Cultural adaptation and preliminary psychometric assessment of the IMEVID questionnaire for assessing lifestyle in adults with type 2 diabetes in Peru.

BACKGROUND: Multidomain patient-reported and self-reported instruments are often summarized using total scores, even when their domains represent conceptually distinct aspects of health behavior, emotional functioning, or self-management. Such scoring practices may obscure clinically meaningful domain-specific information if the instrument has not been shown to behave as a unidimensional reflective scale. This study culturally adapted the IMEVID questionnaire for use in Peru and evaluated its psychometric properties and score interpretation in adults with type 2 diabetes.

METHODS: We conducted a cross-sectional methodological study in 180 adults with self-reported type 2 diabetes in Peru. IMEVID underwent cross-cultural adaptation and expert-based content validity assessment. Psychometric evaluation included expert agreement for content validity, item and domain descriptive statistics, floor and ceiling effects, internal consistency estimates, Kaiser-Meyer-Olkin measures and Bartlett's tests based on Pearson and polychoric correlation matrices, exploratory factor analysis, confirmatory factor analysis, and hypothesis-driven Spearman correlations among domains. Cronbach's alpha was used for domains with three or more items, while inter-item Spearman correlations were used for two-item domains.

RESULTS: The adapted IMEVID showed high expert-based content validity agreement across clarity, coherence, relevance, and sufficiency criteria, with an overall mean agreement of 0.96 and acceptable overall internal consistency (α = 0.82). Domain-level internal consistency varied across the instrument, with Cronbach's alpha ranging from 0.43 to 0.78 and two-item domain correlations ranging from 0.26 to 0.74. Factorability assessment differed according to the correlation matrix: the Pearson matrix showed acceptable sampling adequacy (KMO = 0.757), whereas the polychoric matrix yielded a very low KMO value (KMO = 0.14), likely influenced by sparse response patterns and marked ceiling effects in selected domains. Exploratory factor analysis was more consistent with a seven-factor solution aligned with the original IMEVID domains. Confirmatory factor analysis showed poor fit for the one-factor model (CFI = 0.677; TLI = 0.648; RMSEA = 0.104; SRMR = 0.151) and substantially better fit for the seven-domain model (CFI = 0.946; TLI = 0.936; RMSEA = 0.044; SRMR = 0.093). All standardized factor loadings in the seven-domain model were statistically significant.

CONCLUSIONS: The Peruvian adaptation of IMEVID showed high content validity agreement, acceptable overall reliability, and preliminary structural support for the original seven-domain organization. The findings were more consistent with a multidomain lifestyle assessment tool than with a strictly unidimensional reflective scale. Domain scores may provide complementary information about distinct aspects of lifestyle and self-management. However, the structural findings should be considered preliminary, particularly given the very low polychoric KMO and the moderate sample size. Further validation is needed in larger clinically characterized samples.