Psychometric properties of the Amharic Version of the Demoralization Scale-II in patients with chronic diseases

Mesfin Tadese
Department of Midwifery, School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University

Tadele Mesfin
Department of Medicine, Debre Berhan University, Ethiopia

Saba Desta
Department of Midwifery, Debre Berhan University, Ethiopia

Yeshinat Lakew
Department of Midwifery, Debre Berhan University, Ethiopia

Lidya Asalefew
Department of Medicine, Debre Berhan University, Ethiopia

Kidist Ayalew
Department of Midwifery, Debre Berhan University, Ethiopia

Abstract

Background: Demoralization syndrome (DS) is a psychological suffering from feelings of helplessness, hopelessness, as well as meaning and purpose loss, giving up, and subjective incompetence. The Demoralization Scale–II (DS-II) is a short, 16-item version developed to measure demoralization. Thus, this study aimed to evaluate the psychometric properties, including the reliability and validity, of the Amharic version of the Demoralization Scale-II (ADS-II) among patients with chronic illness.

Methods: In this cross-sectional study, the primary instrument was the DS-II, which was translated into Amharic, culturally adapted, and psychometrically evaluated among 868 patients with chronic diseases in North Shewa Zone, Ethiopia. The pre-testing process, the quality of forward and back translations and face/content validity of Amharic version of questions were assessed by experts. Exploratory factor analysis, evaluation of internal consistency, and convergent validity were components of the psychometric assessment.

Results: The EDS-II showed good reliability as indicated by alphas of 0.93 for Meaning and Purpose (MP), 0.90 for Distress and Coping Ability (DCA) and 0.95 for the total scale combined. For each item, corrected item–total correlations were above 0.50. Two factors (Meaning and Purpose, 52.8% variance explained; Distress and Coping Ability, 42.9%) with factor loadings of 0.62 0.88 based on principal component analysis were identified which together explained a total of 95.7% of the variance in scores across all items. Both subscales showed good convergent validity (CR = 0.94, AVE = 0.68; CR = 0.92, AVE = 0.58, respectively).

Conclusion: The ADS-II demonstrated good reliability, convergent validity, and construct validity among patients with chronic disease. The scale provides a culturally appropriate and reliable screening tool for identifying demoralization and related psychological distress, thereby facilitating early recognition and optimizing psychological and palliative care within routine chronic disease management. Future studies should further evaluate its applicability across diverse clinical settings and populations in Ethiopia.

Keywords: Demoralization, Psychometric, Amharic version, Chronic illness, Ethiopia