Relationship Between Electronic Health Literacy and Self-Management in People With Type 2 Diabetes Using a Structural Equation Modeling Approach.

BACKGROUND: Electronic health (eHealth) literacy is a relatively new concept used to determine health outcomes. However, it is not well known how eHealth literacy relates to health outcomes such as diabetes self-management. PURPOSE: This study was designed to examine the relationships among eHealth literacy, self-efficacy, social support, and self-management in people with Type 2 diabetes. METHODS: A cross-sectional design was used to examine secondary data from a field survey of people with Type 2 diabetes recruited from outpatient clinics from August to December 2021 ( N = 453). A structural equation model was used that first analyzed the measurement model using confirmatory factor analysis and then tested the hypothesized structural model to estimate the expected relationships among the study variables. The significance of the statistical estimates for the model was assessed based on the 95% bias-corrected bootstrap confidence interval from 5,000 bootstrap resamples. RESULTS: Significant, indirect relationships were found between eHealth literacy and self-management via self-efficacy (ß = 0.26, B = 0.17, 95% CI [0.10, 0.24]) and via social support and, in turn, self-efficacy (ß = 0.08, B = 0.05, 95% CI [0.04, 0.08]). eHealth literacy, social support, and self-efficacy together explained 58.1% of the variance in self-management. CONCLUSION/IMPLICATIONS FOR PRACTICE: This study provides new evidence regarding how eHealth literacy relates to self-management in people with Type 2 diabetes via two indirect pathways, including self-efficacy alone and social support and self-efficacy in series. An eHealth literacy program for self-management should be developed in clinical practice that includes strategies for inducing synergistic effects from self-efficacy and social support on self-management in people with Type 2 diabetes.

Relationship between Type D personality and adverse health outcomes in people with type 2 diabetes: The parallel mediating roles of diabetes distress and social isolation.

AIM: To investigate the relationship between Type D personality and adverse health outcomes [glycated haemoglobin (HbA1c) and health-related quality of life (HRQOL)] directly, and indirectly via diabetes distress and social isolation in people with type 2 diabetes. DESIGN: A secondary analysis of 524 participant's data derived from a cross-sectional, correlational study with people with type 2 diabetes. METHODS: Data were analysed using the PROCESS macro of SPSS. RESULTS: Type D personality was present in 31.3% of the participants, and exerted a direct effect on HRQOL but not on HbA1c. Type D personality indirectly affected both HbA1c and HRQOL via the mediators of diabetes distress and social isolation. Nurses need to monitor people with type 2 diabetes to determine whether Type D personality is present. Those with Type D personality should be provided with interventions to reduce diabetes distress and alleviate social isolation in order to improve HbA1c and HRQOL.

Development and psychometric evaluation of a new brief scale to measure eHealth literacy in people with type 2 diabetes.

BACKGROUND: The internet has become a major source of health information, and obtaining appropriate information requires various abilities and skills, labeled as electronic health literacy (eHealth literacy). The existing instruments for measuring eHealth literacy are outdated because they were developed during the Web 1.0 era, or not sufficiently sensitive for people with a specific condition or disease because they were designed to assess eHealth literacy over a broad range for a general population. Approximately one in ten adults worldwide live with diabetes. Health professionals have a responsibility to identify patients with low eHealth literacy to prevent them from obtaining misleading internet diabetes information. AIMS: The aims were to develop a condition-specific eHealth literacy scale for diabetes and to evaluate its psychometric properties among people with type 2 diabetes. METHODS: An instrument development design was used. This study recruited 453 people diagnosed with type 2 diabetes at the outpatient clinics of hospitals in 2021. Psychometric properties (internal consistency, measurement invariance, and content, structural, convergent, and known-groups validities) were analyzed. RESULTS: An expert panel assessed content validity. Exploratory factor analysis, exploratory graph analysis, and confirmatory factor analysis (CFA) for structural validity yielded a two-factor solution (CFI = 0.977, SRMR = 0.029, RMSEA = 0.077). Cronbach's alpha and omega values were excellent for each factor (0.87-0.94). Multigroup CFA yielded configural and metric measurement invariance across the gender, age, and glycemic control status groups. Convergent validity with a comparator instrument to measure health literacy was supported by a moderate correlation, and known-groups validity determined using groups with different internet-use frequencies was satisfied with a high effect size. CONCLUSION: A new condition-specific eHealth literacy scale for people with type 2 diabetes was developed, comprising 10 items. The scale exhibited good psychometric properties; however, test-retest reliability must be determined for the stability of the scale and cross-cultural validity is required among different languages. The brief scale has the merits of being feasible to use in busy clinical practice and being less burdensome to respondents. The scale can be applied in clinical trials of internet-based diabetes interventions for assessing the eHealth literacy of respondents.

Development and effects of a post-traumatic growth program for patients with breast cancer.

PURPOSE: This study aimed to develop a post-traumatic growth (PTG) program, based on the PTG promotion resources suggested by Cahlhoun, Cann, and Tedeschi, and to apply it to breast cancer patients to determine its effect. METHODS: A non-equivalent control group pretest-posttest experimental design was used. In total, 74 participants were enrolled in this study, with 37 in the experimental group and 37 in the control group. The PTG program developed in this study consisted of writing and self-reflection for self-analysis, talking and sharing for self-disclosure, and participation in a self-help group for social support. The instruments used for this study were the Korean version of the Event Related Rumination Inventory, the Korean version of the Hospital Anxiety and Depression Scale, and the Korean version of the Post-traumatic Growth Inventory. The data were analyzed with the χ2test, t-test, Fisher's exact test and all analysis were conducted based on an intention-to-treat principle. RESULTS: The experimental group that underwent a PTG program had a lower emotional distress score than the control group (anxiety: t = -3.84, p = .001; depression: t = -3.22, p = .002). The experimental group had a lower intrusive rumination (t = -3.55, p = .001) and had higher deliberate rumination score than the control group (t = 2.10, p = .039). The experimental group had a higher PTG score than the control group (t = 2.34, p = .022). CONCLUSIONS: The PTG program developed in this study for breast cancer patients has the potential to contribute to the promotion of PTG in breast cancer patients.

Psychometric properties of the revised Diabetes Knowledge Test using Rasch analysis.

OBJECTIVE: The revised Diabetes Knowledge Test (DKT2) is the instrument that is the most widely used for measuring diabetes knowledge; nevertheless, its structural validity has never been evaluated. This study aimed to determine the psychometric properties of the DKT2. METHODS: This study performed a secondary data analysis of people with diabetes recruited at university hospitals. Rasch analysis was used. RESULTS: One item in the 14-item DKT2 measuring general diabetes knowledge exhibited a poor-fit, and so it was eliminated. The person-item map showed that items of greater difficulty need to be added to the instrument. The principal-components analysis of residuals revealed a unidimensional structure. The person reliability was 0.50, with a person separation index of 1.01. Measurement invariance was not satisfied for items 11 and 2 according to gender and age. CONCLUSIONS: The unidimensional structure of the 13-item DKT2 demonstrated poor person reliability and a low person separation index. Females and elderly persons found it more difficult to respond to items 11 and 2, respectively. PRACTICE IMPLICATIONS: Careful consideration is necessary when using the 13-item DKT2 in practice and research. It is recommended for future studies to add items of greater difficulty to the instrument.

Pathways Linking Health Literacy to Self-Management in People with Type 2 Diabetes.

Health literacy is considered to be an emerging determinant of health behaviors and outcomes. The underlying mechanisms linking health literacy to diabetes self-management are currently unclear. This study assessed a mediation model consisting of a direct pathway between health literacy and self-management, and indirect pathways via social isolation only, self-efficacy only, and social isolation and self-efficacy serially in people with type 2 diabetes. A cross-sectional design was employed, and a total of 524 participants were recruited from outpatient clinics of multi-institutions from June 2020 to February 2021. The mediation model was analyzed using the PROCESS macro on SPSS with bootstrap bias-corrected 95% confidence intervals (CIs) with 10,000 bootstrapping iterations. Health literacy positively affected self-management. The estimated indirect effect of health literacy on self-management via social isolation was significant, at 0.018 (95% CI = 0.004-0.036). The indirect effect via self-efficacy was estimated at 0.214 (95% CI = 0.165-0.266). The indirect effect via social isolation and self-efficacy serially was 0.013 (95% CI = 0.006-0.023). The findings of this study suggest that clinical practice can be improved through more comprehensive diabetes self-management interventions that promote all of the components of health literacy, social contacts/networks, and self-efficacy in particular.

Supportive Care Needs and Health-Related Quality of Life of Esophageal Cancer Survivors.

OBJECTIVE: The aim of this study is (1) to describe the prevalence and correlates of unmet needs among esophageal cancer survivors (ECS) in Korea and (2) to identify the association between unmet needs and health-related quality of life (HRQOL). METHODS: We used a cross-sectional descriptive study design. Participants were 118 ECS from a hospital in Korea who received surgery at least 12 months before participating. We collected data including the Supportive Care Needs Survey-short form 34 and to measure HRQOL, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 with a self-report questionnaire. RESULTS: Participants' mean age was 65.2 years, and 92.4% were male. Among five domains of supportive care needs, unmet need prevalence ranged from 0.8% to 50%. The most commonly reported domains of unmet needs were Health System and Information and Physical and Daily Living. Participants with unmet needs in Psychological Needs, Physical and Daily Living Needs, and Patient Care and Support Needs demonstrated significantly poorer HRQOL in almost all measured domains. CONCLUSIONS: Our finding suggests that Korean ECS had substantial unmet needs, especially in the Health System and Information domain. Psychological, Patient Care and Support, and Physical and Daily Living Needs were related to HRQOL. The study can advance understanding of priority issues in ECS.

Exploring the Subjective Frame of References in the Development of Gerotranscendence in Korean Older Adults: Q Methodology.

Introduction: This study aims to explore how older people structure the subjectivity that accompanies the development of gerotranscendence in late adulthood within a specific sociocultural context. Method: Q methodology, a common method for assessing subjectivity, was applied. Results: The four subjective frames of reference that accompany the development of gerotranscendence, represented by four corresponding Q-factors, were (a) generation awareness, (b) awareness of aging, (c) awareness of the big picture of life, and (d) awareness of temporality. Discussion: The subjective frames of reference that characterize the development of gerotranscendence in late adulthood are closely related to cultural and psychosocial environmental influences over the course of an individual's life.

A New Self-management Scale with a Hierarchical Structure for Patients with Type 2 Diabetes.

PURPOSE: The aims of this study were to develop a new instrument for measuring self-management with a hierarchical structure [the Diabetes Self-Management Scale (DSMS)] in patients with type 2 diabetes, and evaluate its psychometric properties. METHOD: The DSMS instrument was developed in three phases: (1) conceptualization and item generation; (2) content validity and pilot testing; and (3) field testing of its psychometric properties. A convenience sample of 473 participants was recruited in three university hospitals and one regional health center, South Korea. RESULTS: Exploratory and confirmatory factor analyses yielded two second-order component models explaining the common variance among six first-order factors. Principal axis factoring with a varimax rotation accounted for 60.88% of the variance. Confirmatory factor analysis of the hierarchical structure revealed the following fit indices: χ2/df = 1.373, standardized root-mean-square residual = .050, goodness-of-fit index = .935, incremental fit index = .975, comparative fit index = .974, and root-mean-square error of approximation = .039. All Cronbach' α values for internal consistency exceeded the criterion of .70. All of the intraclass correlation coefficients for test-retest reliability exceeded .70 except that for the taking-medication subscale. The components of the DSMS were moderately correlated with the comparator measures of self-efficacy and health literacy administered for convergent validity. CONCLUSION: The DSMS is a new instrument for measuring the complex nature of self-management in patients with type 2 diabetes, comprising 17 items scored on a five-point Likert scale. The DSMS exhibits satisfactory psychometric properties for five reliability and validity metrics, and so is a suitable instrument to apply in both research and clinical practices.

A New Objective Health Numeracy Test for Patients with Type 2 Diabetes: Development and Evaluation of Psychometric Properties.

PURPOSE: Patients with diabetes frequently need to perform certain numeric tasks such as interpreting blood glucose levels. However, there is no psychometrically sound instrument for objectively measuring diabetes-specific health numeracy. This study aimed to develop a new objective diabetes health numeracy test (DHNT) and evaluate its psychometric properties in adult patients with type 2 diabetes. METHODS: An instrument development study was conducted. Initial items were evaluated by six experts for content validity. After a pilot test, a convenience sample of 257 participants with type 2 diabetes was recruited at 2 university hospitals from May to September 2018. The structural, convergent, and criteria validity, and internal consistency of the DHNT with binary item responses were evaluated. Data were analyzed using exploratory factor analysis, Rasch analysis, tetrachoric correlation, Spearman's correlation, and the Kuder-Richardson-20 formula. RESULTS: Exploratory factor analysis yielded a single-factor solution comprising seven items. Rasch analysis confirmed that no item did not fit with the single factor and identified that the item difficulty parameters had moderate values. The convergent and criterion validity of the instrument were demonstrated, with diabetes knowledge and subjective diabetes numeracy, respectively, as was its acceptable internal consistency, by a Kuder-Richardson-20 coefficient of .81. CONCLUSION: The DHNT demonstrated satisfactory psychometric properties. The instrument with moderate levels of item difficulty may have a lower cognitive burden. The developed instrument can be applied in practice to tailor the education of diabetes self-management as per the levels of health numeracy of specific patients.

Improvement of the qualification system in Korea for foreign nurses eligible to take Korean nursing licensing examination

PURPOSE: We aimed to review and provide a quality improvement for the document utilized by the relevant Korean government body to verify and evaluate foreign university/college graduates' eligibility for nursing and qualification to take the Korean nursing licensing examination. METHODS: This was a descriptive study. We analyzed the current Korean qualification system for foreign graduates to Korean nursing licensing examination and the same system utilized in some other countries. Then, we created a draft of the reviewed qualification standards document based on the 2 prior analyses and their comparisons, and applied a questionnaire in an open hearing with 5 experts to enhance the draft's quality. Finally, we presented and discussed the final draft. RESULTS: The reviewed criteria of the qualification standards included confirming whether the foreign graduate's university has an accreditation provided by its relevant government body, the exclusion of foreign graduates' provision of several documents previously required, a minimum number of credits (1,000 hours) for their original course, a 3-year minimum enrollment period for their original course, and a mandatory reassessment of the foreign graduates' university recognition in a 5-year cycle. DISCUSSION: We believe that by creating a review draft that addresses the flaws of the current document utilized to determine the qualification for foreign graduates to take the Korean nursing licensing examination, we have simplified it for a better understanding of the application process. We hope that this draft will contribute to a more objective and equitable qualification process for foreign university nurse graduates in Korea.

The mediating and moderating effects of meaning in life on the relationship between depression and quality of life in patients with dysphagia.

AIMS AND OBJECTIVES: To identify whether meaning in life has moderating and mediating effects on the relationship between depression and quality of life in patients with dysphagia. BACKGROUND: Dysphagic patients typically have multidimensional problems, such as depression, which can negatively influence their quality of life. Meaning in life, therefore, can be used as a psychological resource that may enhance quality of life for these patients. DESIGN: A descriptive cross-sectional research design was used. METHODS: Ninety patients with dysphagia were recruited for a survey from eight general and rehabilitation hospitals in Korea. The questionnaires, which included the Korean version of the Swallowing Quality of Life scale developed by Cha, the Center for Epidemiological Studies-Depression Scale developed by Radloff, and the Purpose in Life test developed by Crumbaugh and Maholick, were used for data collection. Descriptive statistics, Hayes' PROCESS macro and Cronbach's alpha were used for data analyses. RESULTS: Meaning in life was found to mediate the relationship between depression and quality of life in patients with dysphagia. However, the index of moderation was not statistically significant, which mean that meaning in life did not moderate the relationship between the patients' depression and quality of life. CONCLUSIONS: Meaning in life had a mediating effect on the relationship between depression and quality of life in patients with dysphagia. Thus, to improve the quality of life of patients with dysphagia, nurses should apply interventions to help them find meaning in life. RELEVANCE TO CLINICAL PRACTICE: Meaning in life can be used as a nursing intervention strategy to improve the quality of life for patients living with dysphagia and depression.

A new comprehensive diabetes health literacy scale: Development and psychometric evaluation.

BACKGROUND: The prevalence of diabetes is close to reaching an epidemic level, and health literacy has recently emerged as a concept that can influence the health outcomes of patients with diabetes. Health literacy was once defined from the perspective of basic reading and understanding skills, but this has now become more comprehensive to include the abilities and skills to assess, understand, appraise, communicate, and use health information. Nevertheless, there is no instrument reflecting the comprehensive health literacy relevant to diabetes. OBJECTIVES: The aims of this study were to develop a comprehensive Diabetes Health Literacy Scale and to evaluate its psychometric properties. DESIGN: An instrument-development study was applied that comprised three steps: conceptualization, item generation and content validity, and field testing of the psychometric properties. SETTINGS: A convenience sample of 462 participants was recruited from December 2016 to September of 2017 at outpatient clinics in 2 Korean university hospitals. PARTICIPANTS: The inclusion criteria for participants were being aged at least 19 years, articulate in the Korean language, and diagnosed with diabetes, while the presence of gestational diabetes was applied as an exclusion criterion. Approximately half of the participants were female (51.1%). The participants were aged 54.5 (SD, 11.0) years, 67.1% of them were taking an oral hypoglycemic agent, and 21.9% of them had well-controlled blood-glucose levels. METHODS: The content validity, factorial structure validity, convergent validity, criterion validity, internal consistent reliability, and test-retest reliability of the Diabetes Health Literacy Scale were evaluated. Data were analyzed using exploratory and confirmatory factor analyses, Pearson's correlation, Cronbach's alpha, and the intraclass correlation coefficient. RESULTS: The content validity was assessed by five experts. Exploratory and confirmatory factor analyses yielded a three-factor solution. Convergent validity was demonstrated using measures of diabetes knowledge and self-efficacy. Criterion validity was demonstrated with generic health-literacy questions. Internal consistency reliability and test-retest reliability were found to be acceptable, as indicated by a Cronbach's alpha of 0.91 and an intraclass correlation coefficient of 0.89, respectively. CONCLUSIONS: The Diabetes Health Literacy Scale is a new instrument that measures comprehensive aspects of informational, numeracy, and communicative health literacy. It is a short instrument, comprising only 14 items scored on a 5-point Likert scale. The instrument exhibits good psychometric properties for four validity metrics (content, structural, convergent, and criterion validity) and two reliability metrics (internal consistency and test-retest reliability). These findings indicate that the instrument can be applied in both research and clinical practice.

First-order vs. second-order structural validity of the Health Literacy Scale in patients with diabetes.

OBJECTIVE: The purpose of this study was to determine the structural validity of the Health Literacy Scale (HLS) in Korean patients with diabetes based on the previously reported first-order three-factor and two-factor models and a newly proposed second-order model, to identify which model best represents the structure of the Korean version of the HLS (HLS-K). METHODS: The HLS was translated from Japanese into Korean using a translation and back-translation technique. A secondary data analysis was used to validate the structure of the HLS. Data were obtained from a cross-sectional survey involving 459 adults with diabetes recruited from outpatient clinics at two university hospitals in South Korea. The structural validity was examined using confirmatory factor analysis. Additionally, the known-groups validity by education level and internal consistency validity were assessed. RESULTS: The second-order three-factor model of the HLS-K exhibited a good fit to the data, as indicated by χ2 /df = 3.891, SRMR = 0.042, GFI = 0.924, RMSEA = 0.079 (90% CI = 0.069-0.090), and CFI = 0.962. The second-order three-factor model empirically demonstrated that both communicative and critical factors explained the variance in the overall health literacy better than did the functional factor. The HLS-K mean score was significantly lower for patients with only elementary school education than for those with higher education levels, implying the presence of known-groups validity. Cronbach's alpha for the total scale was 0.90. CONCLUSIONS: This study found that the second-order three-factor model of the HLS-K is better than that the original first-order three-factor and first-order two-factor models. Further validation studies are needed to generalise the underlying structure of the instrument in diabetes populations across various cultures.

A Structural Equation Model Linking Health Literacy to Self-efficacy, Self-care Activities, and Health-related Quality of Life in Patients with Type 2 Diabetes.

PURPOSE: Health literacy has been attracting increasing attention because low health literacy is considered an important predictor of adverse health outcomes in many chronic conditions, including diabetes. However, it is unclear how health literacy is associated with health outcomes. The purpose of this study was to formulate a hypothetical structural equation model linking health literacy to self-efficacy, self-care activities, and health-related quality of life (HRQOL) in patients with type 2 diabetes. METHODS: A cross-sectional survey design was employed, and 459 patients with type 2 diabetes were recruited from outpatient clinics in two university hospitals. The patients completed a pack of questionnaires. The hypothetical model was tested using structural equation modeling analysis. RESULTS: The values of multiple fit indices indicated that the proposed model provided a good fit to the data. Health literacy exerted not only a direct effect on self-care activities, but also an indirect effect on self-care activities via self-efficacy. However, health literacy exerted only an indirect effect on HRQOL. This structural model was invariant across hemoglobin-A1c-controlled and hemoglobin-A1c-uncontrolled groups. Based on R(2) values, the final model accounted for 20.0% of the variance in self-efficacy, 61.0% of the variance in self-care activities, and 16.0% of the variance in HRQOL. CONCLUSIONS: This study suggests that self-care activities are crucial to the link between health literacy and HRQOL. Both health literacy and self-efficacy need to be considered in clinical practice for enhancing self-care activities in patients with type 2 diabetes. This approach may ultimately improve HRQOL in these patients.

Clinical Alarms in Intensive Care Units: Perceived Obstacles of Alarm Management and Alarm Fatigue in Nurses.

OBJECTIVES: The purpose of this descriptive study was to investigate the current situation of clinical alarms in intensive care unit (ICU), nurses' recognition of and fatigue in relation to clinical alarms, and obstacles in alarm management. METHODS: Subjects were ICU nurses and devices from 48 critically ill patient cases. Data were collected through direct observation of alarm occurrence and questionnaires that were completed by the ICU nurses. The observation time unit was one hour block. One bed out of 56 ICU beds was randomly assigned to each observation time unit. RESULTS: Overall 2,184 clinical alarms were counted for 48 hours of observation, and 45.5 clinical alarms occurred per hour per subject. Of these, 1,394 alarms (63.8%) were categorized as false alarms. The alarm fatigue score was 24.3 ± 4.0 out of 35. The highest scoring item was "always get bothered due to clinical alarms". The highest scoring item in obstacles was "frequent false alarms, which lead to reduced attention or response to alarms". CONCLUSIONS: Nurses reported that they felt some fatigue due to clinical alarms, and false alarms were also obstacles to proper management. An appropriate hospital policy should be developed to reduce false alarms and nurses' alarm fatigue.

Post-traumatic growth in stomach cancer survivors: Prevalence, correlates and relationship with health-related quality of life.

PURPOSE: Post-traumatic growth (PTG) is defined as positive psychological changes experienced as a result of struggle with highly challenging life circumstances. Interest in PTG has increased in cancer survivorship care; however, little is known about PTG among stomach cancer survivors. This study aimed to examine the prevalence and correlates of PTG, and to identify relationships between PTG and health-related quality of life (HRQOL). METHODS: Cross-sectional descriptive design. In total, 122 stomach cancer survivors were recruited from one university hospital in South Korea. Measurements included the Korean version of the Post-traumatic Growth Inventory and the Functional Assessment of Cancer Therapy--General Population. RESULTS: Over half (53.3%) of the participants experienced moderate to high levels of PTG. 'Change of self-perception' was the most common growth domain, followed by 'relating to others', 'new possibilities' and 'spiritual change'. Older age, low socio-economic status (i.e. low education level and low monthly income) and lack of religion were associated with lower levels of PTG. Survivors with higher levels of PTG had better social/family well-being (P < 0.001) and better functional well-being (P < 0.001). CONCLUSIONS: Psychological interventions to enhance PTG may have a positive effect on impaired HRQOL among stomach cancer survivors.

A Korean version of the Appraisal of Diabetes Scale (ADS-K): psychometric evaluation with a population of Koreans with type 2 diabetes.

The purpose of this study was to evaluate the psychometric properties of the Appraisal of Diabetes Scale (ADS) in Korean patients with Type 2 diabetes. The English-language version of the ADS was translated into Korean using a forward-and-backward translation technique. The Korean version of the ADS (ADS-K) was administered to 250 patients who were recruited from two university hospitals. The data were analyzed using principal-component analysis, Cronbach's alpha, analysis of variance, t test, and Pearson's correlation. Six of seven items were meaningfully clustered into a two-factor structure by principal-component analysis, these factors accounting for 63.75% of the total variance. The underlying structure was consistent regardless of either gender or the presence of complications. The Cronbach's alpha of the subscales ranged from .71 to .79, indicating an acceptable internal consistency reliability. As hypothesized, the ADS-K score was moderately correlated with the diabetes-specific quality of life and had satisfactory convergent validity. The known-groups validity of the ADS-K was established using depression groups and HbA1c control status. The ADS-K demonstrated good psychometric properties. In addition, it possessed satisfactory practical properties, such as acceptability and feasibility. Therefore, the ADS-K appears to be suitable for use in both clinical research and clinical practice.

Measurement of diabetes-related emotional distress using the Problem Areas in Diabetes scale: psychometric evaluations show that the short form is better than the full form.

BACKGROUND: The Problem Areas in Diabetes (PAID) scale is widely used for measuring diabetes-related emotional distress. There has been debate over the last 2 decades about the underlying factorial-construct validity of the PAID, with one- to four-factor structures being reported. A short form of the PAID, which comprises five items (PAID-5), was recently developed using Western patients with type 2 diabetes. This study measured the psychometric properties of the full and short forms of the PAID in Korean patients with type 2 diabetes, with the aim of determining which form is preferable. METHODS: The PAID and PAID-5 were translated into Korean (K-PAID and K-PAID-5, respectively) using a forward-and-backward translation technique. The study participants were recruited from university hospitals. The factorial-construct, convergent, and known-groups validity, and internal-consistency and test-retest reliability of both the K-PAID and K-PAID-5 were evaluated. RESULTS: For the K-PAID, confirmatory factor analysis revealed a marginal fit to the one-, two-, three-, and four-factor models. The three- and four-factor models of the K-PAID partially satisfied the internal-consistency and test-retest reliability, and convergent and known-groups validity. For the K-PAID-5, confirmatory factor analysis demonstrated an excellent fit to the one-factor model, with a Cronbach's alpha of 0.87 and an intraclass correlation coefficient of 0.89. The K-PAID-5 satisfied the convergent validity, as evaluated using the Center for Epidemiologic Studies Depression Scale and hemoglobin A1c. Known-groups validity by gender was also satisfied. CONCLUSIONS: The K-PAID-5 demonstrated excellent psychometric properties as a one-factor scale. The brevity of the K-PAID-5 represents a major advantage in a practical context in that it may impose a minimum burden upon patients with diabetes.