Abstract
This study aimed to test the validity and reliability of a four-item patient health questionnaire as a psychological distress screening tool for patients with type 2 diabetes in Indonesia. This cross-cultural adaptation study was applied in five public health-care centres in Indonesia in August-October 2018 using a four-item patient health questionnaire. The content, convergent and factorial validity were assessed, and Cronbach's alpha coefficient was the reliability indicator. A total of 147 participants were involved. Content validity resulted in acceptable outcomes (item and scale content validity indexes were 0.95 and 0.75, respectively). Anxiety and depression were associated with total score and psychological distress status (P < 0.001), supporting the convergent validity outcomes. Principal component analysis using varimax rotation revealed two factors, explaining 76.14% of variance (P < 0.001). Cronbach's alpha coefficients for anxiety, depression and total score were 0.780, 0.500 and 0.713, respectively. The study demonstrated adequate validity and reliability for the Indonesian version of a four-item patient health questionnaire among patients with type 2 diabetes. Therefore, it is applicable as a screening tool for psychological distress in this population.
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