CC-SCODI (English)

Authored By

Davide Ausili, RN, MSc, PhD

Assistant Professor

Università degliStudi di Milano –Bicocca,

Via Cadore 48, Monza –Italy

Phone: +390264488032

Email: davide.ausili@unimib.it

Dr. Barbara Riegel, PhD, RN, FAHA, FAAN

Professor

University of Pennsylvania, School of Nursing
Claire M. Fagin Hall, 418 Curie Boulevard
Philadelphia, PA 19104-4217
briegel@nursing.upenn.edu
215-898-9927 Phone
240-282-7707 eFax
Co-Director, International Center for Self-Care Research www.selfcareresearch.org
Confidenal material subject to authorizaon for every use. Developed by Ausili D. and Fabrizi D., School of Medicine and Surgery, University of Milano-Bicocca. Useful contacts: davide.ausili@unimib.it ; dilea.fabrizi@unimib.it Caregiver Contribuon to Self-Care of Diabetes Index (CC-SCODI) Please think about what you did in the last month. SECTION A Below are listed some behaviors that a person with diabetes could perform to maintain health and wellness. How oſten do you recommend the following things to the person you care for? Or, how oſten do you do these acvies because the person you care for is not able to do them? (circle one number) NEVER ALWAYS 1. Maintain an acve lifestyle (e.g., walking, going out, doing acvies) 1 2 3 4 5 2. Perform physical exercise for 2 hours and 30 minutes each week (e.g., swimming, going to the gym, cycling, walking) 1 2 3 4 5 3. Eat a balanced diet of carbohydrates (e.g., pasta, rice, sugars, bread), proteins (e.g., meat, fish, legumes), fruits, and vegetables 1 2 3 4 5 4. Avoid eang salt and fats (e.g., cheese, cured meats, sweets, red meat) 1 2 3 4 5 5. Limit alcohol intake (no more than 1 glass of wine/day for women and 2 glasses/day for men) 1 2 3 4 5 6. Try to avoid geng sick (example: washing hands, geng recommended vaccinaons) 1 2 3 4 5 7. Avoid cigarees and tobacco smoke 1 2 3 4 5 8. Take care of feet (e.g., washing and drying the skin, applying moisture, using correct socks) 1 2 3 4 5 9. Maintain good oral hygiene (e.g., brushing teeth at least twice/day, using mouthwash, using dental floss) 1 2 3 4 5 10. Keep appointments with healthcare provider 1 2 3 4 5 11. Have health check-ups on me (e.g., blood tests, urine tests, ultrasounds, eye exams) 1 2 3 4 5 12. Many people have problems taking all their prescribed medicines. Take all medicines as prescribed to by the healthcare provider (please also consider insulin if prescribed) 1 2 3 4 5 1
Confidenal material subject to authorizaon for every use. Developed by Ausili D. and Fabrizi D., School of Medicine and Surgery, University of Milano-Bicocca. Useful contacts: davide.ausili@unimib.it ; dilea.fabrizi@unimib.it SECTION B Below are listed some behaviors that a person with diabetes could perform to monitor their diabetes. How oſten do you recommend the following things to the person you care for? Or, how oſten do you do these acvies because the person you care for is not able to do them? (circle one number) NEVER ALWAYS 13. Monitor blood sugar regularly 1 2 3 4 5 14. Monitor weight 1 2 3 4 5 15. Monitor blood pressure 1 2 3 4 5 16. Keep a record of blood sugars in a diary or notebook 1 2 3 4 5 17. Monitor the condion of feet daily to see if there are wounds, redness or blisters 1 2 3 4 5 18. Pay aenon to symptoms of high blood sugar (e.g., thirst, frequent urinaon) and low blood sugar (e.g., weakness, perspiraon, anxiety) 1 2 3 4 5 The last me the person you care for had symptoms: I DIDN’T RECOGNIZE SYMPTOMS NOT QUICKLY VERY QUICKLY 19. How quickly did you recognize that he/she was having symptoms? 0 1 2 3 4 5 20. How quickly did you know that the symptoms were due to diabetes? 0 1 2 3 4 5 2
Confidenal material subject to authorizaon for every use. Developed by Ausili D. and Fabrizi D., School of Medicine and Surgery, University of Milano-Bicocca. Useful contacts: davide.ausili@unimib.it ; dilea.fabrizi@unimib.it SECTION C Below are listed some behaviors that a person with diabetes could perform to improve their blood sugar when it’s too high or too low. How oſten do you recommend the following things to the person you care for? Or, how oſten do you do these acvies because the person you care for is not able to do them? (circle one number) NEVER ALWAYS 21. If symptoms (e.g., thirst, frequent urinaon, weakness, perspiraon, anxiety) occur, check blood sugar 1 2 3 4 5 22. If abnormal blood sugar levels occur, take notes about the events that could have caused it and acons he/she took 1 2 3 4 5 23. If abnormal blood sugar levels occur, ask a family member or friend for advice 1 2 3 4 5 24. If symptoms occur and blood sugar is low , eat or drink something with sugar to solve the problem 1 2 3 4 5 25. If blood sugar is high , adjust the diet to fix it 1 2 3 4 5 26. If blood sugar is high, adjust physical acvity to fix it 1 2 3 4 5 27. Aſter taking acons adjust an abnormal blood sugar level, to re-check blood sugar to assess if the acons were effecve 1 2 3 4 5 28. If blood sugar is very low or very high , call the healthcare provider for advice 1 2 3 4 5 Does the person you care for take insulin? Yes No If yes, please answer the following queson. 29. If blood sugar is too high or too low, adjust the insulin dosage in the way the healthcare provider suggested. 1 2 3 4 5 3
Confidenal material subject to authorizaon for every use. Developed by Ausili D. and Fabrizi D., School of Medicine and Surgery, University of Milano-Bicocca. Useful contacts: davide.ausili@unimib.it ; dilea.fabrizi@unimib.it SECTION D In reference to the person you care for, how much do you feel confident that you can recommend or do these acvies? (circle one number) NOT CONFIDENT AT ALL EXTREMELY CONFIDENT 30. Prevent high or low blood sugar levels and its symptoms 1 2 3 4 5 31. Follow advice about nutrion and physical acvity 1 2 3 4 5 32.. Take medicines in the appropriate way (including insulin if prescribed) 1 2 3 4 5 33. Persist in following the treatment plan even when it is difficult 1 2 3 4 5 34. Monitor blood sugar as oſten as the health care provider asked that it be done 1 2 3 4 5 35. Understand if blood sugar levels are good or not 1 2 3 4 5 36. Recognize the symptoms of low blood sugar 1 2 3 4 5 37. Persist in monitoring diabetes even when it is difficult 1 2 3 4 5 38. Take acon to adjust blood sugar and relieve symptoms 1 2 3 4 5 39. Evaluate if the implemented acons were effecve to change blood sugar and relieve symptoms 1 2 3 4 5 40. Persist in carrying out acons to improve blood sugar even when it is difficult 1 2 3 4 5 Thank you for compleng this survey! 4