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The Diabetes Self-management Assessment Report Tool (D-SMART®)

Process Evaluation and Patient Satisfaction

From the School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Charron-Prochownik); Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Zgibor, Mr Noullet); Sociology, Loyola College, Baltimore, Maryland (Dr Peyrot); American Association of Diabetes Educators, Chicago, Illinois (Ms Peeples); and the University of Pittsburgh Medical Center and Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (Ms McWilliams, Ms Koshinsky, Dr Siminerio).

Correspondence to Denise Charron-Prochownik, PhD, CPNP, Health Promotion & Development, School of Nursing, 440 Victoria Building, University of Pittsburgh, Pittsburgh, PA 15261 (dcpro{at}pitt.edu).

Purpose

The purpose of this article is to present the results of the process evaluation and patient experience in completing the Diabetes Self-management Assessment Report Tool (D-SMART®), an instrument within the AADE Outcome System to assist diabetes educators to assess, facilitate, and track behavior change in the provision of diabetes self-management education (DSME).

Methods

The D-SMART was integrated into computer and telephonic systems at 5 sites within the Pittsburgh Regional Initiative for Diabetes Education (PRIDE) network. Data were obtained from 290 patients with diabetes using the system at these programs via paper-and-pencil questionnaires following baseline D-SMART assessments and electronic system measurement of system performance. Process evaluation included time of completion, understanding content, usability of technology, and satisfaction with the system. Patients were 58% female and 85% Caucasian and had a mean age of 58 years. Fifty-six percent of patients had no more than a high school education, and 78% had Internet access at home.

Results

Most patients reported completing the D-SMART at home (78%), in 1 attempt (86%) via the Internet (55%), and in less than 30 minutes. Seventy-six percent believed the questions were easy to understand, and 80% did not need assistance. Age was negatively associated with ease of use. Moreover, 76% of patients believed the D-SMART helped them think about their diabetes, with 67% indicating that it gave the diabetes educator good information about themselves and their diabetes. Most (94%) were satisfied with the D-SMART. Level of satisfaction was independent of the system being used.

Conclusions

The D-SMART was easily completed at home in 1 attempt, content was understandable, and patients were generally satisfied with the wording of questions and selection of answers. The D-SMART is easy to use and enhanced communication between the patient and clinician; however, elderly patients may need more assistance. Computer-based and telephonic D-SMARTs appear to be feasible and useful assessment methods for diabetes educators.

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