Quality of Life Research

, Volume 25, Issue 9, pp 2373–2378 | Cite as

Validity and reliability of the 19-item Audit of Diabetes-Dependent Quality of Life (ADDQoL-19) questionnaire in Chinese patients with type 2 diabetes mellitus in primary care

  • Colman S. C. Fung
  • Eric Y. F. Wan
  • Charlotte L. Y. Yu
  • Carlos K. H. Wong
Brief Communication



This study aimed to determine the psychometric properties of the 19-item Audit of Diabetes-Dependent Quality of Life (ADDQoL-19) in Chinese patients with type 2 diabetes mellitus (T2DM) in primary care setting.


The ADDQoL-19 and SF-12v2 were administered to 386 Chinese patients with T2DM in public primary outpatient clinic in Hong Kong. Internal consistency reliability was determined by Cronbach’s alpha, whereas construct validity was assessed by the Spearman’s correlations between the scores of the ADDQoL-19 and SF-12v2. Independent t tests were used in known-group comparisons to identify the differences in the ADDQoL-19 scores between respondents with different duration of diabetes, treatment modalities, body mass index and glycemic control.


The ADDQoL-19 had a moderate to weak correlation with SF-12v2 in convergent validity but with statistically significant results in known-group comparisons. Good internal consistency was generated with an acceptable value of 0.81, which was comparable to original English version. Construct validity was proven except the convergent validity is found to be weak with the generic SF-12v2, which was similar to the results in prior psychometric studies.


Despite weak convergent validity, the ADDQoL-19 was found to have a satisfactory psychometric property, especially known-group comparisons and internal consistency reliability in the primary care setting.


Quality of life Validity Type 2 diabetes Chinese Primary care ADDQoL-19 



Diabetes mellitus


Health-related quality of life


19-item Audit of Diabetes-Dependent Quality of Life


Body mass index


Quality of life


Average weight impact


Weight impact



This study was supported by the Seed Funding Programme for Basic Research (Project Code: 201102159001) of the University of Hong Kong. Thanks also go to Mr Anca Chan for statistical assistance and Ms Mansy Sham for technical editing.

Author contributions

C. F. and C. W. provided direct input into the design and execution of the study. C. W. and Y. F. W. undertook statistical analysis and generated the results. C. F., C. W., C. Y. and Y. F. W. drafted the manuscript. All authors contributed to its editing. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors do not have any conflicts of interest.


  1. 1.
    Guariguata, L., Whiting, D. R., Hambleton, I., Beagley, J., Linnenkamp, U., & Shaw, J. E. (2014). Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Research and Clinical Practice, 103(2), 137–149.CrossRefPubMedGoogle Scholar
  2. 2.
    Deshpande, A. D., Harris-Hayes, M., & Schootman, M. (2008). Epidemiology of diabetes and diabetes-related complications. Physical Therapy, 88(11), 1254–1264.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Rosenthal, M. J., Fajardo, M., Gilmore, S., Morley, J. E., & Naliboff, B. D. (1998). Hospitalization and mortality of diabetes in older adults: A 3-year prospective study. Diabetes Care, 21(2), 231–235.CrossRefPubMedGoogle Scholar
  4. 4.
    Rubin, R. R., & Peyrot, M. (1999). Quality of life and diabetes. Diabetes/metabolism research and reviews, 15(3), 205–218.CrossRefPubMedGoogle Scholar
  5. 5.
    Shim, Y. T., Lee, J., Toh, M. P., Tang, W. E., & Ko, Y. (2012). Health-related quality of life and glycaemic control in patients with Type 2 diabetes mellitus in Singapore. Diabetic Medicine, 29(8), 1464–5491.CrossRefGoogle Scholar
  6. 6.
    Wang, H.-F., & Yeh, M. C. (2013). The quality of life of adults with type 2 diabetes in a hospital care clinic in Taiwan. Quality of Life Research, 22(3), 577–584.CrossRefPubMedGoogle Scholar
  7. 7.
    Watkins, K., & Connell, C. M. (2004). Measurement of health-related QOL in diabetes mellitus. Pharmacoeconomics, 22(17), 1109–1126.CrossRefPubMedGoogle Scholar
  8. 8.
    Anderson, R. M., Fitzgerald, J. T., Wisdom, K., Davis, W. K., & Hiss, R. G. (1997). A comparison of global versus disease-specific quality-of-life measures in patients with NIDDM. Diabetes Care, 20(3), 299–305.CrossRefPubMedGoogle Scholar
  9. 9.
    Bradley, C., Todd, C., Gorton, T., Symonds, E., Martin, A., & Plowright, R. (1999). The development of an individualized questionnaire measure of perceived impact of diabetes on quality of life: the ADDQoL. Quality of Life Research, 8(1–2), 79–91.CrossRefPubMedGoogle Scholar
  10. 10.
    Kong, D., Ding, Y., Zuo, X., Su, W., Xiu, L., Lin, M., et al. (2011). Adaptation of the Audit of Diabetes-Dependent Quality of Life questionnaire to people with diabetes in China. Diabetes Research and Clinical Practice, 94(1), 45–52.CrossRefPubMedGoogle Scholar
  11. 11.
    Soon, S. S., Goh, S. Y., Bee, Y. M., Poon, J. L., Li, S. C., Thumboo, J., & Wee, H. L. (2010). Audit of Diabetes-Dependent Quality of Life (ADDQoL) [Chinese version for Singapore] questionnaire. Applied Health Economics and Health Policy, 8(4), 239–249.CrossRefPubMedGoogle Scholar
  12. 12.
    Fung, C. S. C., Wan, E. Y. F., Jiao, F., & Lam, C. L. K. (2015). Five-year change of clinical and complications profile of diabetic patients under primary care: A population-based longitudinal study on 127,977 diabetic patients. Diabetology and Metabolic Syndrome, 7(1), 79.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Fong, D. Y., Lam, C. L., Mak, K. K., Lo, W. S., Lai, Y. K., Ho, S. Y., & Lam, T. H. (2010). The Short Form-12 Health Survey was a valid instrument in Chinese adolescents. Journal of Clinical Epidemiology, 63(9), 1020–1029.CrossRefPubMedGoogle Scholar
  14. 14.
    Lam, C. L., Eileen, Y., & Gandek, B. (2005). Is the standard SF-12 health survey valid and equivalent for a Chinese population? Quality of Life Research, 14(2), 539–547.CrossRefPubMedGoogle Scholar
  15. 15.
    Lam, C. L., Wong, C. K., Lam, E., Lo, Y. Y. C., & Huang, W. (2010). Population norm of Chinese (HK) SF-12 health survey-version 2 of Chinese adults in Hong Kong. Hong Kong Practitioner, 32(2), 77–86.Google Scholar
  16. 16.
    Wong, C. K. H., Lo, Y. Y. C., Wong, W. H. T., & Fung, C. S. C. (2013). The associations of body mass index with physical and mental aspects of health-related quality of life in Chinese patients with type 2 diabetes mellitus: Results from a cross-sectional survey. Health and Quality of Life Outcomes, 11(1), 142.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Wong, C. K. H., Wong, W. C. W., Wan, E. Y., Wong, W. H., Chan, F. W., & Lam, C. L. K. (2015). Increased number of structured diabetes education attendance was not associated with the improvement in patient-reported health-related quality of life: Results from Patient Empowerment Programme (PEP). Health and Quality of Life Outcomes, 13, 126.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Todd, C., & Bradley, C. (1994). Evaluating the design and development of psychological scales. Handbook of psychology and diabetes: A guide to psychological measurement in diabetes research and practice (pp.15–42). Harwood Academic Publishers: Chur, Switzerland Google Scholar
  19. 19.
    Mukaka, M. (2012). A guide to appropriate use of Correlation coefficient in medical research. Malawi Medical Journal, 24(3), 69–71.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Hinkle, D. E., Wiersma, W., & Jurs, S. G. (2003). Applied statistics for the behavioral sciences. Hong Kong: Primary Care Office, Department of Health, Food and Health Bureau HKSAR.Google Scholar
  21. 21.
    Food and Health Bureau HKSAR. (2013). Hong Kong Reference Framework for Diabetes Care for Adults in Primary Care Settings.
  22. 22.
    Wee, H. L., Cheung, Y. B., Loke, W. C., Tan, C. B., Chow, M. H., Li, S. C., et al. (2008). The association of Body Mass Index with health-related quality of life: An exploratory study in a multiethnic Asian population. Value in Health, 11(s1), S105–S114.CrossRefPubMedGoogle Scholar
  23. 23.
    Wee, H. L., Tan, C. E., Goh, S. Y., & Li, S. C. (2006). Usefulness of the Audit of Diabetes-Dependent Quality-of-Life (ADDQoL) questionnaire in patients with diabetes in a multi-ethnic Asian country. Pharmacoeconomics, 24(7), 673–682.CrossRefPubMedGoogle Scholar
  24. 24.
    Ostini, R., Dower, J., & Donald, M. (2012). The Audit of Diabetes-Dependent Quality of Life 19 (ADDQoL): Feasibility, reliability and validity in a population-based sample of Australian adults. Quality of Life Research, 21(8), 1471–1477.CrossRefPubMedGoogle Scholar
  25. 25.
    Iversen, M. M., Espehaug, B., Rokne, B., Haugstvedt, A., & Graue, M. (2013). Psychometric properties of the Norwegian version of the Audit of Diabetes-Dependent Quality of Life. Quality of Life Research, 22(10), 2809–2812.CrossRefPubMedGoogle Scholar
  26. 26.
    Speight, J., Sinclair, A. J., Browne, J. L., Woodcock, A., & Bradley, C. (2013). Assessing the impact of diabetes on the quality of life of older adults living in a care home: Validation of the ADDQoL Senior. Diabetic Medicine, 30(1), 74–80.CrossRefPubMedGoogle Scholar
  27. 27.
    Holmanová, E., & Ziaková, K. (2009). Audit diabetes-dependent quality of life questionnaire: Usefulness in diabetes self-management education in the Slovak population. Journal of Clinical Nursing, 18(9), 1276–1286.CrossRefPubMedGoogle Scholar
  28. 28.
    Zhang, X.-H., Tan, K., Tan, H.-H., Thumboo, J., & Li, S.-C. (2012). Are English and Chinese Versions of the Audit of Diabetes-Dependent Quality of Life Equivalent? An Exploratory Study Based on the Universalist Approach. Value in Health Regional Issues, 1(1), 75–81.CrossRefGoogle Scholar
  29. 29.
    Jannoo, Z., Yap, B., Musa, K., Lazim, M., & Hassali, M. (2015). An audit of diabetes-dependent quality of life in patients with type 2 diabetes mellitus in Malaysia. Quality of Life Research, 24(9), 2297–2302.CrossRefPubMedGoogle Scholar
  30. 30.
    Petterson, T., Lee, P., Hollis, S., Young, B., Newton, P., & Dornan, T. (1998). Well-being and treatment satisfaction in older people with diabetes. Diabetes Care, 21(6), 930–935.CrossRefPubMedGoogle Scholar
  31. 31.
    Glasgow, R. E., Ruggiero, L., Eakin, E. G., Dryfoos, J., & Chobanian, L. (1997). Quality of life and associated characteristics in a large national sample of adults with diabetes. Diabetes Care, 20(4), 562–567.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Family Medicine and Primary CareThe University of Hong KongAp Lei ChauHong Kong

Personalised recommendations