Validation of The Acceptance & Action Diabetes Questionnaire in Spanish (AADQ-S)

Diabetes is a devastating disease that disproportionately affects Hispanic/Latino/ Latinx (H/L) populations. Assessing factors that influence diabetes outcomes is crucial, including diabetes acceptance, which is linked to better glycemic control, improved physical and mental health, and enhanced quality of life. The Acceptance and Action Diabetes Questionnaire (AADQ) is an established measure of diabetes acceptance, available in five languages. However, despite the incidence of diabetes in H/L communities being more than twice that of non-Hispanic White patients, no Spanish-language version of the AADQ currently exists. Therefore, this study aimed to evaluate the psychometric properties of a Spanish translation of the AADQ (AADQ-S).

The AADQ-S was developed by a team of bilingual experts following best practices for translation. To evaluate its psychometric properties, the study evaluated associations among the AADQ-S and self-reported current HbA1c, diabetes self-care (Summary of Diabetes Self-Care Activities), and health-related quality of life (HRQOL) among 144 Spanish-speaking participants at a diabetes center in the southwestern United States. Descriptive, correlational, and factor analytic models were conducted.

Most participants (71%) reported female cis-gender identity, 54% had completed at least high school, and more than half reported an annual income below $20,000. Nearly half (43%) reported they were born in Mexico; most (76%) had unmanaged diabetes (HbA1c ≥7%). A series of factor analyses was conducted to evaluate the structure with best fit to the data. Cronbach's alpha coefficient was also calculated to evaluate internal consistency reliability. The resulting 10-item AADQ-S demonstrated good internal consistency reliability (0.85). Results indicate lower AADQ-S scores (i.e., lower diabetes acceptance) were associated with higher HbA1c (r = -0.24) and worse self-rated general health (r = -0.23). However, the AADQ-S was unrelated to days of healthy self-care (r = 0.06), indicating mixed convergent validity.

This study found that the AADQ-S demonstrated good internal consistency reliability and evidence of construct validity. Also discovered in this study, the link between diabetes acceptance and self-reported self-management may be more complex than previously understood, especially in marginalized populations, requiring further investigation. Limitations include the modest sample size and self-reported HbA1c. The AADQ-S allows a better understanding of diabetes acceptance, a critical target to improve assessment, treatment targets, and outcomes for H/L populations dealing with type 2 diabetes.