{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T14:49:37Z","timestamp":1785854977298,"version":"3.56.0"},"reference-count":45,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Diabetes"],"abstract":"\n Background<\/jats:title>\n The management of type 2 diabetes mellitus (T2DM) includes mastery of complex care activities, self-management skills, and routine health care encounters to optimize glucose control and achieve good health. Given the lifelong course of T2DM, patients are faced with navigating complex medical and disease-specific information. This health-seeking behavior is a driver of health disparities and is associated with hospitalization and readmission. Given that health-seeking behavior is a potentially intervenable social determinant of health, a better understanding of how people navigate these complex systems is warranted.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To address this need, we aimed to develop new patient-reported outcome (PRO) measures that evaluate health-seeking behavior in persons with T2DM. These new PROs were designed to be included in the Re-Engineered Discharge for Diabetes-Computer Adaptive Test (REDD-CAT) measurement system, which includes several other PROs that capture the importance of social determinants of health.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Overall, 225 participants with T2DM completed 56 self-report items that examined health-seeking behaviors. Classical Test Theory and Item Response Theory were used for measurement development. Exploratory factor analysis (EFA; criterion ratio of eigenvalue 1 to eigenvalue 2 being >4; variance for eigenvalue 1 \u226540%) and confirmatory factor analysis (CFA; criterion 1-factor CFA loading <.50; 1-factor CFA residual correlation >.20; comparative fit index \u22650.90; Tucker-Lewis index \u22650.90; root mean square error of approximation <0.15) were used to determine unidimensional sets of items. Items with sparse responses, low-adjusted total score correlations, nonmonotonicity, low factor loading, and high residual correlations of high error modification indices were candidates for exclusion. A constrained graded response model was used to examine item misfit, and differential item functioning was examined to identify item bias. Cronbach \u03b1 was used to examine internal consistency reliability for the new PROs (criterion \u22650.70), and floor and ceiling effects were examined (criterion \u226420%).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Four unidimensional sets of items were supported by EFA (all EFA eigenvalue ratios >4; variance for eigenvalue 1=41.4%-67.3%) and CFA (fit statistics all exceeded criterion values). This included (1) \u201cHealth-Seeking Behavior: PCP-Specific\u201d (6 items); (2) \u201cHealth-Seeking Behavior: General Beliefs\u201d (13 items); (3) \u201cHealth-Seeking Behavior: Family or Friends-Specific\u201d (5 items); and (4) \u201cHealth-Seeking Behavior: Internet-Specific\u201d (4 items). All items were devoid of differential item functioning for age, sex, education, or socioeconomic status factors. \u201cHealth-Seeking Behavior: General Beliefs\u201d was developed to include both a computer adaptive test and a 6-item short form version; all other PROs were developed as static short forms. The psychometric reliability of these new PROs was supported; internal consistency ranged from acceptable to excellent (Cronbach \u03b1=.78-.91), and measures were free of significant floor or ceiling effects (floor effects range: 0%-8.9%; ceiling effects range: 0%-8.4%).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The new REDD-CAT Health-Seeking Behavior PROs provide reliable assessments of health-seeking behaviors among those with T2DM.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/63434","type":"journal-article","created":{"date-parts":[[2024,11,22]],"date-time":"2024-11-22T11:31:29Z","timestamp":1732275089000},"page":"e63434","source":"Crossref","is-referenced-by-count":1,"title":["Four New Patient-Reported Outcome Measures Examining Health-Seeking Behavior in Persons With Type 2 Diabetes Mellitus (REDD-CAT): Instrument Development Study"],"prefix":"10.2196","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5618-7383","authenticated-orcid":false,"given":"Suzanne E","family":"Mitchell","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4814-1107","authenticated-orcid":false,"given":"Michael A","family":"Kallen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1183-8330","authenticated-orcid":false,"given":"Jonathan P","family":"Troost","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0012-8413","authenticated-orcid":false,"given":"Barbara A","family":"De La 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A","family":"Miner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6497-2437","authenticated-orcid":false,"given":"Brian W","family":"Jack","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0439-9429","authenticated-orcid":false,"given":"Noelle E","family":"Carlozzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2024,11,22]]},"reference":[{"key":"ref1","unstructured":"National Diabetes Statistics ReportCenters for Disease Control and 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