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Cultural Adaptation, Translation, and Psychometric Validation of the Chinese Diabetes Education Questionnaire
Jennifer Xiao1, Gabriela Lima de Melo Ghisi2, Anne Cao3
1Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Canada.
Aims:
To culturally adapt and translate the DiAbeTes Education Questionnaire (DATE-Q) into Chinese (DATE-Q-Chinese); and psychometrically validate the DATE-Q-Chinese for Chinese-speaking adults with type 2 diabetes (T2D).
Methods:
We culturally adapted and translated the DATE-Q using a structured framework. We measured content and face validity among 7 care providers and 7 Chinese people with T2D. We conducted a multi-site, cross-sectional survey at outpatient clinics in Toronto, Canada (2024-25) for psychometric validation of the DATE-Q-Chinese among 103 Cantonese and/or Mandarin-speaking adults aged ≥18 years with T2D, excluding those who were pregnant or had conditions precluding questionnaire completion. We conducted exploratory factor analysis, calculated Cronbach's α (internal consistency), measured the correlation between DATE-Q-Chinese and Health Literacy index scores (criterion validity), and conducted analyses of variance to compare DATE-Q-Chinese scores across educational levels (construct validity).
Results:
Mean content validity and face validity scores were 4.7 (standard deviation 0.6) and 4.7 (0.5) out of 5. Validation study participants were 35.9% female (mean age 63.5 (12.6) years). Five factors matching the original DATE-Q domains (self-management, long-term complications, being active, healthy eating, psychosocial wellbeing) explained 64.2% of the total variance. Cronbach's α was 0.84 (range: 0.70-0.85 across domains). The total DATE-Q-Chinese score (mean 13.4 (3.8) out of 20) was positively correlated with health literacy (r=0.269, p=0.006) and increased with education level (p=0.01). The "healthy eating" items had the highest mean score (3.5 (0.9)) and least "I don't know responses" (range: 6.8-10.7% across items), while "self-management" items had the lowest mean score (1.8 (1.2)) and most "I don't know" responses (range: 9.7-41.7%).
Conclusions:
The DATE-Q-Chinese is reliable and valid for assessing T2D-related knowledge among Chinese adults with T2D attending routine diabetes care.