Translation, cultural adaptation, and psychometric evaluation of the arabic version of the type 1 diabetes stigma assessment scale (DSAS-1-Ar) among adults in Jazan, Saudi Arabia

Abstract

Background: Diabetes-related stigma adversely affects psychological wellbeing, self-care behaviors, and glycemic control in individuals with Type 1 diabetes (T1D). Despite the high prevalence of T1D in the Middle East and North Africa region, validated Arabic instruments to assess stigma remain limited. This study aimed to translate, culturally adapt, and evaluate the psychometric properties of the Arabic version of the Type 1 Diabetes Stigma Assessment Scale (DSAS-1-Ar) from the original English instrument. Methods: A cross-sectional study was conducted among 299 adults with T1D attending the Endocrinology and Diabetes Centre in Jazan, Saudi Arabia, recruited using consecutive sampling (response rate 99.3%). Translation followed established cross-cultural adaptation guidelines. Construct validity was examined using confirmatory factor analysis, with three competing structural models tested. In addition, Known-groups comparisons were executed between DSAS-1-Ar scores and self-reported clinical variables. Results: All 19 items loaded significantly onto their hypothesized latent factors (Treated Differently (TD), Blame and Judgment (BJ), and Identity Concerns (IC); standardised loadings 0.642-0.947). Internal consistency was good (total α = 0.985, ω = 0.986). None of the three compared structural models met conventional fit thresholds (CFI range 0.812-0.888; RMSEA range 0.167-0.202). SRMR for the three-factor model was acceptable (0.065), while CFI (0.816) and RMSEA (0.202) indicated suboptimal global fit. Known-groups validation analyses yielded plausibly different scores across distinct populations; e.g. higher stigma scores among females, older participants and those with diabetes-related complications. Conclusions: The DSAS-1-Ar represents an important initial step toward assessing T1D-related stigma in Arabic-speaking populations. Items loaded strongly onto theoretically assigned subscales and internal consistency was good. However, global CFA fit indices were suboptimal, indicating that the factor structure requires further evaluation in this cultural context. Future studies can include assessing convergent validity, test-retest stability, and model fit in more diverse Arabic-speaking samples. Trial registration: Clinical trial number: not applicable. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-026-02022-2.