The psychometric properties of the Swedish version of the Problem Areas in Diabetes Scale (Swe-PAID-20): Scale development

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Abstract

Background

Considering the importance of psychological aspects in the management of diabetes, there is a need of validated measurements in this area. Such tools make it possible to screen patients for specific conditions as well as they serve as reliable measures when evaluating medical, psychological and educational interventions.

Objectives

The current study was conducted to adapt the Problem Areas in Diabetes Scale for use among Swedish-speaking patients with type 1 diabetes and to evaluate the psychometric properties.

Design

Methodological research design was used in this study.

Setting and participants

A convenience sample of 325 type 1 diabetes patients was systematically selected from the local diabetes registry of a university hospital in Stockholm, Sweden.

Methods

Following the linguistic adaptation using the forward–backward translation method, the 20-item PAID was answered by the selected patients. Statistics covered exploratory factor analysis, Cronbach's alpha, convergent validity and content validity.

Results

In the factor analysis a three-factor solution was found to be reasonable with the sub-dimensions diabetes-related emotional problems (15 items), treatment-related problems (2 items) and support-related problems (3 items). Cronbach's alpha coefficient for the total score was 0.94 and varied between 0.61 and 0.94 in the three subscales. The findings also gave support for the convergent and content validity.

Conclusions

The Swedish version of the Problem Areas in Diabetes Scale (Swe-PAID-20) seems to be a reliable and valid outcome for measuring diabetes-related emotional distress in type 1 diabetes patients.

Section snippets

What is already known about the topic?

  • Previous research indicates that psychological aspects might be related to poor self-care of diabetes.

  • To meet the needs of specific patients and situation measurements in this area is of value for both clinical and research purposes.

  • The Problem Areas in Diabetes Scale is a brief self-report measure of diabetes-related emotional distress. The scale is widely used and translated into many languages. A Swedish version of the scale is not yet available.

What this paper adds

  • The psychometric properties of the Swedish version of PAID (Swe-PAID-20) were confirmed in a Swedish population.

  • The Swe-PAID-20 is a brief, reliable and valid tool that is easy to administer to people with type 1 diabetes.

Translation procedure

The original version of the PAID was initially translated by the first (SA) and last author (U-B J) into Swedish. An authorised, bilingual translator then retranslated the Swedish version into English. A four-member back-translation committee, consisting of the authorised translator, the first (SA), second (RW) and last author (U-B J), was then formed to examine discrepancies between the original English version, the initial Swedish version and the back-translated English version. The

Demographic and clinical data

The questionnaire was returned by 325 patients, thus yielding a response rate of 60%. Of the total sample, 53% of the patients had an HbA1c level of 7.5% or less. Data on age, sex and HbA1c were also available from the non-respondents. A significant difference related to age was found between respondents (mean 47.8±14.7) and non-respondents (mean 42.5±14.0), P<0.001, but no significant differences with respect to sex or HbA1c were observed. When constructing frequency distribution for the total

Discussion

In the current study the reliability and validity of the Swe-PAID-20 were examined among Swedish patients with type 1 diabetes. The reliability findings of this study are consistent with earlier studies using the original PAID, suggesting that despite modifications of individual scale items, the scale remained internally consistent. The findings of the study also provide support for the construct validity, as well as the convergent and content validity. Repeated component analysis suggested the

Acknowledgements

This study was supported by grants from the Health Care Sciences Postgraduate School, Karolinska Institutet, Sophiahemmet University College, the Foundation for Medical Research at Sophiahemmet, the Bert von Kantzow Foundation, and the Swedish Diabetes Federation. We also wish to thank Lena Landstedt-Hallin and Anna-Lena Wedfelt for assistance with the study and Eva Lagercrantz and Jenny Larson for statistical support. We also appreciate the assistance provided by diabetes specialist nurses as

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    The CFA results of the PAID Scale showed satisfactory fit indices (CFI = 0.90; root mean square error of approximation = 0.090), suggesting adequate construct validity. The 3-factor solution was similar to the one obtained in validation studies for Sweden,8 Greece,21 and Iran.22 It shall be noted that only few studies reported formal CFA results of the factor structure of PAID.

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