Development and psychometric validation of the Diabetic Retinopathy Psychosocial Adjustment Questionnaire (DRPAQ) in Iranian patients

Diabetic retinopathy (DR) is a leading cause of vision impairment in adults with diabetes and is associated with substantial psychosocial stressors, including progressive vision loss, high treatment costs, and reduced personal and social functioning. These challenges can impair adaptive coping, exacerbate emotional distress, and worsen clinical outcomes. Although several instruments assess vision-related quality of life in DR, none specifically measure broader psychosocial adjustment processes in culturally diverse settings. This study aimed to develop and psychometrically validate a new questionnaire—the Diabetic Retinopathy Psychosocial Adjustment Questionnaire (DRPAQ)—grounded in Lazarus and Folkman’s transactional model of stress and coping, for use in Iranian patients with DR. This cross-sectional psychometric study was conducted in 2025 at a tertiary eye hospital in northeastern Iran. An initial 65-item pool was generated from prior qualitative data and refined using DeVellis’s eight-step approach. Face validity (qualitative and quantitative), content validity (CVR and CVI with 12 experts), and construct validity (exploratory and confirmatory factor analysis on 364 patients) were assessed. Reliability was evaluated through internal consistency (Cronbach’s alpha) and test-retest stability (intraclass correlation coefficient) in 30 patients. Analyses were performed using SPSS 25 and AMOS. The final 35-item DRPAQ demonstrated a clear six-factor structure corresponding to the transactional model constructs, explaining 62.4% of variance. Confirmatory factor analysis showed excellent fit (χ²/df = 2.14, RMSEA = 0.056, CFI = 0.95, TLI = 0.94, NFI = 0.92, SRMR = 0.045). Cronbach’s alpha ranged from 0.971 to 0.995 across subscales (overall 0.992) in the full validation sample ( n = 364), and test-retest intraclass correlation in the pilot subsample ( n = 30) was 0.89. The DRPAQ demonstrates promising psychometric properties and appears to be a culturally relevant instrument for assessing psychosocial adjustment in diabetic retinopathy. It may offer a potentially valuable tool for clinical screening and research, enabling early identification of adaptation barriers and facilitating targeted interventions to improve coping and quality of life in this population.