Reliability and validity of the Icelandic version of the problem area in diabetes (PAID) scale

Background: Diabetes is a burdensome disease that increases distress among people with diabetes. Objectives: To test the validity and reliability of an Icelandic version of the problem area in diabetes scale (PAID) and to assess the hitherto unknown distress level of Icelandic people with insulin requiring diabetes. Design: Methodological research design. Setting: Diabetes clinics. Participants: People with insulin-dependent diabetes, between 18 and 61 years. Methods: All instruments were translated using a back-translation technique. Participants answered three consecutive questionnaires in succession, the PAID scale, the diabetes empowerment scale (DES) and the diabetes knowledge test (DKT). Principical component analysis with varimax rotation was conducted on the PAID scale to identify latent factors. Results: Factor analysis revealed two factors: (a) distress in relation to life with diabetes, with Cronbach α coefficient of 0.93 and (b) distress in relation to management of diabetes, with Cronbach α coefficient of 0.88, for PAID overall Cronbach α coefficient was 0.94. PAID showed neither floor nor ceilings effects. Propositions set to indicate validity were generally met. However, PAID's factor structure and predictive validity needs to be tested further. Conclusions: The Icelandic version of PAID is sufficiently psychometrically robust. PAID is simple to administer and by using the scale clinicians can identify people at risk for developing diabetes-related distress. The results are comparable to results from studies in other countries using the PAID scale.