• diabetes mellitus;
  • Problem Areas in Diabetes scale;
  • quality of life

Accessible summary

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    Several instruments have been developed for the assessment of emotional distress in patients with diabetes. The Problem Areas in Diabetes Scale (PAID) is a brief self-report scale that evaluates diabetes-related distress.
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    There is a lack of validated instruments for the evaluation of psychological aspects in patients with diabetes in Greek language.
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    The current study was conducted to translate and adapt the PAID scale in Greek language and to evaluate the psychometric properties in two different study populations of patients with diabetes.


The aim of this study was to translate the Problem Areas in Diabetes (PAID) scale into Greek, adapt it culturally to Greece and determine its psychometric properties. The translation process included two forward translations, reconciliation, backward translation and pre-testing steps. The validation incorporated the exploration of internal consistency (Cronbach's alpha), test–retest reliability (interclass correlation coefficient), construct validity (exploratory factor analysis) and responsiveness (Spearman correlation coefficient). Participants included 101 consecutive patients from a rural primary healthcare centre and 101 patients from an urban hospital. All patients completed the PAID scale and the Short Form-36 (SF-36) version 2. Internal consistency considered good (Cronbach's alpha = 0.948). Interclass correlation coefficient was 0.942 (95% CI 0.915–0.961). Factor analysis yielded three factors: ‘Diabetes-related emotional problems’ (51.79% variance, Cronbach's alpha = 0.910), ‘Food-related problems’ (9.55% variance, Cronbach's alpha = 0.824) and ‘Social support-related problems’ (5.96% variance, Cronbach's alpha = 0.704). Scree plot test and conceptual congruency of items supported a three-factor solution. Total PAID showed a negative correlation with both SF-36 mental component summary (r = −0.733, P < 0.0001) and SF-36 physical component summary (r = −0.594, P < 0.0001). Our findings indicate that the Greek version of the PAID questionnaire is reliable and valid for patients with diabetes mellitus in Greece.