Published in PLOS One on 2026-06-11, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Yohannes Mulu Ferede, Margareta Westerbotn, Mignote Hailu Gebrie, Debrework Tesgera Beshah, Kerstin Erlandsson
Source: PLOS One • DOI 10.1371/journal.pone.0329197
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Chronic conditions are a significant global health challenge that adversely affects the quality of care for patients with type 2 diabetes (T2D). To evaluate and improve the quality of care, the Patient Assessment Chronic Illness Care (PACIC-5As) tool has been developed. It is the most widely used tool designed to assess the perceived quality of care among individuals with chronic conditions, including diabetes. Nevertheless, it has not yet been culturally adapted and validated in the Ethiopian context. Therefore, this study aimed to translate, culturally adapt, and evaluate the psychometric properties of the PACIC-5As tool in Ethiopia.
A multicenter cross-sectional study was conducted among individuals with type 2 diabetes from March 24, 2025, to May 5, 2025, in the Amhara region’s comprehensive specialized referral hospitals. A systematic random sampling technique was used to select the study participants. Data were collected through face-to-face interviews. The tool consists of 26 items and 5 domains. Content validity was assessed at both the individual and scale levels. Internal consistency was evaluated using Cronbach’s alpha (α) and composite reliability (CR), with a value ≥ 0.70 considered acceptable. Confirmatory factor analysis (CFA) was conducted to evaluate model fit and factor structure. Model fit was assessed using the absolute and incremental fit indices and interpreted based on the recommended thresholds. Convergent validity was computed using average variance extracted (AVE), with a value ≥ 0.4 considered adequate, while discriminant validity was evaluated using AVE and inter-construct correlations.
A total of 520 study participants were enrolled, and 517 (99.4%) were included in the study. The overall mean summary score of PACIC-5As-ET was 2.68 (±0.62). The content validity index at the item and scale levels ranged from 80% to 100%, with an inter-rater agreement of 95%. The Cronbach’s alpha and composite reliability (CR) of the PACIC-5As-ET were 0.93. The Cronbach’s alpha values for the subscales ranged from 0.71 (Assist) to 0.82 (Arrange). The test-retest reliability of PACIC-5As-ET was 0.94. The model fit indices were χ²/df (2.79), RMSEA (0.06), SRMR (0.08), GFI (0.89), and CFI (0.40). The AVE value of the overall PACIC-5As-ET was 0.93, and the subscales ranged from 0.47 (Advise) to 0.59 (Arrange).
The Amharic version of the PACIC-5As-ET tool demonstrated excellent internal consistency and acceptable validity for assessing the perceptions of patients with T2D. The absolute fit indices were generally within the recommended range, whereas the incremental fit indices were low. Therefore, support for the hypothesized five-factor structure is limited and should be interpreted with caution.
Introduction
Type 2 diabetes (T2D) is a global pandemic disease characterized by hyperglycemia resulting from reduced insulin secretion, resistance, or both [1]. Globally, around 462 million people are living with T2D, accounting for more than 95% of all diabetes cases [2–6]. Nearly 80% of these cases are in low- and middle-income countries [7]; in Africa, the proportion ranges from 70% to 90% [8]; in sub-Saharan Africa, the reported prevalence is 5% [9]; and in Ethiopia, it ranges from 5.8% to 7.3% [10].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider hospital systems desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Yohannes Mulu Ferede, Margareta Westerbotn, Mignote Hailu Gebrie, Debrework Tesgera Beshah, Kerstin Erlandsson. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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