The Chinese Localization Of The Type 1 Diabetes Distress Scale And Its Preliminary Application

Objective1.To translate the Type 1 Diabetes Distress Scale(T1-DDS)into Chinese and to test its reliability and validity in Chinese patients with type 1 Diabetes.2.To use the Chinese version of the T1-DDS to investigate the status of psychological distress of type 1 patients and analyze its related influencing factors.Methods1.The translation,reliability and validity evaluation of the scale : Obtained the authorization by emailing to the original author,translated the English-version of the T1-DDS by the Brislin translation model and formed the Chinese version of the T1-DDS.During September 2018 to July 2019,a total of 203 patients with type 1diabetes were recruited from Nanjing Gulou hospital endocrinology inpatient and outpatient clinic by convenience sampling method and investigated by a general data questionnaire,the Chinese version of the T1-DDS,the World Health Organization Five Item Well-being the Index(WHO-5)questionnaire,assessed the scale reliability and validity of the scale according to the results.Item analysis includes the discriminant test and the homogeneity test.The validity tests were conducted by the structural validity,content validity and criterion correlation validity,and the reliability tests were conducted by the internal consistency,half-reliability and retest reliability.2.Status survey: 199 patients with type 1 diabetes were selected August 2019 to January 2020 in endocrinology inpatient and outpatient clinic of Nanjing Gulou hospital by convenience sampling method,and investigated by a general data questionnaire,the Chinese version of the T1-DDS scale,Medical Coping Modes Questionnaire(MCMQ),Perceived Social Support Scale(PSSS).the relevant influencing factors of type 1 diabetes distress were analyzed by the survey results.Measurement data was described by mean±standard deviation,counting data was described by frequency,rate,percentage.The data was analyzed by SPSS22.0,the general information difference in type 1 diabetes distress was compared by t test and one-way ANOVA,the correlations of diabetes distress between coping styles,social support were analyzed by Pearson correlation analysis,the influence factors of diabetes distress were analyzed by multiple linear regression analysis.Results1.The translation,reliability and validity evaluation of the scale:the critical ratio(CR)values of all the Chinese-version T1-DDS items were>3,and the differences were statistically significant(P<0.001).The correlation coefficients between each item and the scale total score were 0.339~0.714(P<0.05).Except of item 22 and item 27,the others were>0.4.There were 28 items in the scale,7 factors were extracted by the exploratory factor analysis,and the cumulative variance contribution rate was69.987%,the factor loads of all items were 0.557~0.831(all>0.4),and there was no double load.The content validity of the scale level is 0.99,and each item level were0.86~1.00.The total score and all items of the Chinese-version T1-DDS were negatively correlated with the WHO-5 questionnaire(r=-0.152~-0.408,P<0.05).The Cronbach's ? coefficient of the scale is 0.921,the dimension of Cronbach's ?coefficient ranged from 0.701 to 0.919,the reliability of the scale is 0.924,the total binary reliability ranged from 0.726 to 0.892,each dimension binary scale retest reliability is 0.839,the dimension weight measuring reliability ranged from 0.716 to0.918.2.Application of the scale: the total scores of the Chinese-version T1-DDS was(60.14±17.01),the average score of each dimension: the average score of powerlessness distress dimension was(2.52±0.90),the negative social cognitive dimension was(2.12±1.04),the disease management dimension was(2.20±0.81),the family/friends distress dimension was(1.98±0.88),the dietary distress dimension was(2.36±1.00),the doctor distress dimension was(1.58±0.67)and the hypoglycaemia distress dimension was(2.23±0.86).Regression analysis showed that family support,avoidance coping style,friend support,yield coping style,numbers of cohabitation,complications,facing cope style,and severe hypoglycemia events were the main influencing factors of the total score of diabetes distress,the total variation accounted for 87.7%.The influence factors of other dimensions: age,cultural level were the main influencing factors of negative social cognitive dimension,marital status was the main factor of the hypoglycaemia distress dimension,number of cohabitation was the main factor of family/friends distress dimension,dietary distress dimension,course of diabetes,Hb A1 c were the main influence factors of the diet distress dimension,complication of diabetes was the main factor of powerlessness distress dimension.Conclusion1.The Chinese version of the type 1 diabetes distress scale has good reliability and validity,which can be used to evaluate the distress of type 1 diabetes patients in China.2.Diabetes distress was common seen in type 1 diabetes.Age,education degree influenced negative social cognitive distress,marital status influenced the distress of hypoglycaemia,number of cohabitation influenced the family/friends related distress and the dietary distress,course of diabetes,Hemoglobin A1 c influenced the patient's dietary distress,diabetes complications influenced the powerlessness distress,medical coping styles of disease,family support,friend support were the main influenced factors of diabetes distress.Therefore,clinical medical workers can take the influencing factors of diabetes distress as the entry point,give attentions to type 1diabetes distress.Guiding patients to adopt positive coping methods,using social support effectively to reduce diabetes distress,promote physical and mental health.