The problem areas in diabetes scale: an evaluation of its clinical utility

Welch, Garry W; Jacobson, Alan M; Polonsky, William H

doi:10.2337/diacare.20.5.760

Cited by 664Diabetes Management and EducationPsychometric Methodologies and TestingHealth Education and Validation

The problem areas in diabetes scale: an evaluation of its clinical utility

Welch, Garry W, Jacobson, Alan M, Polonsky, William H·1997·Diabetes Care

DOI 10.2337/diacare.20.5.760

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Abstract

OBJECTIVE: To evaluate the reliability and concurrent and discriminant validity of the Problem Areas in Diabetes (PAID) scale, a new measure of emotional functioning in diabetes. RESEARCH DESIGN AND METHODS: A battery of questionnaires, including the PAID, was completed by 256 volunteer diabetic outpatients. In our analyses, we examined the PAID's internal structure and compared mean IDDM and NIDDM treatment group scores in regression analyses to explore its discriminant validity. We also evaluated concurrent validity from the correlations between the PAID and diabetes-specific measures of coping and health attitudes and HbA1c. RESULTS: Principal component analyses identified a large emotional adjustment factor, supporting the use of the total score. Significant sizable correlations were found between the PAID and a range of selected health attitudinal measures. There were significant differences (with small-to-moderate effect sizes) in PAID scores between IDDM and NIDDM patients and between IDDM and NIDDM insulin- and tablet-treated subgroups; no differences were found between NIDDM insulin- and tablet-treated subgroups. CONCLUSIONS: The study findings provided support for the construct validity of the PAID, including evidence for discriminant validity from its ability to detect differences between IDDM and NIDDM treatment groups expected to differ in the emotional impact of life with diabetes. Future studies should explore the PAID's performance in nonspecialist treatment settings as well as its responsiveness to clinical change.

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Participants were experiencing severe diabetes distress (>40) on average.
“However, participants were experiencing severe diabetes distress (>40) (Welch et al., 1997).”
From An online acceptance, commitment, and self-compassion based treatment to decrease psychological distress in people with type 2 diabetes: A feasibility randomised-controlled trial (2023) · cites this paper as Welch et al., 1997
The original PAID Scale and the Swedish version (Swe-PAID-20) have been proven in terms of validity and reliability.
“The original PAID Scale and the Swedish version of the scale (Swe-PAID-20), which will be used in this study, have been proven in terms of validity and reliability.25 32 33”
From Acceptance and commitment therapy (ACT) for adult type 1 diabetes management: Study protocol for a randomised controlled trial (2018) · cites this paper as [33]

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Gabbay, R. A., Lendel, I., Saleem, T. M., Shaeffer, G., Adelman, A. M., Mauger, D. T., Collins, M., & Polomano, R. C. (2006) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2005.05.002 · Cited by 107 · see citing works
National recommendations: Psychosocial management of diabetes in India
Kalra, S., Sridhar, G. R., Balhara, Y. P. S., Sahay, R. K., Bantwal, G., Baruah, M., John, M., Unnikrishnan, A., Madhu, K., Verma, K., et al. (2013) · Indian Journal of Endocrinology and Metabolism · doi:10.4103/2230-8210.111608 · Cited by 105 · see citing works
“…been included in various evidence‑based guidelines for psychosocial care, such as Well‑being Questionnaire (WHO‑5) [61] (in SIGN, ADA, IDF‑2005; Patient Health Questionnaire‑9 (PHQ‑9) [62] by SIGN, German Diabetic Association; Problem Areas in Diabetes (PAID) Scale [63] by NICE and ADA guidelines.”
Background
Diabetes-related emotional distress in adults: Reliability and validity of the Norwegian versions of the Problem Areas in Diabetes Scale (PAID) and the Diabetes Distress Scale (DDS)
Graue, M., Haugstvedt, A., Wentzel‐Larsen, T., Iversen, M. M., Karlsen, B., & Rokne, B. (2011) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2011.08.007 · Cited by 104 · see citing works
“Previous research (Welch et al., 1997) pports using a total score (with one general 20-item ctor), but both four-factor and two-factor solutions have en reported (Snoek et al.”
BackgroundMethodInfluential
Motivational interviewing delivered by diabetes educators: Does it improve blood glucose control among poorly controlled type 2 diabetes patients?
Welch, G. W., Zagarins, S., Feinberg, R. G., & Garb, J. (2010) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2010.09.036 · Cited by 103 · see citing works
“[14] Welch GW, Jacobson AM, Polonsky WH.”
MethodSelf-citation
Health Care Transition Preparation and Experiences in a U.S. National Sample of Young Adults With Type 1 Diabetes
Garvey, K. C., Foster, N. C., Agarwal, S., DiMeglio, L. A., Anderson, B. J., Corathers, S. D., Desimone, M. E., Libman, I. M., Lyons, S. K., Peters, A. L., et al. (2016) · Diabetes Care · doi:10.2337/dc16-1729 · Cited by 102 · see citing works
“in Diabetes (PAID) scale (23,24) were administered to all participants.”
Method
Diabetes distress: understanding the hidden struggles of living with diabetes and exploring intervention strategies
Berry, E., Lockhart, S. M., Davies, M., Lindsay, J. R., & Dempster, M. (2015) · Postgraduate Medical Journal · doi:10.1136/postgradmedj-2014-133017 · Cited by 102 · see citing works
“Two scales are accepted as statistically sound measures of diabetes distress; The Problem Areas in Diabetes scale (PAID), [15,16] and the Diabetes Distress Scale (DDS), [11].”
Method
Web-based self-management support for people with type 2 diabetes (HeLP-Diabetes): randomised controlled trial in English primary care
Murray, E., Sweeting, M. J., Dack, C., Pal, K., Modrow, K., Hudda, M. T., Li, J., Ross, J., Alkhaldi, G., Barnard, M., et al. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-016009 · Cited by 98 · see citing works
“0 point difference in PAID score at 12 months postrandomisation between the randomised groups.(25) 26 Since HbA1c and PAID were joint primary outcomes measuring different aspects of T2DM, both were tested at a 5% significance level.”
Brazilian version of the Problem Areas in Diabetes Scale (B-PAID): Validation and identification of individuals at high risk for emotional distress
Gross, C. C., Scain, S. F., Scheffel, R. S., Gross, J. L., & Hutz, C. S. (2006) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2006.09.022 · Cited by 98 · see citing works
Effects of a group-based counselling programme on diabetes-related stress, coping, psychological well-being and metabolic control in adults with type 1 or type 2 diabetes
Karlsen, B., Idsøe, T., Dirdal, I., Hanestad, B. R., & Bru, E. (2004) · Patient Education and Counseling · doi:10.1016/j.pec.2003.10.008 · Cited by 97 · see citing works
“Such coping styles were assessed by a scale developed by Karlsen and Bru[11] on the basis of subscales from the Diabetes Coping Measure [24,26], the COPE scale[27], and the Ways of Coping Questionnaire [28] as well as a subscale developed for our project assessing knowledge-seeking.”
BackgroundMethod
Look Who’s (Not) Talking
Beverly, E. A., Ganda, O. P., Ritholz, M. D., Lee, Y., Brooks, K. M., Lewis-Schroeder, N. F., Hirose, M., & Weinger, K. (2012) · Diabetes Care · doi:10.2337/dc11-2422 · Cited by 97 · see citing works
“Diabetic patients experience disproportionately high rates of social and emotional difficulties compared with the general population (16,20,21).”
Background
Are current psychometric tools suitable for measuring outcomes of diabetes education?
Eigenmann, C. A., Colagiuri, R., Skinner, T. C., & Trevena, L. J. (2009) · Diabetic Medicine · doi:10.1111/j.1464-5491.2009.02697.x · Cited by 95 · see citing works
Improving Adherence and Reducing Medication Discrepancies in Patients with Diabetes
Grant, R. W., Devita, N. G., Singer, D. E., & Meigs, J. B. (2003) · Annals of Pharmacotherapy · doi:10.1345/aph.1c452 · Cited by 91 · see citing works
“5 Unable to follow plan for diabetes 3 (5) 12 (21) 0.”
Background
Glycemia, Treatment Satisfaction, Cognition, and Sleep Quality in Adults and Adolescents with Type 1 Diabetes When Using a Closed-Loop System Overnight Versus Sensor-Augmented Pump with Low-Glucose Suspend Function: A Randomized Crossover Study
Sharifi, A., de Bock, M. I., Jayawardene, D., Loh, M., Horsburgh, J. C., Berthold, C. L., Paramalingam, N., Bach, L. A., Colman, P. G., Davis, E. A., et al. (2016) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2016.0288 · Cited by 93 · see citing works
“DTSQs: Diabetes Treatment Satisfaction Questionnaire status (scored 0–36); DTSQ items 2 and 3 (scored 0–6); PAID: Problem Areas in Diabetes (scored 0–100); HFS-II: Hypoglycemia Fear Survey, version 2 (scored 0–4); CHFS: Children Hypoglycemia Fear Survey (scored 0–4).”
Psychotherapy intervention to reduce depressive symptoms in patients with diabetic foot syndrome
Simson, U., Nawarotzky, U., Friese, G., Porck, W., Schottenfeld-Naor, Y., Hahn, S., Scherbaum, W. A., & Kruse, J. (2008) · Diabetic Medicine · doi:10.1111/j.1464-5491.2007.02370.x · Cited by 88 · see citing works
Impact of inpatient diabetes management, education, and improved discharge transition on glycemic control 12 months after discharge
Wexler, D. J., Beauharnais, C. C., Regan, S., Nathan, D. M., Cagliero, E., & Larkin, M. E. (2012) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2012.09.016 · Cited by 89 · see citing works
“Diabetes-specific emotional impact was measured by the 20-item Problem Area in Diabetes (PAID) Scale [18].”
Method
Standardizing disease-specific quality of life measures across multiple chronic conditions: development and initial evaluation of the QOL Disease Impact Scale (QDIS®)
Ware, J. E., Gandek, B., Guyer, R., & Deng, N. (2016) · Health and Quality of Life Outcomes · doi:10.1186/s12955-016-0483-x · Cited by 90 · see citing works
“QDIS-7 scored so a higher score equals worse health Abbreviations: CKD chronic kidney disease Self-rating of disease severity (5 categories, None-Very Severe) Disease-specific QOL measures are Arthritis: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC®) Total scale [6]; CKD: Kidney-Disease Qualit…”
Diabetes Fear of Injecting and Self-Testing Questionnaire: a psychometric evaluation.
Mollema, E. D., Snoek, F. J., Pouwer, F., Heine, R. J., & van der Ploeg, H. M. (2000) · Diabetes Care · doi:10.2337/diacare.23.6.765 · Cited by 89 · see citing works
Improvement in glycemic control following a diabetes education intervention is associated with change in diabetes distress but not change in depressive symptoms
Zagarins, S., Allen, N. A., Garb, J., & Welch, G. W. (2011) · Journal of Behavioral Medicine · doi:10.1007/s10865-011-9359-z · Cited by 87 · see citing works
“The PAID has high internal reliability (a [ 0.90), sound concurrent validity as determined by moderate to strong correlations with a range of theoretically-related measures (Polonsky et al. 1995; Welch et al. 1997 ), and responsiveness to change with brief psychosocial and educational interventions (Welch et al. 2003).”
BackgroundInfluentialSelf-citation
A systematic review of the relationships among psychosocial factors and coping in adults with type 2 diabetes mellitus
McCoy, M., & Theeke, L. A. (2019) · International Journal of Nursing Science · doi:10.1016/j.ijnss.2019.09.003 · Cited by 85 · see citing works
“Concurrent and discriminant validity is well documented [37].”
Background
Putting PAID to Diabetes-Related Distress: The Potential Utility of the Problem Areas in Diabetes (PAID) Scale in Patients with Diabetes
Reddy, J., Wilhelm, K. A., & Campbell, L. V. (2013) · Psychosomatics · doi:10.1016/j.psym.2012.08.004 · Cited by 89 · see citing works
Severe hypoglycaemia and its association with psychological well-being in Australian adults with type 1 diabetes attending specialist tertiary clinics
Hendrieckx, C., Halliday, J. A., Bowden, J. P., Colman, P. G., Cohen, N. D., Jenkins, A. J., & Speight, J. (2014) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2013.12.005 · Cited by 87 · see citing works
Development and Psychometric Properties of the 12-Item Diabetes Fatalism Scale
Egede, L. E., & Ellis, C. (2009) · Journal of General Internal Medicine · doi:10.1007/s11606-009-1168-5 · Cited by 87 · see citing works
A comparison of health-related quality of life of elderly and younger insulin-treated adults with diabetes
Trief, P. M., Wade, M. J., Pine, D., & Weinstock, R. S. (2003) · Age and Ageing · doi:10.1093/ageing/afg105 · Cited by 87 · see citing works
“95) and strong concurrent and discriminant validity [24, 25].”
Background
Telemonitoring and Team-Based Management of Glycemic Control on People with Type 2 Diabetes: a Cluster-Randomized Controlled Trial
Lee, J. Y., Chan, C. K. Y., Chua, S. S., Ng, C. J., Paraidathathu, T., Lee, K. K. C., & Lee, S. W. H. (2020) · Journal of General Internal Medicine · doi:10.1007/s11606-019-05316-9 · Cited by 79 · see citing works
“Emotional distress and functioning in diabetes were measured using the Problem Area in Diabetes (PAID) questionnaire.(15)”
Method
Diabetes nurse case management and motivational interviewing for change (<scp>DYNAMIC</scp>): Results of a 2‐year randomized controlled pragmatic trial (糖尿病护士病例管理以及促进改变的动机性会谈（DYNAMIC）：一项为期2年的实用随机对照研究)
Gabbay, R. A., Añel‐Tiangco, R. M., Dellasega, C., Mauger, D. T., Adelman, A., & Van Horn, D. H. A. (2013) · Journal of Diabetes · doi:10.1111/1753-0407.12030 · Cited by 85 · see citing works
“A five-point scale is used to rate each item and the score is rescaled from 0 to 100, with a high score indicating greater emotional distress from diabetes.(19) The DTSQ is a six-item measure of satisfaction with the diabetes regimen, rated from 0 to 6.”
Method
Health Related Quality of Life Measurements for Diabetes: A Systematic Review
Oluchi, S. E., Manaf, R. A., Ismail, S., Shahar, H. K., Mahmud, A., & Udeani, T. K. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18179245 · Cited by 102 · see citing works
Gender Differences in Functional Limitations in Adults Living with Type 2 Diabetes: Biobehavioral and Psychosocial Mediators
Chiu, C.-J., & Wray, L. A. (2011) · Annals of Behavioral Medicine · doi:10.1007/s12160-010-9226-0 · Cited by 84 · see citing works
“a ten-item Problem Areas In Diabetes scale [51], asking the participants their feelings on a wide array of diabetes situations (e.”
Background
Development and Validation of a New Measure to Evaluate Psychological Resistance to Insulin Treatment
Petrak, F., Stridde, E., Leverkus, F., Crispin, A., Forst, T. M., & Pfützner, A. (2007) · Diabetes Care · doi:10.2337/dc06-2042 · Cited by 84 · see citing works
The Association between Diabetes-Related Distress and Medication Adherence in Adult Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study
Kretchy, I. A., Koduah, A., Ohene‐Agyei, T., Boima, V., & Appiah, B. (2020) · Journal of Diabetes Research · doi:10.1155/2020/4760624 · Cited by 87 · see citing works
“Diabetes distress was assessed using the Problem Areas In Diabetes Questionnaire [37].”
Method
The influence of diabetes psychosocial attributes and self-management practices on change in diabetes status
Zulman, D. M., Rosland, A.-M. M., Choi, H., Langa, K. M., & Heisler, M. (2011) · Patient Education and Counseling · doi:10.1016/j.pec.2011.07.013 · Cited by 78 · see citing works
A Qualitative Study of Perceived Responsibility and Self-Blame in Type 2 Diabetes: Reflections of Physicians and Patients
Beverly, E. A., Ritholz, M. D., Brooks, K. M., Hultgren, B. A., Lee, Y., Abrahamson, M. J., & Weinger, K. (2012) · Journal of General Internal Medicine · doi:10.1007/s11606-012-2070-0 · Cited by 84 · see citing works
The effect of an education programme (HyPOS) to treat hypoglycaemia problems in patients with type 1 diabetes
Hermanns, N., Kulzer, B., Kubiak, T., Krichbaum, M., & Haak, T. (2007) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.710 · Cited by 80 · see citing works
Supporting insulin initiation in type 2 diabetes in primary care: results of the Stepping Up pragmatic cluster randomised controlled clinical trial
Furler, J., O’Neal, D., Speight, J., Manski-Nankervis, J.-A., Gorelik, A., Holmes-Truscott, E., Ginnivan, L., Young, D., Best, J., dean, et al. (2017) · BMJ · doi:10.1136/bmj.j783 · Cited by 78 · see citing works
If it does not significantly change HbA<sub>1c</sub> levels why should we waste time on it? A plea for the prioritization of psychological well‐being in people with diabetes
Jones, A., Vallis, M., & Pouwer, F. (2015) · Diabetic Medicine · doi:10.1111/dme.12620 · Cited by 79 · see citing works

Authors: Welch, G. W., Jacobson, A. M., & Polonsky, W. H.
Affiliations: Mental Health Unit, Balboa Medical Center San Diego, California
Joslin Diabetes Center (US)
ORCID: Polonsky, William H
Venue: Diabetes Care
Publisher: American Diabetes Association
Published: 1997-05-01
Volume: 20
Issue: 5
Pages: 760-766
ISSN: 0149-5992 (ISSN-L)
1935-5548
DOI: 10.2337/diacare.20.5.760
OpenAlex: W2134365893
Cited by: 664
References: 0
Citations by year: 2026: 20 · 2025: 20 · 2024: 35 · 2023: 37 · 2022: 49 · 2021: 46 · 2020: 35 · 2019: 37 · 2018: 28 · 2017: 33 · 2016: 23 · 2015: 31 · 2014: 32 · 2013: 25 · 2012: 37
FWCI: 0.71
Type: journal article
Language: en
Open access: closed
Locations: Diabetes Care (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (5r01dk027845-14)
National Institute of Diabetes and Digestive and Kidney Diseases (DK27845, DK42315, R01DK042315)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
Social Sciences › Education › Health Education and Validation
Keywords: Problem Areas in Diabetes scale, emotional adjustment, type 1 diabetes, type 2 diabetes, discriminant validity, concurrent validity, psychometric properties, coping, health attitudes, insulin-treated diabetes, HbA1c
MeSH terms: Adaptation, Psychological, Adult, Attitude to Health, Demography, Diabetes Mellitus, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Diet, Diabetic, Education, Emotions, Female, Humans, Hypoglycemic Agents, Insulin, Male, Middle Aged, Surveys and Questionnaires, Socioeconomic Factors, Reproducibility of Results, Discriminant Analysis

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The problem areas in diabetes scale: an evaluation of its clinical utility

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