Translation and validation of the Chinese version of Type 2 Diabetes Distress Assessment System (C-T2-DDAS)

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AIMS: This study aimed to translate the Type 2 Diabetes Distress Assessment System (T2-DDAS) into Traditional Chinese (C-T2-DDAS) and evaluate its psychometric properties among individuals with type 2 diabetes in Hong Kong. T2-DDAS is a comprehensive tool designed to assess diabetes-related core emotional distress and the sources contributing to the distress. METHODS: A two-phase approach was employed. Phase 1 involved translation and cultural adaptation through forward and backward translation, expert panel review, and pilot testing. Phase 2 comprised a cross-sectional validation study with 292 participants recruited from a public hospital outpatient clinic. Psychometric evaluation included assessments of reliability (internal consistency and test-retest), content validity, structural validity via confirmatory factor analysis, and convergent validity through correlations with the Chinese Diabetes Distress Scale. RESULTS: The C-T2-DDAS demonstrated good internal consistency (0.95 for CORE scale; 0.76-0.88 for seven SOURCE scales) and moderate test-retest reliability (ICC = 0.63). Content validity indices were high (S-CVI = 1.00 for CORE; 0.96 for seven SOURCE scales). Confirmatory factor analysis supported the original eight-factor structure, indicating a strong model fit (RMSEA = 0.045; SRMR = 0.041; CFI/NNFI = 1.00). Convergent validity was confirmed through strong correlations with the Chinese Diabetes Distress Scale (CORE scale: r = 0.78, p < 0.001). CONCLUSIONS: The C-T2-DDAS is a reliable and culturally appropriate tool for assessing diabetes-related distress in Chinese adults with type 2 diabetes. Its multidimensional structure facilitates targeted psychosocial interventions, supporting routine screening and improved diabetes management in both clinical and research contexts. Future research should explore its longitudinal responsiveness and applicability across broader Chinese-speaking populations.

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