general practice. BMC Family Practice, 12, 130. doi: 10.1186/1471-2296-12-130
  • Koponen, A.M., Simonsen, N., Laamanen, R., & Suominen, S. (2015). Health-care climate, perceived self-care competence, and glycemic control among patients with T2D in primary care. Health Psychology Open, 2(1), 2055102915579778. doi: 10.1177/2055102915579778
  • Leblanc, V., Bégin, C., Hudon, A.M., Royer, M.M., Corneau, L., Dodin, S., et al. (2014). Gender differences in the long-term effects of a nutritional intervention program promoting the Mediterranean diet: Changes in dietary intakes, eating behaviors, anthropometric and metabolic variables. Nutrition Journal, 13, 107. doi: 10.1186/1475-2891-13-107
  • Limonero, J.T., Tomás-Sábado, J., Gómez-Romero, M.J., Mate-Méndez, J., Sinclair, V.G., Wallston, K.A., et al. (2014). Evidence for validity of the brief resilient coping scale in a young Spanish sample. The Spanish Journal of Psychology, 17, E34. doi: 10.1017/sjp.2014.35
  • Martín-Payo, R., Suárez-Álvarez, J., Amieva-Fernández, M.E., Duaso, M.J., & Álvarez-Gómez, E. (2016). Adherence to healthy diet and physical activity in clinical patients. Psicothema, 28(4), 457-464.
  • Miquelon, P., & Castonguay, A. (2016). Motives for participation in physical activity and observance of physical activity recommendations among adults with T2D. Canadian Journal of Diabetes, 40(5), 399405. doi: 10.1016/j.jcjd.2016.02.009
  • Millán-Reyes, M.J., Rioja-Vázquez, R., & Muñoz-Arias, S. (2015). Educación diabetológica y cuidados de enfermería en las personas con diabetes en el ámbito extrahospitalario [Diabetes education and nursing care for people with diabetes in the out-of-hospital setting]. Retrieved from uploads/2015/07/educacion-diabetes-enfermeria.pdf
  • Ng, J.Y., Ntoumanis, N., Thøgersen-Ntoumani, C., Deci, E.L., Ryan, R.M., Duda, J.L., et al. (2012). Self-determination theory applied to health contexts: A meta-analysis. Perspectives on Psychological Science, 7(4), 325-340. doi: 10.1177/1745691612447309
  • 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 T2D mellitus. Health Psychology, 30(6), 771-779. doi: 10.1037/a0024500
  • Pesantes, M.A., Lazo-Porras, M., Abu Dabrh, A.M., Avila-Ramírez, J.R., Caycho, M., Villamonte, G.Y., et al. (2015). Resilience in vulnerable populations with T2D mellitus and hypertension: A systematic review and meta-analysis. The Canadian Journal of Cardiology, 31(9), 11801188. doi: 10.1016/j.cjca.2015.06.003
  • Reusch, J.E., & Manson, J.E. (2017). Management of T2D in 2017: Getting to goal. JAMA, 317(10), 1015-1016. doi: 10.1001/jama.2017.0241
  • Ryan, R.M., & Deci, E.L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and wellbeing. The American Psychologist, 55, 68-78.
  • Ryan, R., Patrick, H., Deci, E., & Williams, G. (2008). Facilitating health behavior change and its maintenance: Interventions based on self-determination theory. The European Health Psychologist, 10, 2-5.
  • Shigaki, C., Kruse, R.L., Mehr, D., Sheldon, K.M., Bin, G.E., Moore, C., et al. (2010). Motivation and diabetes self-management. Chronic Illness, 6(3), 202-214. doi: 10.1177/1742395310375630
  • Sociedad Española de Endocrinología y Nutrición (2017). Diabetes y obesidad: más peligrosas juntas [Diabetes and obesity: More dangerous together]. Retrieved from apartados/700/folleto-diabetes.pdf
  • Soriguer, F., Goday, A., Bosch-Comas, A., Bordiú, E., Calle-Pascual, A., Carmena, R., et al. (2012). Prevalence of diabetes mellitus and impaired glucose regulation in Spain: The Study. Diabetologia, 55(1), 88-93. doi: 10.1007/s00125-011-2336-9
  • Teixeira, P.J., Carraça, E.V., Markland, D., Silva, M.N., & Ryan RM. (2012). Exercise, physical activity, and self-determination theory: A systematic review. The International Journal of Behavioral Nutrition and Physical Activity, 9, 78. doi: 10.1186/1479-5868-9-78
  • Timmerman, M.E., & Lorenzo-Seva, U. (2011). Dimensionality assessment of ordered polytomous items with parallel analysis. Psychological Methods, 16(2), 209-220. doi: 10.1037/a0023353
  • Umpierre, D., Ribeiro, P.A., Kramer, C.K., Leitao, C.B., Zucatti, A.T., Gross, J.L., et al. (2011). Physical activity advice only or structured exercise training and association with HbA1c levels in T2D: A systematic review and meta-analysis. JAMA, 305(17), 1790-1799. doi: 10.1001/jama.2011.576
  • Weman-Josefsson, K., Lindwall, M., & Ivarsson, A. (2015). Need satisfaction, motivational regulations and exercise: Moderation and mediation effects. The International Journal of Behavioral Nutrition and Physical Activity, 12, 67. doi: 10.1186/s12966-015-0226-0