Translation and validation of a Spanish version of the Patient Experience with Treatment and Self-Management (PETS) measure

Context: Treatment burden reflects the personal workload of healthcare, including self-management, and its impact on function and well-being.

Objective: Translate into Spanish and validate a comprehensive measure of treatment burden, the PETS, in people with diabetes and multimorbidity.

Study Design and Analysis: Cross-sectional survey study; validity testing after a robust translation.

Setting: Safety net clinics in the U.S. upper Midwest.

Population Studied: 52 Spanish-speaking patients with multimorbidity, including diabetes.

Instrument: Telephone or web-based survey including demographics; measures of distress (DDS); self-efficacy (PDSMS); physical and mental well-being (PROMIS); medication adherence, financial difficulties, English language proficiency, glycosylated hemoglobin (HbA1c); and the PETS measure of 12 domains: medical information (7 items), medications (7 items), bother due to medications (2 items), medical appointments (6 items), monitoring health (2 items), diet (3 items), exercise (4 items), medical equipment (2 items), medical and healthcare expenses (5 items), difficulty with healthcare services (7 items), role and social activity limitations (6 items), and physical and mental fatigue (5 items). Higher scores indicated greater burden.

Outcome measures: Linguistic translation using forward/back translation, review and reconciliation. Cronbach’s alpha to test internal consistency reliability of PETS domains, Spearman correlations to test convergent validity of domains with related constructs (DDS, PDSMS, PROMIS), and independent samples t-tests to compare domains across distinct groups.

Results: Respondents were 18-77 years old, 54% female, and 80% with limited English proficiency. Translated PETS scales showed good reliability (Cronbach’s alpha range: 0.62 to 0.92). Higher PETS scale scores correlated with more diabetes distress (rho range: 0.16 to 0.55), lower self-efficacy (rho range: -0.14 to -0.60), and worse physical (rho range: -0.25 to -0.61) and mental wellbeing (rho range: -0.05 to -0.62; all ps <0.1 except for 4). Patients less (versus more) adherent to medications and those with more (versus fewer) healthcare financial difficulties had higher composite PETS scores. English proficiency and HbA1c were not associated with PETS scores though limited by missing HbA1c data.

Conclusions: The Spanish PETS is a reliable and valid measure for assessing perceived treatment burden in people coping with diabetes.