The 17-item DEKS-C, a modified Chinese instrument derived from the Turkish DEKS, showed high internal consistency and a provisional three-factor grouping (exercise benefits cognition, exercise implementation, exercise safety) in patients with T2DM, but because the factors were highly intercorrelated and the structure is unverified, the multidimensional model cannot be regarded as firmly established and independent multicenter confirmatory factor analysis is required.
Key Findings
Results
Adapting the Turkish DEKS into the Chinese DEKS-C required item consolidation, new items and a revised response format, yielding a 17-item instrument scored 1-4.
Content validation consolidated nine overlapping items into three and added three new items.
Three rounds of cognitive interviewing (n = 23) consolidated or relocated four items and merged one into the foot-care item.
The final instrument had 17 items with a total score range of 17-68.
The instrument is described as a modified, DEKS-derived instrument rather than a direct translation.
Results
The DEKS-C showed very high internal consistency.
Cronbach's α was 0.967.
Corrected item-total correlations ranged from 0.668 to 0.837.
The sample comprised 438 patients with T2DM at a tertiary hospital in Hangzhou, China (February-July 2025).
Results
The data were suitable for factor analysis.
The Kaiser-Meyer-Olkin measure was 0.965.
Bartlett's test gave χ2(136) = 6945.15, p < 0.001.
Exploratory factor analysis used principal axis factoring with oblimin rotation.
Results
Floor and ceiling effects were present and arose entirely from respondents giving uniform extreme responses.
Floor and ceiling effects were 13.47% and 8.90%.
These came entirely from 59 all-lowest-response and 39 all-highest-response respondents.
The all-lowest group answered faster than the all-highest group (median 89 vs. 232 s, p < 0.001).
Results
Horn's parallel analysis identified a three-factor structure corresponding to exercise benefits cognition, exercise implementation and exercise safety.
The three factors explained 55.73-71.23% of total variance (71.23% in the full sample).
The factors were substantially intercorrelated (|r| = 0.51-0.79).
An equivalent structure emerged when the three-factor solution was re-examined on a polychoric matrix.
Results
The factor solution is provisional because of a pattern coefficient exceeding unity and elevated inter-factor correlations.
One pattern coefficient exceeded unity.
Inter-factor correlations were elevated (0.51-0.79).
The grouping was broadly stable across sensitivity samples and alternative correlation matrices.
Conclusions
The multidimensional model cannot be regarded as firmly established and requires confirmatory testing.
The structure remains unverified.
Independent multicenter and multiregional confirmatory factor analysis is required.
Exercise knowledge is seldom evaluated as a standalone construct in China and no validated instrument for self-perceived mastery of exercise knowledge among T2DM patients previously existed.
What This Means
This study developed and began testing a Chinese questionnaire, the DEKS-C, that asks people with type 2 diabetes how well they feel they understand exercise as it relates to their condition. It was adapted from a Turkish scale, but changed enough (items merged, added and reworded, with a new response format) that it is better thought of as a new, related tool than as a simple translation. The final version has 17 items scored from 1 to 4. It was refined with expert review and interviews with 23 patients, then completed by 438 patients at a hospital in Hangzhou.
The questionnaire's items were highly consistent with one another, and the answers tended to group into three themes: the benefits of exercise, carrying out exercise, and exercise safety. However, these groups were strongly related to each other, and one statistical value was out of the expected range, so the three-part structure should be treated as tentative. In addition, some people gave the lowest or highest score on every item; those giving all-lowest answers finished much faster, which may hint at hurried responding.
This research suggests the DEKS-C is a promising starting point for measuring self-rated exercise knowledge in Chinese patients with type 2 diabetes, but it is not yet fully validated. The authors call for further testing in multiple centers and regions before the tool and its three-part structure are relied upon.
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Mei L, Pan H, Zhu K, Yin D, Yao H, Zhu M, et al.. (2026). Development and preliminary psychometric evaluation of a modified Chinese instrument for self-rated mastery of diabetes exercise knowledge (DEKS-C).. Frontiers in public health. https://doi.org/10.3389/fpubh.2026.1902317