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VOLUME 13 NUMBER 1 • JULY 2016
7
SA JOURNAL OF DIABETES & VASCULAR DISEASE
RESEARCH ARTICLE
these items. Cronbach’s alpha was 0.90 (lambda 2 = 0.90).
The internal consistency of the total PAID, as indicated by
Cronbach’s alpha, was 0.88 (lambda 2 = 0.89), and for the 16 items,
PAID alpha was 0.90 (lambda 2 = 0.90). For subjects with T1DM,
Cronbach’s alpha was 0.89 (lambda 2 = 0.90), while for subjects with
T2DM, Cronbach’s alpha was 0.86 (lambda 2 = 0.88). Inspections
of the item total correlations revealed that 15 out of 20 items were
worthy of retention. The greatest increase in alpha resulted from
deleting the following items; ‘coping with complications’ (0.06),
‘feeling constantly concerned about food’ (0.17), ‘deprivation
regarding food and meals’ (0.23), ‘feeling overwhelmed by diabetes
regimens’ (0.24) and ‘not having a clear and concrete goal for
diabetes’ (0.33). Removal of these items increased the alpha by only
0.03 (0.91). Cronbach’s alpha for HFS was 0.80 and lambda 2 =
0.81, for the SCI, alpha was 0.71 and lambda 2 = 0.74, and for the
MDI, alpha was 0.79 and lambda 2 = 0.80.
Table 3 shows that regardless of the type of diabetes, ‘worry
about low blood sugar reactions’ was most endorsed as a serious
problem (i.e. a score of 3 or 4, ‘a problem’ or ‘a serious problem’)
among T2DMpatients and in all patients (62 and 61%, respectively).
Overall, 60% of the patients (T1DM and T2DM) endorsed ‘the
feeling that diabetes was taking up too much of their mental and
physical energy’ and was a serious problem.
Women with T2DM scored higher (54 ± 21, 95% CI: 46–61)
than men or women with T1DM (49.0 ± 24.0, 95% CI: 41.8–56.0;
49.5 ± 23.0, 95% CI: 42.6–56.40), respectively. Men with T2DM
scored higher (51 ± 22, 95% CI: 43–60) than men (49 ± 24, 95%
CI: 42–56) and women (50 ± 23, 95% CI: 43–60) with T1DM, and
these differences were significant (see Table 4).
Concurrent validity of the PAID scale was evaluated by assessing
the correlations between the PAID and age, body mass index, socio-
economic status, fear of hypoglycaemia, depression and diabetes
self-care. Table 5 shows the correlation between the PAID and other
variables of interest. There was a moderately significant correlation
between the PAID with the diabetes self-care [
r
(157) = –0.30], fear
of hypoglycaemia [
r
(157) = 0.35] and depression [
r
(157) = 0.39]
scores. However, there was no significant correlation between the
PAID and age [
r
(157) = 0.12], socio-economic status [
r
(156) =
–0.01] and body mass index [
r
(157) = –0.14].
Table 6 shows a stepwise multiple regression model that examined
the relationship of six variables with the total PAID score. In the first
step, demographic variables were entered as control variables; no
significant associations were found with diabetes distress. In the
second step, clinical variables (body mass index, depression, diabetes
self-care and fear of hypoglycaemia) were entered. These variables
were positively associated with total PAID scores, except for body
mass index, which was negatively associated with diabetes distress.
The strongest predictor of diabetes-specific distress was fear for
hypoglycaemia (beta = 0.29), followed by depression (beta = 0.27),
and perceived diabetes self-care was the third most significant
predictor of diabetes-specific distress (beta = 0.25). The predictor
variables explained 32% (
p
< 0.01) of total variance of the PAID.
Table 3.
Proportion of participants that endorsed an item as a ‘serious problem’
#
Type 1 diabetes
Type 2 diabetes
Type 1 and 2 diabetes
PAID 20 items
Males
Females
Males Females males and females
% (
n
)
% (
n
)
% (
n
)
% (
n
)
% (
n
)
Diabetes-related emotional problems
Worry about low blood sugar reactions
57 (27/47)* 59 (27/46)* 61 (17/28)
63 (19/30)* 61 (95/157)*
Feeling that diabetes is taking up too much mental and physical energy
62 (29/47)* 50 (23/46)
68 (19/28)* 67 (20/30)* 60 (94/157)*
Feeling guilt/anxious when you get off track with your diabetes management 66 (31/47)* 41 (19/46)
75 (21/28)* 60 (18/30)* 58 (91/157)*
Worrying about the future and possibility of serious complications
55 (26/47)* 61 (28/46)* 71 (20/28)* 47 (14/30)
57 (90/157)*
Feeling depressed when you think about living with diabetes
55 (26/47)* 54 (25/46)* 57 (16/28)
53 (16/30) 54 (84/157)
Feeling scared when you think about living with diabetes
53 (25/47)
54 (25/46)* 50 (14/28)
53 (16/30) 52 (82/157)
Not knowing if the mood or feeling you are experiencing are related to
47 (22/47)
54 (25/46)* 61 (17/28)* 53 (16/30)
53 (83/157)
your blood glucose
Feeling constantly burned out by the constant effort to manage diabetes
51 (24/47)
37 (17/46)
54 (15/28)
63 (19/30)* 49 (77/157)
Not accepting diabetes
45 (21/47)
37 (17/46)
50 (14/28)
43 (13/30)
41 (64/157)
Coping with complications of diabetes
38 (17/47)
39 (18/46)
21 (6/28)
60 (18/30)* 40 (62/157)
Feeling angry when you think about living with diabetes
40 (19/47)
30 (14/46)
39 (11/28)
50 (15/30)
39 (61/157)
Feeling overwhelmed by your diabetes regimen
19 (9/47)
28 (13/46)
11 (3/28)
27 (8/30)
22 (34/157)
Treatment-related problems
Not having clear and concrete treatment goals for your diabetes care
38 (18/47)
37 (17/46)
36 (10/28)
63 (19/30)* 41 (65/157)
Feeling unsatisfied with your diabetes physician
34 (16/47)
46 (21/46)
61 (17/28)* 33 (10/30)
41 (65/157)
Feeling discouraged with your diabetes regimens
36 (17/47)
39 (18/46)
46 (13/28)
43 (13/30)
40 (62/157)
Food-related problems
Feeling constantly concerned about food
45 (21/47)
44 (20/46)
32 (9/28)
43 (13/30)
42 (66/157)
Feelings of deprivation regarding food and meals
34 (16/47)
44 (20/46)
32 (9/28)
50 (15/30) 40 (63/157)
Uncomfortable interactions around diabetes with family/friends (e.g. other
38 (18/47)
35 (16/46)
3 (11/28)
40 (12/30)
37 (58/157)
people telling you what to eat)
Social support-related problems
Feeling that friends/family are not supportive of diabetes-management efforts 55 (26/47)* 41 (19/46)
64 (18/28)* 40 (12/30)
48 (75/157)
Feeling alone with diabetes
40 (19/47)
44 (20/46)
43 (12/28)
37 (11/30)
40 (63/157)
#Total PAID ranges from 0–80 on a scale (0–1) ‘not a problem’, (2) ‘a little problem’ and (3–4) ‘serious problem.
*Very high areas concerning diabetes-specific distress in Zambian patients.