Developing the Type 5 Diabetes Knowledge Scale for Assessing Community Knowledge in Rural Settings

Abstract

The International Diabetes Federation’s 2025 recognition of type 5 diabetes, a malnutrition-related form of diabetes, highlights the urgent need for validated tools to assess public knowledge in underserved settings. This study aimed to develop and validate the Type 5 Diabetes Knowledge Scale (T5DKS), a contextually appropriate instrument to measure awareness of type 5 diabetes among rural adults. A cross-sectional instrument development design, guided by COSMIN standards, was used. Item generation drew on literature review and expert input, producing a 15-item draft. Content validity was established by four experts and piloted in a separate rural sample. The main validation study involved 312 rural adults across three regions. Items were dichotomously scored (true/false, reverse-coded where appropriate) and summarized as percent correct. Exploratory factor analysis supported a three-factor structure: core clinical understanding, risk factors, and prevention and management. Five items were removed for low loadings or redundancy, yielding a 10-item scale. The final version showed strong internal consistency (Cronbach’s α = 0.84) and acceptable item–total correlations (0.45–0.63). Item performance ranged from 59% to 83% correct, suggesting generally adequate knowledge but highlighting misconceptions, particularly regarding differentiation from other diabetes types and epidemiology. The T5DKS was also linguistically validated in English and Bahasa Indonesia. The scale is brief, culturally adapted, and psychometrically sound, with utility for identifying knowledge gaps, guiding education, and supporting community health programs in low-resource settings. Future research should evaluate test–retest reliability, responsiveness, and cross-cultural applicability.