Confirmatory factor analysis of the parent and child problem areas in diabetes measures in a clinical sample of youth with type 1 diabetes

OBJECTIVE: The Problem Areas in Diabetes Child version (PAID-C) and Parent version (P-PAID-C) have demonstrated initial validity and reliability in research samples; however, little is known about their performance in routine clinical settings. This study evaluated the factor structure of the PAID-C and P-PAID-C using clinic-based screening data from school-aged children (aged 8-12 years) with type 1 diabetes (T1D) and their parents. METHODS: Children with T1D and their parents completed the PAID-C and P-PAID-C as part of standard clinic screening. We conducted confirmatory factor analyses using weighted least-squares mean and variance-adjusted estimation. We tested one-, two-, and four-factor models based on previous validation work and evaluated model fit using comparative fit index, Tucker-Lewis index, root mean square error of approximation, and standardized root mean squared residual. RESULTS: Across approximately 24 months, 371 children completed the PAID-C and 893 parents completed the P-PAID-C. For the PAID-C, the one- and two-factor models both showed acceptable fit, with the two-factor model demonstrating the best fit. For the P-PAID-C, only the four-factor model reached acceptable fit after we correlated two similar error terms. Child PAID-C scores did not correlate with glycated hemoglobin (HbA1c), while parent P-PAID-C scores showed a small positive association with child HbA1c and were higher among parents of Hispanic children. CONCLUSIONS: Findings support the structural validity of the PAID-C and P-PAID-C when used in real-world clinical care. Results confirm diabetes distress as a multidimensional construct and reinforce the clinical utility of these brief measures for identifying specific distress domains and informing tailored interventions for children with T1D and their caregivers.