Erma Wahyu Mashfufa, Mario Pratama, Rudy Kurniawan, Ollyvia Freeska Dwi Marta, Safiruddin Al Baqi, Debby Syahru Romadlon
Loneliness is an important psychosocial factor in type 2 diabetes, especially for adults who live alone. This study aimed to culturally adapt and validate the Indonesian version of the ALONE scale (ALONE-ID) and examine its associations with glycemic control and psychosocial outcomes. We conducted a cross-sectional psychometric study with 222 single-living adults with type 2 diabetes from urban primary healthcare centers in Java, Indonesia. The ALONE scale was translated using forward–backward procedures, expert review, and cognitive interviews. Participants completed the ALONE-ID, IMFI-20, PSQI, and BDI-II, and HbA1c values were obtained from medical records. Content validity, exploratory factor analysis (EFA), reliability, convergent validity, and ROC analysis were performed. Content validity was strong (S-CVI/Ave = 0.96). EFA supported a unidimensional structure (KMO = 0.74; eigenvalue = 2.84) explaining 56.8 % of variance, with factor loadings of 0.53–0.84. Internal consistency was good (α = 0.81) and test–retest reliability in 30 participants was excellent (ICC = 0.87). Higher ALONE-ID scores were associated with greater fatigue, poorer sleep, and more depressive symptoms, and were higher among those with uncontrolled HbA1c (>7 %). ROC analysis showed good discrimination for poor sleep (AUC = 0.79), with an optimal cut-off ≥8 (sensitivity 81.3 %, specificity 72.2 %). The ALONE-ID is a reliable and valid instrument for assessing loneliness among single-living adults with type 2 diabetes in Indonesia. The proposed cut-off ≥8 may help identify patients at greater psychosocial risk, but should be confirmed in larger, more diverse samples. © 2025 The Authors.
Nursing Department, Faculty of Health Sciences, Universitas Muhammadiyah Malang, Malang, Indonesia; Department of Psychology, Faculty of Psychology and Health, Universitas Negeri Padang, Padang, Indonesia; Diabetes Connection Care, Eka Hospital Bumi Serpong Damai, Tangerang, Indonesia; Faculty of Education and Teaching Sciences, State Islamic University of Kiai Ageng Muhammad Besari Ponorogo, Ponorogo, Indonesia; Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
