Background
Material and methods
The problem areas in diabetes (PAID) questionnaire
Translation and cross-cultural adaptation
Psychometric evaluation and statistical analysis
Participants
Statistical analyses
Ethical approval
Results
Cultural adaptation
Characteristics of the sample of the psychometric evaluation
Gender, n (%) | |
Female | 181 (68.05) |
Male | 85 (31.95) |
Age, mean (SD), median (IQR) | 48 (10.92), 49 (40–57) |
Marital status, n (%) | |
Single | 25 (9.40) |
Married | 152 (57.14) |
Cohabitation | 44 (16.54) |
Divorced | 4 (1.50) |
Widowed | 36 (13.53) |
Other | 5 (1.88) |
Most usual living situation, n (%) | |
Lives alone | 6 (2.27) |
Has other people living with him/her | 258 (97.73) |
Number of people are living with him/her, mean (SD), median (IQR) | 4.97 (2.28), 5 (3–6) |
Area of residency, n (%) | |
Urban | 80 (30.30) |
Semiurban | 65 (24.62) |
Rural | 119 (45.08) |
Years of completed education, mean (SD), median (IQR) | 7.59 (3.45), 6 (6–9) |
Highest degree obtained, n (%) | |
No formal education | 18 (6.87) |
Primary school | 160 (61.07) |
Secondary school | 48 (18.32) |
University degree | 12 (4.58) |
Vocational school | 23 (8.78) |
Postgraduate studies | 1 (0.38) |
Employment status, n (%) | |
Unemployed | 121 (45.49) |
Employed | 138 (51.88) |
Retired | 7 (2.63) |
Abilities, mean (SD), median (IQR)a | |
Writing | 3.29 (0.66), 3 (3–4) |
Read and understand | 3.27 (0.67), 3 (3–4) |
Converse with other people and understand | 3.54 (0.54), 4 (3–4) |
Hear clearly | 3.59 (0.54), 4 (3–4) |
See things clearly | 3.12 (0.72), 3 (3–4) |
Do normal daily activities | 3.15 (0.76), 3 (3–4) |
Move about the community by himself/herself | 3.61 (0.56), 4 (3–4) |
Self-rated overall health, mean (SD), median (IQR)b | 3.27 (0.60), 3 (3–4) |
Types of diabetes, n (%) | |
Type I | 26 (9.92) |
Type II | 228 (87.02) |
Unknown | 8 (3.05) |
Years since diagnosis, mean (SD), median (IQR) | 5.83 (4.67), 5 (2–8) |
Construct validity (confirmatory factor analysis)
Model | χ2 | df | Relative χ2 | RMSEA (90% CI) | CFI | TLI | WRMR |
---|---|---|---|---|---|---|---|
One-factor (Original US) | 370.838 | 170 | 2.18 | 0.067 (0.058–0.076) | 0.928 | 0.919 | 1.085 |
Two-factor (Southern US) | 354.683 | 169 | 2.10 | 0.065 (0.055–0.074) | 0.933 | 0.925 | 1.054 |
Two-factor (Turkey) | 349.735 | 169 | 2.07 | 0.064 (0.054–0.073) | 0.935 | 0.927 | 1.041 |
Two-factor (Iceland) | 364.193 | 169 | 2.15 | 0.066 (0.057–0.076) | 0.930 | 0.921 | 1.074 |
Three-factor (Greece) | 327.065 | 167 | 1.96 | 0.060 (0.051–0.070) | 0.942 | 0.934 | 1.003 |
Four-factor (The Netherlands) | 307.809 | 164 | 1.88 | 0.058 (0.048–0.068) | 0.948 | 0.940 | 0.962 |
Four-factor (Spain) | 300.228 | 164 | 1.83 | 0.056 (0.046–0.066) | 0.951 | 0.943 | 0.946 |
Mean (SD), median (IQR) | Standardised loading a | S.E | R2 | |
---|---|---|---|---|
Emotional problems (CR = 0.875, Cronbach’s α = 0.85) | ||||
3. Feeling scared when you think about living with diabetes | 2.27 (1.40), 2 (1–4) | 0.709 | 0.037 | 0.503 |
6. Feeling depressed when you think about living with diabetes | 2.08 (1.45), 2 (1–3) | 0.762 | 0.028 | 0.581 |
7. Not knowing if your mood or feelings are related to your diabetes | 2.12 (1.23), 2 (1–3) | 0.481 | 0.047 | 0.231 |
8. Feeling overwhelmed by your diabetes | 2.39 (1.33), 2 (1–4) | 0.659 | 0.041 | 0.435 |
9. Worrying about low blood sugar reactions | 2.33 (1.34), 2 (1–4) | 0.451 | 0.047 | 0.204 |
10. Feeling angry when you think about living with diabetes | 1.44 (1.43), 1 (0–3) | 0.661 | 0.039 | 0.437 |
12. Worrying about the future and the possibility of serious complications | 3.11 (1.15), 4 (3–4) | 0.633 | 0.046 | 0.401 |
13. Feelings of guilt or anxiety when you get off track with your diabetes management | 2.31 (1.20), 3 (1–3) | 0.460 | 0.050 | 0.212 |
14. Not “accepting” your diabetes | 1.27 (1.33), 1 (0–2) | 0.556 | 0.047 | 0.309 |
16. Feeling that diabetes is taking up too much of your mental and physical energy every day | 2.16 (1.38), 2 (1–3) | 0.637 | 0.044 | 0.405 |
19. Coping with complications of diabetes | 2.26 (1.30), 2 (1–3) | 0.497 | 0.051 | 0.247 |
20. Feeling “burned out” by the constant effort needed to manage diabetes | 1.88 (1.43), 2 (1–3) | 0.737 | 0.032 | 0.544 |
Treatment problems (CR = 0.666, Cronbach’s α = 0.63) | ||||
1. Not having clear and concrete goals for your diabetes care | 1.99 (1.37), 2 (1–3) | 0.722 | 0.064 | 0.521 |
2. Feeling discouraged with your diabetes treatment plan | 1.71 (1.43), 2 (0–3) | 0.691 | 0.061 | 0.478 |
Food-related problems (CR = 0.602, Cronbach’s α = 0.54) | ||||
4. Uncomfortable social situations related to your diabetes care (e.g., people telling you what to eat) | 1.71 (1.31), 2 (1–3) | 0.556 | 0.049 | 0.309 |
5. Feelings of deprivation regarding food and meals | 2.01 (1.35), 2 (1–3) | 0.485 | 0.052 | 0.235 |
11. Feeling constantly concerned about food and eating | 2.38 (1.39), 3 (1–4) | 0.689 | 0.047 | 0.475 |
Social support problems (CR = 0.745, Cronbach’s α = 0.61) | ||||
15. Feeling unsatisfied with your diabetes physician | 0.54 (1.14), 0 (0–0) | 0.536 | 0.077 | 0.287 |
17. Feeling alone with your diabetes | 1.25 (1.36), 1 (0–2) | 0.838 | 0.044 | 0.702 |
18. Feeling that your friends and family are not supportive of your diabetes management efforts | 1.38 (1.46), 1 (0–3) | 0.718 | 0.045 | 0.516 |
Emotional problemsa (range 0–60) | Treatment problemsa (range 0–10) | Food-related problemsa (range 0–15) | Social support problemsa (range 0–15) | Total scorea (range 0–100) | |
---|---|---|---|---|---|
Gender | |||||
Female, median (IQR) | 32.5 (23.75–41.25) | 5 (2.5–7.5) | 7.5 (5–11.25) | 2.5 (1.25–7.5) | 47.5 (36.25–62.5) |
Male, median (IQR) | 31.25 (23.75–41.25) | 3.75 (2.5–6.25) | 7.5 (5–8.75) | 2.5 (1.25–6.25) | 47.5 (33.75–60) |
Mann–Whitney test | z = 0.227, p = 0.821 | z = 1.167, p = 0.244 | z = 0.630, p = 0.530 | z = 0.589, p = 0.557 | z = 0.737, p = 0.462 |
ES | r = 0.014 | r = 0.072 | r = 0.039 | r = 0.036 | r = 0.045 |
Age, Spearman’s correlation | rs = − 0.069 p = 0.263 | rs = 0.017 p = 0.780 | rs = 0.072 p = 0.244 | rs = − 0.075 p = 0.224 | rs = − 0.046 p = 0.451 |
Age | |||||
21–44 years, median (IQR) | 32.5 (25–42.5) | 3.75 (2.5–6.25) | 6.25 (5–10) | 3.75 (1.25–7.5) | 48.75 (36.25–61.25) |
45–54 years, median (IQR) | 31.25 (21.25–41.25) | 5 (1.25–6.25) | 8.75 (5–11.25) | 2.5 (0–5) | 47.5 (35–63.75) |
55–64 years, median (IQR) | 31.25 (23.75–41.25) | 5 (2.5–7.5) | 7.5 (5–11.25) | 2.5 (1.25–6.25) | 46.25 (33.75–60.625) |
Kruskal Wallis H | H(2) = 0.935, p = 0.627 | H(2) = 0.493, p = 0.782 | H(2) = 1.414, p = 0.493 | H(2) = 4.118, p = 0.128 | H(2) = 0.815, p = 0.665 |
Area of residency | |||||
Urban, median (IQR) | 29.375 (18.75–39.375) | 3.75 (1.25–6.25) | 6.25 (5–10) | 2.5 (0–6.875) | 45 (26.875–56.875) |
Rural or semi, median (IQR) | 32.5 (25–42.5) | 5 (2.5–7.5) | 7.5 (5–10) | 2.5 (1.25–6.25) | 49.375 (37.5–63.125) |
Mann–Whitney test | z = − 2.211, p = 0.027 | z = − 1.684 p = 0.092 | z = − 1.355, p = 0.176 | z = − 1.612, p = 0.107 | z = − 2.133, p = 0.033 |
ES | r = − 0.136 | r = − 0.104 | r = − 0.083 | r = − 0.099 | r = − 0.131 |
Years of completed education, Spearman’s correlation | rs = − 0.214 p = 0.001 | rs = − 0.203 p = 0.001 | rs = − 0.115 p = 0.061 | rs = − 0.214 p = 0.001 | rs = − 0.240 p < 0.001 |
Highest degree obtained | |||||
No formal education or primary school, median (IQR) | 33.75 (26.25–43.75) | 5 (2.5–7.5) | 7.5 (5–11.25) | 3.75 (1.25–7.5) | 51.25 (41.25–63.75) |
Secondary school, university, vocational school or postgraduate, median (IQR) | 26.875 (20–35.635) | 3.75 (1.25–6.25) | 7.5 (5–8.75) | 2.5 (0–5) | 41.25 (30–52.5) |
Mann–Whitney test | z = 3.777, p < 0.001 | z = 3.406, p = 0.001 | z = 1.635, p = 0.102 | z = 2.183, p = 0.029 | z = 3.818, p < 0.001 |
ES | r = 0.233 | r = 0.210 | r = 0.101 | r = 0.135 | r = 0.236 |
Self-rated overall health, Spearman’s correlation | rs = − 0.245 p < 0.001 | rs = − 0.078 p = 0.205 | rs = − 0.183 p = 0.003 | rs = − 0.306 p < 0.001 | rs = − 0.266 p < 0.001 |
Moderate, poor, very poor, median (IQR) | 33.75 (26.25–43.75) | 5 (2.5–6.25) | 7.5 (5–11.25) | 3.75 (1.25–7.5) | 52.5 (41.25–65_ |
Very good or good, median (IQR) | 27.5 (20–35.635) | 3.75 (1.25–6.875) | 6.25 (5–8.75) | 1.25 (0–5) | 42.5 (28.125–52.5) |
Mann–Whitney test | z = 3.617, p < 0.001 | z = 1.136, p = 0.258 | z = 2.183, p = 0.029 | z = 4.172, p < 0.001 | z = 3.787, p < 0.001 |
ES | r = 0.222 | r = 0.070 | r = 0.134 | r = 0.256 | r = 0.233 |
Types of diabetes | |||||
Type I, median (IQR) | 30 (25–38.75) | 3.75 (1.25–6.25) | 6.25 (5–8.75) | 2.5 (1.25–6.25) | 47.5 (31.25–56.25) |
Type II, median (IQR) | 31.25 (23.75–41.875) | 5 (2.5–6.875) | 7.5 (5–10.625) | 2.5 (0.625–6.25) | 47.5 (36.25–62.5) |
Mann–Whitney test | z = − 0.681, p = 0.499 | z = − 0.767, p = 0.446 | z = − 1.960, p = 0.050 | z = − 0.265, p = 0.794 | z = − 0.874, p = 0.385 |
ES | r = − 0.043 | r = − 0.048 | r = − 0.123 | r = − 0.017 | r = − 0.055 |
Years since diagnosis, Spearman’s correlation | rs = 0.087 p = 0.155 | rs = 0.084 p = 0.171 | rs = 0.019 p = 0.763 | rs = 0.140 p = 0.022 | rs = 0.100 p = 0.104 |
Years of duration of diabetes | |||||
Up to 2 years, median (IQR) | 31.25 (21.25–37.5) | 3.75 (1.25–6.25) | 7.5 (5–10) | 2.5 (0–5) | 45 (33.75–57.5) |
3 to 5 years, median (IQR) | 32.5 (24.375–41.25) | 3.75 (2.5–6.25) | 8.75 (6.25–10) | 2.5 (1.25–5) | 50 (38.125–61.875) |
6 or more years, median (IQR) | 32.5 (25–42.5) | 5 (2.5–7.5) | 7.5 (5–10.625) | 5 (1.25–7.5) | 48.75 (38.125–63.75) |
Kruskal Wallis H | H(2) = 2.853, p = 0.240 | H(2) = 2.681, p = 0.262 | H(2) = 1.581, p = 0.454 | H(2) = 4.293, p = 0.117 | H(2) = 3.056, p = 0.217 |