Caregiver Contribution CC-SCODI – English

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

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Caregiver Contribution to Self-Care of Diabetes Inventory (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 often do you recommend the following things to the person you care for? (Or, how often do you do these activities because the person you care for is not able to do them?).

(circle one number)

		NEVER				ALWAYS
1.	Maintain an active life-style (example: walking, going out, doing activities)?	1	2	3	4	5
2.	Perform physical exercise for 2 hours and 30 minutes each week? (example: swimming, going to the gym, cycling, walking)	1	2	3	4	5
3.	Eat a balanced diet of carbohydrates (pasta, rice, sugars, bread), proteins (meat, fish, legumes), fruits and vegetables?	1	2	3	4	5
4.	Avoid eating salt and fats (example: 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 getting sick (example: wash your hands, get recommended vaccinations)?	1	2	3	4	5
7.	Avoid cigarettes and tobacco smoke?	1	2	3	4	5
8.	Take care of your feet (wash and dry the skin, apply moisture, use correct socks)?	1	2	3	4	5
9.	Maintain good oral hygiene (brush your teeth at least twice/day, use mouthwash, use dental floss)?	1	2	3	4	5
10.	Keep appointments with your health care provider?	1	2	3	4	5
11.	Have your health check-ups on time? (example: blood tests, urine tests, ultrasounds, eye exams)?	1	2	3	4	5
12.	Many people have problems taking all their prescribed medicines. Do you take all your medicines as prescribed (please also consider insulin if your doctor prescribed it for you)?	1	2	3	4	5

SECTION B

Below are some behaviors that a person with diabetes could practice to monitor their diabetes. How often do you recommend the following things to the person you care for? (Or, how often do you do these activities 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 condition of feet daily to see if there are wounds, redness or blisters?	1	2	3	4	5
18.	Pay attention to symptoms of high blood sugar (thirst, frequent urination) and low blood sugar (weakness, perspiration, anxiety)?	1	2	3	4	5

The last time the person you care for had symptoms:

		I DIDN’T RECOGNIZE SYMPTOMS	NOT QUICKLY				VERY QUICKLY
19.	How quickly did you recognize that he or 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

SECTION C

Below are listed some behaviors a person with diabetes could do to improve their blood sugar when it’s too high or too low. How often do you recommend the following things to the person you care for? (Or, how often do you do these activities because the person you care for is not able to do them?).

(circle one number)

		NEVER				ALWAYS
21.	To check blood sugar when the person you care for feels symptoms (such as thirst, frequent urination, weakness, perspiration, anxiety).	1	2	3	4	5
22.	When the person you care for has abnormal blood sugar levels, to take notes about the events that could have caused it and actions he or she took.	1	2	3	4	5
23.	When the person you care for has abnormal blood sugar levels, to ask a family member or friend for advice.	1	2	3	4	5
24.	When the person you care for has symptoms and discovers that blood sugar is low, to eat or drink something with sugar to solve the problem.	1	2	3	4	5
25.	If the person you care for finds out that blood sugar is high, to adjust the diet to fix it.	1	2	3	4	5
26.	If the person you care for finds out that blood sugar is high, to adjust physical activity to fix it?	1	2	3	4	5
27.	After taking actions to adjust an abnormal blood sugar level, to re-check blood sugar to assess if the actions were effective.	1	2	3	4	5
28.	If the person you care for finds out that blood sugar is very low or very high, to call your health care provider for advice.	1	2	3	4	5

Does the person you care for take insulin?

Yes

If yes, please answer the following question.

29.

If the person you care for finds out that blood sugar is too high or too low, to adjust the insulin dosage in the way your health care provider suggested.

SECTION D

People with diabetes have to develop skills to take care of themselves and to maintain their health. In reference to the person you care for, in general, how confident are you that you can:

(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 nutrition and physical activity.	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’s difficult.	1	2	3	4	5
34.	Monitor his/her blood sugar as often as the health care provider asked that it be done.	1	2	3	4	5
35.	Understand if his/her 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 his/her diabetes even when it’s difficult.	1	2	3	4	5
38.	Take action to adjust his/her blood sugar and relieve his/her symptoms.	1	2	3	4	5
39.	Evaluate if your actions were effective to change his/her blood sugar and relieve his/her symptoms.	1	2	3	4	5
40.	Persist in carrying out actions to improve his/her blood sugar even when it’s difficult.	1	2	3	4	5

Thank you for completing this survey!