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Psychometric evaluation of a Turkish version of the modified Hemodialysis Fear of Injecting Questionnaire for patients undergoing hemodialysis: a methodological study Cover

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Psychometric evaluation of a Turkish version of the modified Hemodialysis Fear of Injecting Questionnaire for patients undergoing hemodialysis: a methodological study

Frontiers of Nursing

Volume 13 (2026): Issue 3 (September 2026)

By: Belgüzar Kara

Open Access

|Sep 2026

Abstract

Objective

There is limited information available addressing injection fears in patients undergoing hemodialysis (HD). This study aimed to assess the psychometric properties of a Turkish version of the modified Hemodialysis Fear of Injecting Questionnaire (HD-FIQ) for patients undergoing HD.

Methods

A methodological study was conducted with 100 patients recruited from one HD center. A personal information form, the State-Trait Anxiety Inventory, and the HD-FIQ were utilized to gather data. Data were analyzed through statistical tests, such as descriptive statistics, the Mann–Whitney U test, the Kruskal–Wallis test, correlation coefficients, and psychometric tests.

Results

The face and content validity of the instrument were confirmed by an expert group. The exploratory factor analyzed a one-factor structure, accounting for 85.4% of the total variance. The HD-FIQ had high internal consistency (Cronbach’s α coefficient = 0.89), and test–retest reliability (intraclass correlation coefficient [ICC] = 0.94), concurrent validity with treatment duration and state anxiety, convergent validity with the visual analog scale (VAS) fear scores, and known group validity with the presence of injection fear and its intensity, as well as the severity of state anxiety. Since the relevant section has been removed from the manuscript, please delete this sentence as well.

Conclusions

The initial psychometric tests of the Turkish version of the modified HD-FIQ demonstrated that it is a valid, and reliable instrument for evaluating the fear of injection in patients undergoing HD. Our findings may offer new insights into developing effective strategies to alleviate patients’ fears regarding injections, as well as providing a more comprehensive understanding of these fears.

References

Leonberg-Yoo A, Weiner D. Epidemiology of end-stage renal disease. In: Magee C, Tucker J, Singh A, eds. Core Concepts in Dialysis and Continuous Therapies. Boston, MA, USA: Springer; 2016: 3–13.
Search in Google Scholar Back to article
Seyahi N, Kocyigit İ, Eren N, Tonbul HZ, Tatar E, Yilmaz Z, et al. Current status of kidney replacement therapy in Türkiye: a summary of 2022 Turkish Society of Nephrology registry report. Turk J Nephrol. 2024;33:134–139.
Search in Google Scholar Back to article
Fielding CA, Hadfield A, White K, et al. A narrative systematic review of randomised controlled trials that compare cannulation techniques for haemodialysis. J Vasc Access. 2022;23:212–224.
Search in Google Scholar Back to article
Duncanson E, Le Leu RK, Shanahan L, et al. The prevalence and evidence-based management of needle fear in adults with chronic disease: a scoping review. PLoS One. 2021;16:e0253048.
Search in Google Scholar Back to article
McMurtry CM, Pillai Riddell R, Taddio A, et al. Far from “just a poke”: common painful needle procedures and the development of needle fear. Clin J Pain. 2015;31(10 suppl):S3–S11.
Search in Google Scholar Back to article
Bălan O, Moise G, Moldoveanu A, Leordeanu M, Moldoveanu F. Fear level classification based on emotional dimensions and machine learning techniques. Sensors (Basel). 2019;19:1738.
Search in Google Scholar Back to article
McLenon J, Rogers MAM. The fear of needles: a systematic review and meta-analysis. J Adv Nurs. 2019;75:30–42.
Search in Google Scholar Back to article
Taddio A, Ipp M, Thivakaran S, et al. Survey of the prevalence of immunization non-compliance due to needle fears in children and adults. Vaccine. 2012;30:4807–4812.
Search in Google Scholar Back to article
Hamilton JG. Needle phobia: a neglected diagnosis. J Fam Pract. 1995;41:169–175.
Search in Google Scholar Back to article
Sokolowski CJ, Giovannitti JA Jr, Boynes SG. Needle phobia: Etiology, adverse consequences, and patient management. Dent Clin North Am. 2010;54:731–744.
Search in Google Scholar Back to article
Snoek FJ, Mollema ED, Heine RJ, Bouter LM, van der Ploeg HM. Development and validation of the Diabetes Fear of Injecting and Self-Testing Questionnaire (D-FISQ): first findings. Diabet Med. 1997;14:871–876.
Search in Google Scholar Back to article
Mollema ED, Snoek FJ, Pouwer F, Heine RJ, van der Ploeg HM. Diabetes fear of injecting and self-testing questionnaire: a psychometric evaluation. Diabetes Care. 2000;23:765–769.
Search in Google Scholar Back to article
Mulder M, Hoog JO, Buytene S, De Vries J. Validation of a screening instrument for the fear of injection in dialysis patients. J Ren Care. 2013;39: 214–221.
Search in Google Scholar Back to article
Shanahan L, Le Leu R, Whittington T, et al. Needle fear: a point prevalence survey of dialysis patients. Hemodial Int. 2019;23:285–286.
Search in Google Scholar Back to article
Van Houtem CMHH, Laine ML, Boomsma DI, Ligthart L, van Wijk AJ, De Jongh A. A review and meta-analysis of the heritability of specific phobia subtypes and corresponding fears. J Anxiety Disord. 2013;27:379–388.
Search in Google Scholar Back to article
de Barbieri I, Sisti D, Strini V, et al. Plastic cannulae versus metal needle cannulation in haemodialysis: results of an international survey from the nurse perspective. J Vasc Access. 2023;24:1025–1031.
Search in Google Scholar Back to article
McMurtry CM, Noel M, Taddio A, et al. Interventions for individuals with high levels of needle fear: systematic review of randomized controlled trials and quasi-randomized controlled trials. Clin J Pain. 2015;31(10 suppl):S109–S123.
Search in Google Scholar Back to article
McLaughlin K, Manns B, Mortis G, Hons R, Taub K. Why patients with ESRD do not select self-care dialysis as a treatment option. Am J Kidney Dis. 2003;41:380–385.
Search in Google Scholar Back to article
Shamasneh AO, Atieh AS, Gharaibeh KA, Hamadah A. Perceived barriers and attitudes toward arteriovenous fistula creation and use in hemodialysis patients in Palestine. Ren Fail. 2020;42: 343–349.
Search in Google Scholar Back to article
Shafi ST, Saleem M, Anjum R, Abdullah W, Shafi T. Refusal of hemodialysis by hospitalized chronic kidney disease patients in Pakistan. Saudi J Kidney Dis Transpl. 2018;29:401–408.
Search in Google Scholar Back to article
Tinsley HE, Tinsley DJ. Uses of factor analysis in counseling psychological research. J Couns Psychol. 1987;34:414–424.
Search in Google Scholar Back to article
Arifin WN. Sample size calculator (web). https://wnarifin.github.io/ssc_web.html. Accessed August 15, 2025.
Search in Google Scholar Back to article
Koivula M, Tarkka MT, Tarkka M, Laippala P, Paunonen-Ilmonen M. Fear and anxiety in patients at different time-points in the coronary artery bypass process. Int J Nurs Stud. 2002;39:811–822.
Search in Google Scholar Back to article
Koivula M, Hautamäki-Lamminen K, Astedt-Kurki P. Predictors of fear and anxiety nine years after coronary artery bypass grafting. J Adv Nurs. 2010;66:595–606.
Search in Google Scholar Back to article
Oner N, Le Compte A. The State-Trait Anxiety Inventory Handbook. 2nd ed. İstanbul: Bogazici University Press; 1998 (In Turkish).
Search in Google Scholar Back to article
Spielberger CD. Manual for the State-Trait Anxiety Inventory: STAI (Form Y). Palo Alto, CA: Consulting Psychologists Press; 1983.
Search in Google Scholar Back to article
Celik S, Pinar R. Psychometric evaluation of a Turkish version of the Diabetes Fear of Self-injecting and Self-testing Questionnaire (D-FISQ). Asian Nurs Res (Korean Soc Nurs Sci). 2016;10:195–200.
Search in Google Scholar Back to article
Rahman A, Iqbal Z, Waheed W, Hussain N. Translation and cultural adaptation of health questionnaires. 2003. https://applications.emro.who.int/imemrf/J_Pak_Med_Assoc/J_Pak_Med_Assoc_2003_53_4_142_147.pdf. Accessed August 12, 2025.
Search in Google Scholar Back to article
Lynn MR. Determination and quantification of content validity. Nurs Res. 1986;35:382–385.
Search in Google Scholar Back to article
Davis LL. Instrument review: Getting the most from a panel of experts. Appl Nurs Res. 1992;5: 194–197.
Search in Google Scholar Back to article
Halek M, Holle D, Bartholomeyczik S. Development and evaluation of the content validity, practicability and feasibility of the innovative dementia-oriented assessment system for challenging behaviour in residents with dementia. BMC Health Serv Res. 2017;17:554.
Search in Google Scholar Back to article
Deng W, Shao H, Zhou Y, Li H, Wang Z, Huang Y. Reliability and validity of commonly used patient-reported outcome measures (PROMs) after medial unicompartmental knee arthroplasty. Orthop Traumatol Surg Res. 2022;108:103096.
Search in Google Scholar Back to article
Maindal HT, Sokolowski I, Vedsted P. Adaptation, data quality and confirmatory factor analysis of the Danish version of the PACIC questionnaire. Eur J Public Health. 2012;22:31–36.
Search in Google Scholar Back to article
Kara B. Health beliefs related to salt-restricted diet in patients on hemodialysis: psychometric evaluation of the Turkish version of the beliefs about dietary compliance scale. J Transcult Nurs. 2014;25:256–264.
Search in Google Scholar Back to article
Nunnally JC, Bernstein IH. Psychometric Theory. 3rd ed. New York: McGraw-Hill; 1994.
Search in Google Scholar Back to article

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DOI: https://doi.org/10.2478/fon-2026-0038 | Journal eISSN: 2544-8994 | Journal ISSN: 2097-5368

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Language: English

Page range: 345 - 355

Submitted on: Sep 22, 2025

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Accepted on: Nov 6, 2025

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Published on: Sep 25, 2026

Published by: Shanxi Medical Periodical Press

In partnership with: Paradigm Publishing Services

Keywords:

fear of injections,

Related subjects:

Assistive professions, nursing

© 2026 Belgüzar Kara, published by Shanxi Medical Periodical Press
This work is licensed under the Creative Commons Attribution 4.0 License.

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