The SA Journal Diabetes & Vascular Disease Vol 13 No 1 (July 2016)

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VOLUME 13 NUMBER 1 • JULY 2016 11
SA JOURNAL OF DIABETES & VASCULAR DISEASE RESEARCH ARTICLE
within the urban Zambian context. Secondly, we were able to
demonstrate that participants did not employ response style bias,
instead respondents were able to map responses based on the
categories given in the survey and were able to comprehend the
question intent.
However, the study is not without limitations. First, the sample
size was relatively small and drawn from urban settings only.
Second, due to the small sample size, we could not conduct a
confirmatory factor analysis, which would have enabled a more
rigorous comparison of different factor solutions. Therefore,
future studies should work with a larger sample size and subject
the Zambian version of the PAID to confirmatory factor analysis.
Third, we cannot rule out the influence of social desirability in the
manner participants responded to the scale. In social research,
participants tend to respond to survey questions in a manner that
will be viewed favourably by others.42
Conclusion
This study revealed good internal consistency, reliability and validity
of the PAID among patients with type 1 and 2 diabetes mellitus in
Zambia. Moreover, the majority of our patients demonstrated that
they were able to comprehend most questions well and match
their responses to the scale categories, although some items may
need to be rewritten. The measure has satisfactory psychometric
properties to assess individual levels of diabetes-specific distress,
which qualifies it for diagnostic and clinical use, although some
items may need to be clarified and simplified to enhance its
comprehensibility. We found a single-factor solution to be the
best approximation of the data. The existence of a single factor
implies that the participants did not make a distinction between
clusters of domains or complaints. Rather, diabetes seems to work
as a global stressor that comes with multiple complaints.
To our knowledge, the findings in the current study are the first
to highlight the use of the PAID in Zambian patients with diabetes.
The study also demonstrated that diabetes-specific emotional
distress is very high in Zambian patients compared to patients with
diabetes in Western Europe or the USA. These results show that
there should be strong pressure to further improve the quality of
medical treatment of Zambian people with diabetes, and it would
be particularly helpful to educate the families.
Acknowledgments
The authors acknowledge the Jacobs Foundation for awarding
the first author the ISSBD Mentored Fellowship, which enabled us
to carry out this study, the Diabetes Association of Zambia, and
the Diabetes Clinic and its patients for supporting this study.
References
1. International Diabetes Federation. IDF Diabetes Atlas.
diabetesatlas. Accessed March 2013.
2. Polonsky WH, Anderson BJ, Lohrer PA, Welch G, Jacobson AM, Aponte JE,
Schwartz CE. Assessment of diabetes related distress. Diabetes Care 1995; 18(6):
754–760.
3. Welch GW, Jacobson AL, Polonsky WH. The problem areas in diabetes scale: An
evaluation of its clinical utility. Diabetes Care 1997; 20(5): 760–766.
4. Kakleas K, Kandyla B, Karayianni C, Karavanaki K. Psychosocial problems in
adolescents with type 1 mellitus. Diabetes Metab 2009; 35(5): 339–350.
5. Rane K, Wajngot A, Wändell PE, Gåfvels C. Psychosocial problems in patients
with newly diagnosed diabetes: Number and characteristics. Diabetes Res Clin
Pract 2011; 93(3): 371–378.
6. Sigurdardottir AK, Benediktsson R. Reliability and validity of the Icelandic version
of the problem areas in diabetes (PAID) scale. Int J Nurs Studies 2008; 45(4):
526–533.
7. Amsberg S, Wredling R, Lins P, Adamson U, Johnsson UB. The psychometric
properties of the Swedish version of the Problem Areas in Diabetes scale (Swe–
PAID–20): Scale development. Int J Nurs Studies 2008; 45(5): 1319–1328.
8. Silverstein J, Klingensmith G, Copeland K, et al. Care of children and adolescents
with type 1 diabetes. A statement from the American Diabetes Association.
Diabetes Care 2005; 28(1): 186–212.
9. Rush WA, Whitebird RR, Rush RM, Solberg LI, O’Connor PJ. Depression in patients
with diabetes: Does it impact clinical goals? J Am Board Family Med 2008; 21(5):
392–397.
10. Nouwen A, Winkley K, Twisk J, et al. European Depression In Diabetes (EDID)
research consortium. Type 2 diabetes mellitus as a risk factor for the onset of
depression: a systematic review and meta–analysis. Diabetologia 2010; 53(12):
2480–2486.
11. Nouwen A, Nefs G, Caramlau I, et al . European Depression in Diabetes rResearch
consortium. Prevalence of depression in individuals with impaired glucose
metabolism or undiagnosed diabetes: a systematic review and meta–analysis of
the European Depression in Diabetes (EDID) research consortium. Diabetes Care
2011; 34(3): 752–762.
12. Johnson B, Eiser C, Young V, Brierley S, Heller S. Prevalence of depression among
young people with type 1 diabetes: A systematic review. Diabetes Med 2012;
30(3): 199–208.
13. Pouwer F, Nefs G, Nouwen A. Adverse effects of depression on glycaemic control
and health outcomes in people with diabetes: a review. Endocrinol Metab Clin
North Am 2013; 42(3): 529–544.
14. Van Dooren FEP, Nefs G, Schram MT, et al. Depression and risk of mortality in
people with diabetes mellitus: A systematic review and meta–analysis. Plos One
2013; 8(3): e57058.
15. Van Bastelaar KMP, Pouwer F, Geelhoed–Duijvestin PHLM, et al. Diabetes–specific
emotional distress mediates the association between depressive symptoms and
glycaemic control in type 1 and type 2 diabetes. Diabetic Med 2010; 27(7): 798–
803.
16. Beran D, Yudkin JS, de Courten M. Access to care for patients with insulin–
requiring diabetes in developing countries. Case studies of Mozambique and
Zambia. Diabetes Care 2005; 28(9): 2136–2140.
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