Patient Self-Efficacy for Diabetes Questions Now I am going to ask you some questions about how confident you feel about doing certain activities. Can you please pull out the ORANGE sheet from your packet. For each of the following questions, please choose the number that corresponds to your confidence that you can do the tasks regularly at the present time from the orange sheet. Okay, are you ready? (Circle the patient’s responses) 25. How confident do you feel that you can eat your meals every 4 to 5 hours not at all | | | | | | | | | | totally every day, including breakfast every confident 1 2 3 4 5 6 7 8 9 10 confident day? 26. How confident do you feel that you can follow your diet when you have to not at all | | | | | | | | | | totally prepare or share food with other confident 1 2 3 4 5 6 7 8 9 10 confident people who do not have diabetes? 27. How confident do you feel that you can choose the appropriate to eat not at all | | | | | | | | | | totally when you are hungry (for example, confident 1 2 3 4 5 6 7 8 9 10 confident snacks)? 28. How confident do you feel that you can exercise 15 to 30 minutes, 4 to 5 times not at all | | | | | | | | | | totally a week? confident 1 2 3 4 5 6 7 8 9 10 confident 29. How confident do you feel that you can do something to prevent not at all | | | | | | | | | | totally your blood sugar level from confident 1 2 3 4 5 6 7 8 9 10 confident dropping when you exercise? 30. How confident do you feel that you know what to do when your blood not at all | | | | | | | | | | totally sugar level goes higher or lower than it confident 1 2 3 4 5 6 7 8 9 10 confident should be? 31. How confident do you feel that you can judge when the changes in your not at all | | | | | | | | | | totally illness mean you should visit the confident 1 2 3 4 5 6 7 8 9 10 confident doctor? 32. How confident do you feel that you can control your diabetes so that it does not at all | | | | | | | | | | totally not interfere with the things you want confident 1 2 3 4 5 6 7 8 9 10 confident to do?
Patient Self-Efficacy for Diabetes Questions Now I am going to ask you some questions about how confident you feel about doing certain activities. Can you please pull out the ORANGE sheet from your packet. For each of the following questions, please choose the number that corresponds to your confidence that you can do the tasks regularly at the present time from the orange sheet. Okay, are you ready? (Circle the patient’s responses) 25. How confident do you feel that you can eat your meals every 4 to 5 hours every day, including breakfast every day? not at all | | | | | | | | | | totally confident 1 2 3 4 5 6 7 8 9 10 confident 26. How confident do you feel that you can follow your diet when you have to prepare or share food with other people who do not have diabetes? not at all | | | | | | | | | | totally confident 1 2 3 4 5 6 7 8 9 10 confident 27. How confident do you feel that you can choose the appropriate to eat when you are hungry (for example, snacks)? not at all | | | | | | | | | | totally confident 1 2 3 4 5 6 7 8 9 10 confident 28. How confident do you feel that you can exercise 15 to 30 minutes, 4 to 5 times a week? not at all | | | | | | | | | | totally confident 1 2 3 4 5 6 7 8 9 10 confident 29. How confident do you feel that you can do something to prevent your blood sugar level from dropping when you exercise? not at all | | | | | | | | | | totally confident 1 2 3 4 5 6 7 8 9 10 confident 30. How confident do you feel that you know what to do when your blood sugar level goes higher or lower than it should be? not at all | | | | | | | | | | totally confident 1 2 3 4 5 6 7 8 9 10 confident 31. How confident do you feel that you can judge when the changes in your illness mean you should visit the doctor? not at all | | | | | | | | | | totally confident 1 2 3 4 5 6 7 8 9 10 confident 32. How confident do you feel that you can control your diabetes so that it does not interfere with the things you want to do? not at all | | | | | | | | | | totally confident 1 2 3 4 5 6 7 8 9 10 confident
ISLL_Patient_W2T1-Final-HC-Version_Questionnaire_ENGLISH-2bw9119.docx