Validity and reliability of the Zambian version of the Problem Areas in Diabetes (PAID) scale: A triangulation with cognitive interviews

Document Type



Institute for Human Development


Abstract: This study aimed to examine the psychometric properties of the Zambian version of the Problem Areas in Diabetes (PAID) scale and to determine the levels of diabetes-specific emotional distress in Zambian people with diabetes. A total of 157 Zambians living with type 1 and 2 diabetes completed the 20-item PAID, self-care inventory (SCI), fear for hypoglycaemia scale (HFS) and the major depression inventory (MDI) in study 1. In addition to exploratory factor analysis (EFA), reliability and validity tests were also conducted. In study 2, eight patients participated in cognitive interviews, in order to evaluate the extent to which participants were able to comprehend the scale items. EFA showed that a one-factor solution was the best interpretable solution and the PAID was a valid and reliable measure. Cognitive interviews showed that the participants were able to comprehend question intent, while a few faced some challenges with the meaning of words such as 'anxious' and 'physician', and with comprehension of some items. The Zambian version of the PAID is a reliable and valid measure to assess diabetes-specific distress. These Zambian participants with diabetes expressed high levels of diabetes-specific distress, and some items needed to be simplified or clarified to enhance comprehensibility.


This work was published before the author joined Aga Khan University.


South African Journal of Diabetes and Vascular Disease