Skip to main content
SpringerLink
Log in

Psychometric properties of Persian Diabetes-Mellitus Specific Quality of Life (DMQoL) questionnaire in a population-based sample of Iranians

  • Original Article
  • Published:
International Journal of Diabetes in Developing Countries Aims and scope Submit manuscript

Abstract

Health-related quality of life (HRQoL) among patients with diabetes mellitus is often poorer than in those with other chronic medical conditions. Appropriate disease specific measures are needed to measure HRQoL in these patients. This study sought to validate a culturally adapted version of the Diabetes-Mellitus Specific Quality of Life (DMQoL) questionnaire module in Persian. Concurrent validity of the scale was assessed by the Diabetes Quality of Life (DQOL) questionnaire. Convergent and discriminative validity of the DMQoL was determined using a brief version of World Health Organization’s Quality of Life Scale Brief version (WHOQOL-BREF), Hospital Anxiety and Depression Scales (HADS), and Medication Adherence Report Scale (MARS). Construct validity was examined using confirmatory factor analysis. Rasch analysis was also performed to examine the unidimensionality of the DMQoL. Known-group method was used to examine the ability of the scale to differentiate between different categories of patients. A sample of 824 patients (512 females) with diabetes mellitus was recruited from diabetic care centers located in Qazvin, Iran. The mean age of participants was 54.1 (SD 6.3) and 27% were smokers. All items loaded on a single factor (factor loadings ≥ 0.6) and internal consistency of the scale was acceptable (α = 0.89). Significant associations were found between the scale and DQOL, indicating concurrent validity (p < 0.001). The DMQoL was able to differentiate subgroups of patients with hypertension, HbA1c, cholesterol, and diabetic diet. All items were appropriate with regard to difficulty level and confirmatory factor analysis verified the scale’s single dimension (CFI = 0.927; RMSEA = 0.067). Persian DMQoL is a reliable and valid measure of HRQoL in a Persian-speaking population with type II diabetes. Further assessment is needed to confirm the psychometric properties of the scale in other cultures and languages. Future studies are needed to determine the sensitivity of the scale to change over time in response to treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. McDowell JRS, Matthews DM, Brown FJ. Diabetes : a handbook for the primary care healthcare team. 2nd ed. Edinburgh: Churchill Livingstone Elsevier; 2007.

    Google Scholar 

  2. Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract. 2014;103(2):137–49. https://doi.org/10.1016/j.diabres.2013.11.002.

    Article  CAS  PubMed  Google Scholar 

  3. Hunt BR, Whitman S, Henry CA. Age-adjusted diabetes mortality rates vary in local communities in a metropolitan area: racial and spatial disparities and correlates. Diabetes Care. 2014;37(5):1279–86. https://doi.org/10.2337/dc13-0988.

    Article  PubMed  Google Scholar 

  4. Zghebi SS, Steinke DT, Carr MJ, Rutter MK, Emsley RA, Ashcroft DM. Examining trends in type 2 diabetes incidence, prevalence and mortality in the UK between 2004 and 2014. Diabetes Obes Metab. 2017;19(11):1537–45. https://doi.org/10.1111/dom.12964.

    Article  PubMed  Google Scholar 

  5. National Diabetes Statistics Report. 2017: Estimates of Diabetes and Its Burden in the United States [database on the Internet]. US Department of Health and Human Services. URL: https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetesstatistics-report.pdf. Accessed 25 Jan 2018.

  6. Wu H, Meng X, Wild SH, Gasevic D, Jackson CA. Socioeconomic status and prevalence of type 2 diabetes in mainland China, Hong Kong and Taiwan: a systematic review. J Global Health. 2017;7(1):011103. https://doi.org/10.7189/jogh.07.011103.

    Article  Google Scholar 

  7. Jan Mohamed HJ, Yap RW, Loy SL, Norris SA, Biesma R, Aagaard-Hansen J. Prevalence and determinants of overweight, obesity, and type 2 diabetes mellitus in adults in Malaysia. Asia Pac J Public Health. 2015;27(2):123–35. https://doi.org/10.1177/1010539514562447.

    Article  PubMed  Google Scholar 

  8. Onat A, Hergenc G, Uyarel H, Can G, Ozhan H. Prevalence, incidence, predictors and outcome of type 2 diabetes in Turkey. Anatol J Cardiol. 2006;6(4):314–21.

    Google Scholar 

  9. Rashedi V, Asadi-Lari M, Delbari A, Fadayevatan R, Borhaninejad V, Foroughan M. Prevalence of diabetes type 2 in older adults: findings from a large population-based survey in Tehran, Iran (urban HEART-2). Diabetol Metab Syndr. 2017;11(Suppl 1):S347–S50. https://doi.org/10.1016/j.dsx.2017.03.014.

    Article  Google Scholar 

  10. Haghdoost AA, Rezazadeh-Kermani M, Sadghirad B, Baradaran HR. Prevalence of type 2 diabetes in the Islamic Republic of Iran: systematic review and meta-analysis. East Mediterr Health J. 2009;15(3):591–9.

    Article  CAS  PubMed  Google Scholar 

  11. Bruni L, Porta PL. Handbook of research methods and applications in happiness and quality of life. Handbooks of research methods and applications. Cheltenham: Edward elgar; 2016.

    Google Scholar 

  12. Neumann A, Schoffer O, Norstrom F, Norberg M, Klug SJ, Lindholm L. Health-related quality of life for pre-diabetic states and type 2 diabetes mellitus: a cross-sectional study in Vasterbotten Sweden. Health Qual Life Outcomes. 2014;12:150. https://doi.org/10.1186/s12955-014-0150-z.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Lu Y, Wang N, Chen Y, Nie X, Li Q, Han B, et al. Health-related quality of life in type-2 diabetes patients: a cross-sectional study in East China. BMC Endocr Disord. 2017;17(1):38. https://doi.org/10.1186/s12902-017-0187-1.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Mills T, Law SK, Walt J, Buchholz P, Hansen J. Quality of life in glaucoma and three other chronic diseases: a systematic literature review. Drugs Aging. 2009;26(11):933–50. https://doi.org/10.2165/11316830-000000000-00000.

    Article  PubMed  Google Scholar 

  15. Roborel de Climens A, Tunceli K, Arnould B, Germain N, Iglay K, Norquist J, et al. Review of patient-reported outcome instruments measuring health-related quality of life and satisfaction in patients with type 2 diabetes treated with oral therapy. Curr Med Res Opin. 2015;31(4):643–65. https://doi.org/10.1185/03007995.2015.1020364.

    Article  CAS  PubMed  Google Scholar 

  16. Strickland OL. General and Specific measures of quality of life--do we need both? J Nurs Meas. 2000;8(1):3–4.

    Article  CAS  PubMed  Google Scholar 

  17. Jacobson AM, de Groot M, Samson JA. The evaluation of two measures of quality of life in patients with type I and type II diabetes. Diabetes Care. 1994;17(4):267–74.

    Article  CAS  PubMed  Google Scholar 

  18. Elasy T, Samuel-Hodge C, Skelly A, Keyserling T, Ammerman A. Development of a health-related quality of life measure in older African American women with type 2 diabetes. Diabetes. 1998;47:A323-A.

    Google Scholar 

  19. Bradley C, Todd C, Gorton T, Symonds E, Martin A, Plowright R. The development of an individualized questionnaire measure of perceived impact of diabetes on quality of life: the ADDQoL. Qual Life Res Int J Qual Life Asp Treat Care Rehab. 1999;8(1–2):79–91.

    CAS  Google Scholar 

  20. Shen W, Kotsanos JG, Huster WJ, Mathias SD, Andrejasich CM, Patrick DL. Development and validation of the diabetes quality of life clinical trial questionnaire. Med Care. 1999;37(4):As45–66. https://doi.org/10.1097/00005650-199904001-00008.

    Article  CAS  PubMed  Google Scholar 

  21. Pakpour AH, Saffari M, Burri A. Translation and validation of an Iranian version of the diabetes quality of life measure. J Diabetes Invest. 2012;3(5):471–8. https://doi.org/10.1111/j.2040-1124.2012.00217.x.

    Article  Google Scholar 

  22. Lin CY, Lee TY, Sun ZJ, Yang YC, Wu JS, Ou HT. Development of diabetes-specific quality of life module to be in conjunction with the World Health Organization quality of life scale brief version (WHOQOL-BREF). Health Qual Life Outcomes. 2017;15(1):167. https://doi.org/10.1186/s12955-017-0744-3.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000;25(24):3186–91.

    Article  CAS  Google Scholar 

  24. Yousefy AR, Ghassemi GR, Sarrafzadegan N, Mallik S, Baghaei AM, Rabiei K. Psychometric properties of the WHOQOL-BREF in an Iranian adult sample. Community Ment Health J. 2010;46(2):139–47. https://doi.org/10.1007/s10597-009-9282-8.

    Article  CAS  PubMed  Google Scholar 

  25. Lin CY, Pakpour AH. Using hospital anxiety and depression scale (HADS) on patients with epilepsy: confirmatory factor analysis and Rasch models. Seizure. 2017;45:42–6. https://doi.org/10.1016/j.seizure.2016.11.019.

    Article  PubMed  Google Scholar 

  26. Lin CY, Saffari M, Koenig HG, Pakpour AH. Effects of religiosity and religious coping on medication adherence and quality of life among people with epilepsy. Epilepsy Behav. 2017;78:45–51. https://doi.org/10.1016/j.yebeh.2017.10.008.

    Article  PubMed  Google Scholar 

  27. Chen FF. Sensitivity of goodness of fit indexes to lack of measurement invariance. Struct Equ Model. 2007;14(3):464–504. https://doi.org/10.1080/10705510701301834.

    Article  Google Scholar 

  28. Choi SE, Liu M, Palaniappan LP, Wang EJ, Wong ND. Gender and ethnic differences in the prevalence of type 2 diabetes among Asian subgroups in California. J Diabetes Complicat. 2013;27(5):429–35. https://doi.org/10.1016/j.jdiacomp.2013.01.002.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kautzky-Willer A, Kosi L, Lin J, Mihaljevic R. Gender-based differences in glycaemic control and hypoglycaemia prevalence in patients with type 2 diabetes: results from patient-level pooled data of six randomized controlled trials. Diabetes Obes Metab. 2015;17(6):533–40. https://doi.org/10.1111/dom.12449.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Boyer JG, Earp JA. The development of an instrument for assessing the quality of life of people with diabetes. Diabetes-39. Med Care. 1997;35(5):440–53.

    Article  CAS  PubMed  Google Scholar 

  31. Stevens J. Applied multivariate statistics for the social sciences. 5th ed. New York: Routledge; 2009.

    Google Scholar 

  32. Hara Y, Koyama S, Morinaga T, Ito H, Kohno S, Hirai H, et al. The reliability and validity of the Japanese version of the appraisal of diabetes scale for type 2 diabetes patients. Diabetes Res Clin Pract. 2011;91(1):40–6. https://doi.org/10.1016/j.diabres.2010.09.034.

    Article  PubMed  Google Scholar 

  33. Chin YW, Lai PSM, Chia YC. The validity and reliability of the English version of the diabetes distress scale for type 2 diabetes patients in Malaysia. BMC Fam Pract. 2017;18:25. https://doi.org/10.1186/s12875-017-0601-9.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Evans M, Ridderstrale M, Jensen HH, Bogelund M, Jensen MM, Ericsson A, et al. Quantifying the short-term impact of changes in Hba1c, weight and insulin regimen on health related quality-of-life. Value Health. 2015;18(7):A616-A. https://doi.org/10.1016/j.jval.2015.09.2148.

    Article  Google Scholar 

  35. Scollan-Koliopoulos M, Bleich D, Maya R, Rapp KJ. Transitional diabetes care, Hba1c, and Quality of Life. Ann Behav Med. 2012;43:S181-S.

    Article  Google Scholar 

  36. Saffari M, Karimi T, Koenig HG, Al-Zaben F. Psychometric evaluation of the Persian version of the type 2 diabetes and health promotion scale (T2DHPS): a diabetes-specific measure of lifestyle. Scand J Caring Sci. 2015;29(3):603–12. https://doi.org/10.1111/scs.12181.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Huang-tzOu and her colleagues who granted us permission to use the DMQoL. Also, we are grateful for the support from Qazvin University of Medical Sciences, Deputy of Health that facilitated data collection for this study.

Author information

Authors and Affiliations

  1. Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran

    Mohsen Saffari

  2. Health Education Department, School of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran

    Mohsen Saffari & Hormoz Sanaeinasab

  3. Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong

    Chung-Ying Lin

  4. Division of Psychology, Department of Psychiatry, Duke University Medical Center, Durham, NC, USA

    Keisha O’Garo

  5. Duke University Medical Center, Durham, NC, USA

    Harold G. Koenig

  6. King Abdulaziz University, Jeddah, Saudi Arabia

    Harold G. Koenig

  7. Ningxia Medical University, Yinchuan, China

    Harold G. Koenig

  8. Social Determinants of Health Research Center (SDH), Qazvin University of Medical Sciences, Qazvin, Iran

    Amir H. Pakpour

  9. Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden

    Amir H. Pakpour

Authors
  1. Mohsen Saffari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chung-Ying Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Keisha O’Garo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Harold G. Koenig
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hormoz Sanaeinasab
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Amir H. Pakpour
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amir H. Pakpour.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Ethic Committee at Qazvin University of Medical Sciences, and all patients gave written informed consent prior to participation.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Saffari, M., Lin, CY., O’Garo, K. et al. Psychometric properties of Persian Diabetes-Mellitus Specific Quality of Life (DMQoL) questionnaire in a population-based sample of Iranians. Int J Diabetes Dev Ctries 39, 218–227 (2019). https://doi.org/10.1007/s13410-018-0648-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13410-018-0648-8

Keywords

Search

Navigation