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VOLUME 13 NUMBER 1 • JULY 2016
RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Study 2
As a further study of the adequacy of the PAID in the Zambian
context, we conducted a qualitative study, addressing the adequacy
of the instrument’s instructions, items and response scale. We used
cognitive interviews to assess the adequacy, comprehensibility and
cultural appropriateness.
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Eight patients (three adolescents and five adults) participated in
the study. These cognitive interviews focused on the 20 items of the
PAID. Patients were asked to provide verbal feedback on each item
regarding (1) response categories, (2) clarity, (3) the respondent’s
knowledge about the specific topics that were enquired, and recall
of experiences and sensitivity of the items and overall impression of
the content (see Table 7).
All interviews were conducted in English and were audio-recorded
and verbatim transcribed. Interviews lasted between 30 and 45
minutes. Table 8 shows examples of questions asked during the
cognitive interview. Of the eight patients who were interviewed,
only one had completed the PAID scale earlier during the research
project.
Verbatim transcriptions were first read through several times in
order to get familiar with the data. After establishing familiarity with
the data, each question response was analysed and comments were
assigned to each response, based on the cognitive theory model by
Tourangeau.
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Themodelconsistsoffourprocesses:(1)comprehension
of the question (question intent and meaning of terms), (2) retrieval
from memory of relevant information (recallability of information
and recall strategy – recalling each one individually versus estimation
strategy), (3) decision process (motivation – devotion of mental effort
to answer question and sensitivity of question or indication of social
desirability), and (4) response process, which involves matching
responses to scale categories.
Results
In general, most of our patients could understand the majority of
the items (16/20 = 80% of the items). The following items were
Table 4.
PAID mean scores on items and sub-dimensions for the males and females subjects with type 1 and type 2 diabetes
Type 1 diabetes Type 2 diabetes
Males (
n
= 47)
Females (
n
= 46)
Males (
n
= 28)
Females (
n
= 30)
Sub-dimension Mean ± SD (95% CI) Mean ± SD (95% CI) Mean ± SD (95% CI) Mean ± SD (95% CI)
Diabetes-related emotional problems
30.9 ± 15.3 (26.4–34.5) 30.0 ± 13.8 (26.9–35.6) 31.6 ± 14.1 (26.1–37.1) 34.3 ± 13.9 (29.0–31.5)
Feeling that diabetes is taking up too much
mental and physical energy
3.1 ± 2.1 (2.5–3.8)
2.8 ± 2.1 (2.3–3.4)
3.3 ± 2.3 (2.5–4.1)
3.9 ± 1.8 (3.1–4.5)
Not knowing if the mood or feeling you are
experiencing are related to your blood glucose
2.6 ± 2.1 (2.0–3.3)
2.9 ± 2.1 (2.3–3.5)
3.5 ± 2.0 (2.6–4.1)
3.3 ± 2.0 (2.5–4.0)
Feeling guilt/anxious when you get off track with
your diabetes management
3.3 ± 1.9 (2.8–3.9)
2.5 ± 2.1 (1.9–3.1)
3.6 ± 1.9 (2.9–4.3)
3.3 ± 2.0 (2.5–4.0)
Feeling constantly burned out by the constant
effort to manage diabetes
2.9 ± 2.1 (2.3–3.5)
2.4 ± 2.3 (1.8–3.0)
3.0 ± 2.1 (2.1–3.8)
3.3 ± 1.9 (2.5–3.9)
Coping with complications of diabetes
1.9 ± 2.1 (1.3–2.5)
2.1 ± 2.1 (1.5–2.8)
1.4 ± 2.0 (0.6–2.1)
3.1 ± 2.1 (2.3–3.9)
Feeling depressed when you think about
living with diabetes
2.8 ± 2.3 (2.1–3.8)
3.1 ± 2.0 (2.5–3.8)
3.0 ± 2.1 (2.1–3.9)
3.0 ± 2.0 (2.3–3.8)
Worry about low blood sugar reactions
3.1 ± 2.0 (2.5–3.8)
3.0 ± 2.0 (2.5–3.6)
3.3 ± 2.1 (2.4–4.1)
3.1 ± 2.0 (2.4–3.9)
Feeling scared when you think about living with diabetes 2.6 ± 2.3 (2.0–3.3)
2.9 ± 2.1 (2.3–3.5)
2.6 ± 2.1 (1.8–3.5)
2.9 ± 2.3 (2.0–3.6)
Feeling angry when you think about living with diabetes 2.3 ± 2.3 (1.6–2.9)
1.9 ± 2.1 (1.3–2.5)
2.3 ± 2.4 (1.3–3.1) 2.8 ± 2.1 (1.9–3.6)
Feeling overwhelmed by your diabetes regimen
1.3 ± 1.8 (0.8–1.8)
1.9 ± 1.8 (1.4–2.4)
0.8 ± 1.6 (0.1–1.4)
1.9 ± 2.0 (1.3–2.6)
Worrying about the future and possibility of
serious complications
3.0 ± 2.1 (2.4–3.8)
3.4 ± 2.0 (2.8–3.9)
3.6 ± 2.0 (2.9–4.4)
2.6 ± 2.3 (1.8–3.4)
Not accepting diabetes
2.5 ± 2.3 (1.8–3.1)
2.1 ± 2.1 (1.5–2.8)
2.6 ± 2.5 (1.6–3.5) 2.3 ± 2.4 (1.3–3.1)
Treatment-related problems
6.6 ± 4.4 (5.3–7.9)
7.1 ± 4.9 (5.6–5.5)
8.0 ± 4.5 (6.3–9.8)
7.6 ± 4.1 (6.1–9.3)
Not having clear and concrete treatment goals
for your diabetes care
2.4 ± 2.0 (1.8–2.9)
2.3 ± 2.1 (1.8–2.9)
2.0 ± 2.3 (1.3–2.9)
3.1 ± 2.1 (2.4–3.9)
Feeling discouraged with your diabetes regimens
2.5 ± 2.1 (1.6–2.9)
2.3 ± 2.1 (1.6–2.9)
2.8 ± 2.1 (1.9–3.5)
2.5 ± 2.3 (1.8–3.4)
Feeling unsatisfied with your diabetes physician
2.0 ± 1.1 (1.4–2.6)
2.6 ± 25 (1.9–3.3)
3.3 ± 2.5 (2.4–4.1)
2.0 ± 2.1 (1.1–2.8)
Food-related problems
6.4 ± 4.5 (5.0–7.6)
6.8 ± 4.3 (5.5–8.0)
6.1 ± 4.3 (4.4–7.8)
7.3 ± 5.3 (5.3–9.3)
Feelings of deprivation regarding food and meals
2.0 ± 2.1 (1.4–2.5)
2.3 ± 2.3 (1.6–2.9)
2.0 ± 2.3 (1.1–2.9)
2.8 ± 2.3 (1.9–36)
Feeling constantly concerned about food
2.3 ± 2.3 (1.6–2.9)
2.4 ± 2.1 (1.8–3.0)
1.9 ± 2.3 (1.0–2.6)
2.4 ± 2.4 (2.6–3.3)
Uncomfortable interactions around diabetes with
family/friends (e.g. other people telling you what to eat) 2.1 ± 2.0 (1.5–2.8)
2.1 ± 2.1 (1.5–2.6)
2.5 ± 2.5 (1.4–3.1)
2.1 ± 2.1 (1.4–2.9)
Social support-related problems
5.1 ± 4.0 (4.0–6.4)
4.6 ± 3.9 (3.5–5.9)
5.6 ± 4.0 (4.0–7.1)
4.4 ± 3.0 (3.4–5.5)
Feeling that friends/family are not supportive
of diabetes management efforts
2.9 ± 2.5 (2.5–3.6)
2.4 ± 2.3 (1.6–3.0)
3.4 ± 2.1 (2.5–4.3)
2.3 ± 2.1 (2.6–3.2)
Feeling alone with diabetes
2.3 ± 2.1 (1.6–2.9)
2.3 ± 2.3 (1.6–3.0)
2.3 ± 2.3 (1.4–3.1)
2.1 ± 2.1 (1.4–3.0)
PAID 20-item scale 40.3 ± 34 49.0 ± 24.0 (41.8–56.0) 49.5 ± 23.0 (42.6–56.40) 51.4 ± 2 1.9 (42.8–59.9) 53.5 ± 20.9 (45.8–61.4)
Total PAID, 16 items 33.8 ± 27.2
Transformed from 0–4 scale (0–80) to a scale 0–5 (0–100) by multiplying the results by 1.25.