Cross-cultural adaptation and psychometric testing of the Indonesian version of the decisional conflict scale in patients with type 2 diabetes

Abstract

As an expression of uncertainty in health-related decision-making, decisional conflict serves as a barrier to optimal patient engagement, adherence, and satisfaction. The Decisional Conflict Scale (DCS) is used to measure this construct, but no validated Indonesian version exists. The high prevalence of type 2 diabetes (T2D) in Indonesia occurs within a societal framework where decision-making is shaped by collectivist values. Thereupon, the absence of an adapted tool limits the ability of healthcare professionals to identify and address decisional conflict. Hence, the study aimed to conduct a cross-cultural adaptation and evaluate the psychometric properties of the Indonesian version of the DCS among patients with T2D. A quantitative research design was utilized to address the study's objectives. Data collection was conducted from 16 April to 10 August 2025. The permission of using the DCS was obtained from the original developer in February 2022. The original English of the DCS was translated into Bahasa, including forward-backwards translation, expert panel review, and pre-testing. Ethical approval was obtained before the study began. In the subsequent stage, a cross-sectional survey was then conducted among 146 patients with T2D attending outpatient from RS PKU Muhammadiyah Yogyakarta, Indonesia. Statistical testing included assessments of construct validity, internal consistency, test-retest reliability, and exploratory factor analysis. The Indonesian version of the DCS demonstrated good face and content validity. Factor analysis supported a structure consistent with the original scale. Also, internal consistency was high across all subscales, and test-retest reliability was acceptable. The scale showed significant correlations with informed, support, uncertainty, values clarity, and effective decision supporting construct validity. The Indonesian version of the DCS is a valid and reliable tool for assessing decision conflict among Indonesian-speaking patients with T2D.