{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T13:01:34Z","timestamp":1784898094121,"version":"3.55.0"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Diabetes Metab Disord"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u20130.947). Internal consistency was good (total \u03b1\u2009=\u20090.985, \u03c9\u2009=\u20090.986). None of the three compared structural models met conventional fit thresholds (CFI range 0.812\u20130.888; RMSEA range 0.167\u20130.202). 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>Clinical trial number: not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s40200-026-02022-2","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T12:07:32Z","timestamp":1784894852000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.1007","volume":"25","author":[{"given":"Husameldin Elsawi","family":"Khalafalla","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osama","family":"Albasheer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatima A.","family":"Elfaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulrahman","family":"Hummadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yahia","family":"Solan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rania","family":"Hassan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norah","family":"Rajeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taif","family":"Solan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huda Mohamed Haroun","family":"Adam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stef P. J","family":"Kremers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"2022_CR1","unstructured":"IDF International Diabetes Federation. The Diabetes Atlas. Available online: https:\/\/diabetesatlas.org\/#:~:text=to%20tackle%20it.-,589%20million%20adults,3 (accessed on 20. October 2025)."},{"key":"2022_CR2","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/S2213-8587(23)00347-9","volume":"12","author":"J Speight","year":"2024","unstructured":"Speight J, Holmes-Truscott E, Garza M, Scibilia R, Wagner S, Kato A, Pedrero V, Desch\u00eanes S, Guzman SJ, Joiner KL, et al. Bringing an End to Diabetes Stigma and Discrimination: An International Consensus Statement on Evidence and Recommendations. Lancet Diabetes Endocrinol. 2024;12:61\u201382. https:\/\/doi.org\/10.1016\/S2213-8587(23)00347-9.","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"2","key":"2022_CR3","doi-asserted-by":"publisher","first-page":"162","DOI":"10.2307\/1519806","volume":"44","author":"P Corrigan","year":"2003","unstructured":"Corrigan P, Markowitz FE, Watson A, Rowan D, Kubiak MA. An attribution model of public discrimination towards persons with mental illness. J Health Soc Behav. 2003;44:162. https:\/\/doi.org\/10.2307\/1519806.","journal-title":"J Health Soc Behav"},{"key":"2022_CR4","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1111\/j.1467-9566.2009.01161.x","volume":"31","author":"G Scambler","year":"2009","unstructured":"Scambler G. Health-related Stigma. Sociol Health Illn. 2009;31:441\u201355. https:\/\/doi.org\/10.1111\/j.1467-9566.2009.01161.x.","journal-title":"Sociol Health Illn"},{"key":"2022_CR5","doi-asserted-by":"publisher","first-page":"27","DOI":"10.2337\/cd16-0020","volume":"35","author":"NF Liu","year":"2017","unstructured":"Liu NF, Brown AS, Folias AE, Younge MF, Guzman SJ, Close KL, Wood R. Stigma in People With Type 1 or Type 2 Diabetes. Clin Diabetes. 2017;35:27\u201334. https:\/\/doi.org\/10.2337\/cd16-0020.","journal-title":"Clin Diabetes"},{"key":"2022_CR6","doi-asserted-by":"publisher","DOI":"10.1210\/jendso\/bvae136","volume":"8","author":"KB Eitel","year":"2024","unstructured":"Eitel KB, Pihoker C, Barrett CE, Roberts AJ. Diabetes stigma and clinical outcomes: an international review. J Endocr Soc. 2024;8:bvae136. https:\/\/doi.org\/10.1210\/jendso\/bvae136.","journal-title":"J Endocr Soc"},{"key":"2022_CR7","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1016\/j.diabres.2011.10.029","volume":"94","author":"DR Whiting","year":"2011","unstructured":"Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract. 2011;94:311\u201321. https:\/\/doi.org\/10.1016\/j.diabres.2011.10.029.","journal-title":"Diabetes Res Clin Pract"},{"key":"2022_CR8","doi-asserted-by":"publisher","first-page":"1532","DOI":"10.1111\/dme.14048","volume":"36","author":"TaF Wylie","year":"2019","unstructured":"Wylie TaF, Shah C, Connor R, Farmer AJ, Ismail K, Millar B, Morris A, Reynolds RM, Robertson E, Swindell R, et al. Transforming Mental Well-Being for People with Diabetes: Research Recommendations from Diabetes UK\u2019s 2019 Diabetes and Mental Well-Being Workshop. Diabet Med. 2019;36:1532\u20138. https:\/\/doi.org\/10.1111\/dme.14048.","journal-title":"Diabet Med"},{"key":"2022_CR9","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-003384","volume":"3","author":"JL Browne","year":"2013","unstructured":"Browne JL, Ventura A, Mosely K, Speight J. \u2018I call it the blame and shame disease\u2019: a qualitative study about perceptions of social stigma surrounding type 2 diabetes. BMJ Open. 2013;3:e003384. https:\/\/doi.org\/10.1136\/bmjopen-2013-003384.","journal-title":"BMJ Open"},{"key":"2022_CR10","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-005625","volume":"4","author":"JL Browne","year":"2014","unstructured":"Browne JL, Ventura A, Mosely K, Speight J. \u2018I\u2019m not a druggie, I\u2019m just a diabetic\u2019: a qualitative study of stigma from the perspective of adults with type 1 diabetes. BMJ Open. 2014;4:e005625. https:\/\/doi.org\/10.1136\/bmjopen-2014-005625.","journal-title":"BMJ Open"},{"key":"2022_CR11","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2023.110774","volume":"202","author":"S Akyirem","year":"2023","unstructured":"Akyirem S, Ekpor E, Namumbejja Abwoye D, Batten J, Nelson LE. Type 2 diabetes stigma and its association with clinical, psychological, and behavioral outcomes: a systematic review and meta-analysis. Diabetes Res Clin Pract. 2023;202:110774. https:\/\/doi.org\/10.1016\/j.diabres.2023.110774.","journal-title":"Diabetes Res Clin Pract"},{"key":"2022_CR12","doi-asserted-by":"publisher","first-page":"1508","DOI":"10.1111\/dme.13448","volume":"34","author":"NE Perrin","year":"2017","unstructured":"Perrin NE, Davies MJ, Robertson N, Snoek FJ, Khunti K. The prevalence of diabetes-specific emotional distress in people with type 2 diabetes: a systematic review and meta-analysis. Diabet Med. 2017;34:1508\u201320. https:\/\/doi.org\/10.1111\/dme.13448.","journal-title":"Diabet Med"},{"key":"2022_CR13","doi-asserted-by":"publisher","first-page":"811","DOI":"10.2337\/dc22-1749","volume":"46","author":"KB Eitel","year":"2023","unstructured":"Eitel KB, Roberts AJ, D\u2019Agostino R, Barrett CE, Bell RA, Bellatorre A, Cristello A, Dabelea D, Dolan LM, Jensen ET, et al. Diabetes Stigma and Clinical Outcomes in Adolescents and Young Adults: The SEARCH for Diabetes in Youth Study. Diabetes Care. 2023;46:811\u20138. https:\/\/doi.org\/10.2337\/dc22-1749.","journal-title":"Diabetes Care"},{"key":"2022_CR14","doi-asserted-by":"publisher","first-page":"1773","DOI":"10.1111\/dme.13507","volume":"34","author":"JL Browne","year":"2017","unstructured":"Browne JL, Ventura AD, Mosely K, Speight J. Measuring type 1 diabetes stigma: development and validation of the Type 1 Diabetes Stigma Assessment Scale (DSAS-1). Diabet Med. 2017;34:1773\u201382. https:\/\/doi.org\/10.1111\/dme.13507.","journal-title":"Diabet Med"},{"key":"2022_CR15","doi-asserted-by":"publisher","unstructured":"Khalafalla HE, Albasheer O, Elfaki FA, Hummadi A, Solan Y, Hassan R, Rajeh N, Solan T, Adam HMH, Kremers SP. Diabetes-Related Stigma among Individuals with Type 1 Diabetes in Jazan, Saudi Arabia: Sociodemographic and Clinical Correlates. Front Endocrinol. 2026;17. https:\/\/doi.org\/10.3389\/fendo.2026.1852460.","DOI":"10.3389\/fendo.2026.1852460"},{"key":"2022_CR16","doi-asserted-by":"publisher","first-page":"3186","DOI":"10.1097\/00007632-200012150-00014","volume":"25","author":"DE Beaton","year":"2000","unstructured":"Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000;25:3186\u201391. https:\/\/doi.org\/10.1097\/00007632-200012150-00014.","journal-title":"Spine (Phila Pa 1976)"},{"key":"2022_CR17","doi-asserted-by":"publisher","first-page":"323","DOI":"10.3200\/JOER.99.6.323-338","volume":"99","author":"JB Schreiber","year":"2006","unstructured":"Schreiber JB, Nora A, Stage FK, Barlow EA, King J. Reporting structural equation modeling and confirmatory factor analysis results: a review. J Educ Res. 2006;99:323\u201338. https:\/\/doi.org\/10.3200\/JOER.99.6.323-338.","journal-title":"J Educ Res"},{"key":"2022_CR18","unstructured":"R Core Team R. The R Project for Statistical Computing Available online: https:\/\/www.r-project.org\/ (accessed on 4 January 2026)."},{"key":"2022_CR19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v048.i02","volume":"48","author":"Y Rosseel","year":"2012","unstructured":"Rosseel Y. Lavaan: an R package for structural equation modeling. J Stat Softw. 2012;48:1\u201336. https:\/\/doi.org\/10.18637\/jss.v048.i02.","journal-title":"J Stat Softw"},{"key":"2022_CR20","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1207\/s15328007sem1302_2","volume":"13","author":"A Beauducel","year":"2006","unstructured":"Beauducel A, Herzberg PY. On the Performance of Maximum Likelihood Versus Means and Variance Adjusted Weighted Least Squares Estimation in CFA. Struct Equation Modeling: Multidisciplinary J. 2006;13:186\u2013203. https:\/\/doi.org\/10.1207\/s15328007sem1302_2.","journal-title":"Struct Equation Modeling: Multidisciplinary J"},{"key":"2022_CR21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/10705519909540118","volume":"6","author":"L Hu","year":"1999","unstructured":"Hu L, Bentler PM. Cutoff Criteria for Fit Indexes in Covariance Structure Analysis: Conventional Criteria versus New Alternatives. Struct Equation Modeling: Multidisciplinary J. 1999;6:1\u201355. https:\/\/doi.org\/10.1080\/10705519909540118.","journal-title":"Struct Equation Modeling: Multidisciplinary J"},{"key":"2022_CR22","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1007\/s40271-017-0289-x","volume":"11","author":"UM Hansen","year":"2018","unstructured":"Hansen UM, Willaing I, Ventura AD, Olesen K, Speight J, Browne JL. Stigma perceived and experienced by adults with type 1 diabetes: linguistic adaptation and psychometric validation of the Danish version of the Type 1 Diabetes Stigma Assessment Scale (DSAS-1 DK). Patient. 2018;11:403\u201312. https:\/\/doi.org\/10.1007\/s40271-017-0289-x.","journal-title":"Patient"},{"key":"2022_CR23","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1016\/j.pcd.2022.08.004","volume":"16","author":"H Alzubaidi","year":"2022","unstructured":"Alzubaidi H, Namara KM, Samorinha C, Saidawi W, Versace VL, Speight J. Type 2 diabetes stigma assessment scale (DSAS-2): cultural and linguistic adaptation and psychometric assessment of the Arabic version. Prim Care Diabetes. 2022;16:703\u20138. https:\/\/doi.org\/10.1016\/j.pcd.2022.08.004.","journal-title":"Prim Care Diabetes"}],"container-title":["Journal of Diabetes &amp; Metabolic Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40200-026-02022-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s40200-026-02022-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40200-026-02022-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T12:07:33Z","timestamp":1784894853000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s40200-026-02022-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,24]]},"references-count":23,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["2022"],"URL":"https:\/\/doi.org\/10.1007\/s40200-026-02022-2","relation":{},"ISSN":["2251-6581"],"issn-type":[{"value":"2251-6581","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,24]]},"assertion":[{"value":"28 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"All procedures adhered to relevant laws and institutional guidelines. The study was approved by the Jazan Research Ethics Committee, Jazan Health Cluster, Saudi Arabia. Ethics Approval No. 2447. All participants gave their informed consent.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"208"}}