Validation of Turkish version of the PAID questionnaire
Dilara Karşıdağ Altıkardeş, Giesje Nefs, Hülya Hacıșahinoğulları, Tom Smeets, Frans Pouwer
Reliability and validity of the Turkish version of the problem areas in diabetes (PAID) survey: Results from diabetes MILES - Turkey. Prim Care Diabetes. 2024 Apr;18(2):218-223.
Living with diabetes often involves emotional and psychological challenges related to daily self-management, fear of complications, and social interactions. These experiences are captured by the concept of diabetes-specific distress, which is distinct from general depression or anxiety. International diabetes guidelines recommend routine assessment of diabetes distress in clinical care, but this requires validated, culturally appropriate measurement tools.
The Problem Areas in Diabetes (PAID) questionnaire is the most widely used instrument to assess diabetes distress. However, most validation studies have been conducted in Western, high-income countries, limiting insight into its applicability across diverse cultural and healthcare settings. This study aimed to validate the Turkish versions of the PAID-20, PAID-5, and PAID-1 and to estimate the prevalence and correlates of diabetes distress among Turkish adults with type 1 and type 2 diabetes.
This cross-sectional study was conducted as part of the international Diabetes MILES collaboration and included 252 adults with type 1 or type 2 diabetes attending an outpatient clinic in Turkey. Participants completed the PAID questionnaires and a range of psychological and clinical measures. The authors evaluated internal consistency, factor structure, and construct validity, and explored demographic and clinical correlates of diabetes distress using regression analyses.
Key findings:
- The Turkish versions of the PAID-20, PAID-5, and PAID-1 demonstrated satisfactory internal consistency and construct validity.
- Factor analysis supported a three-factor structure for PAID-20 and a two-factor structure for PAID-5, reflecting diabetes distress and complication-related worries.
- Diabetes distress was more prevalent in people with type 1 diabetes than in those with type 2 diabetes.
- Elevated diabetes distress was present in 40% of participants with type 1 diabetes and 15% of those with type 2 diabetes using PAID-20 cut-offs.
- Negative illness perceptions were the strongest psychological correlate of diabetes distress, alongside having type 1 diabetes.
This study confirms that diabetes distress is common and measurable using PAID in Turkish adults, particularly among people with type 1 diabetes. By validating both the full and short PAID versions in a non-Western population, the findings support international comparability in research and demonstrate that brief PAID tools are feasible for routine clinical screening, enabling timely identification of psychosocial needs.
Concluding, the authors state
"The 20-item, 5-item and single-item versions of the Problem Areas in Diabetes scale show satisfactory internal consistency, as well as structural and construct validity in measuring diabetes-specific distress among Turkish adults with type 1 and type 2 diabetes" -
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