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

Item No.	Snoek et al. (original English version of the FSI). (When I have to inject myself)	Mollema et al. (abbreviated English version of the FSI). (When I have to inject myself)	Celik and Pinar (Turkish version of the FSI). (When I have to inject myself)	In the present study (HD-FIQ). (When a needle must be inserted into a vascular access for HD)
1	I feel afraid.	I become restless.	I become restless.	I feel tense.
2	I start to sweat.	I feel tense.	I feel tense.	I feel afraid.
3	I become restless.	I feel afraid.	I feel afraid.	I feel nervous.
4	I try to avoid it.	I worry about it.	I worry about it.	I brood about it.
5	I feel tense.	I feel nervous.	I feel nervous.
6	I get a stomachache.	I brood about it.	I brood about it.
7	I panic.
8	I worry about it.
9	My heart starts pounding.
10	I feel nervous.
11	I start trembling.
12	I feel anxious.
13	I have trouble breathing.
14	I try to postpone it.
15	I get angry.

[i] Note: D-FISQ, Diabetes Fear of Injecting and Self-Testing Questionnaire; FSI, Fear of Self-Injecting; HD, Hemodialysis; HD-FIQ, Hemodialysis Fear of Injecting Questionnaire.

STROBE flow diagram of the study design.
*Note: STROBE*: Strengthening the Reporting of Observational Studies in Epidemiology.

Table 2.

Descriptions of participant characteristics and comparison of the HD-FIQ scores by participant characteristics (N = 100).

Variables	n (%)	HD-FIQ
Variables	n (%)	M (SD)	z^†	P-value
Gender
Female	38 (38.0)	5.95 (3.01)	–0.06	0.951
Male	62 (62.0)	6.26 (3.32)
Marital status
Married	58 (58.0)	6.41 (3.50)	–0.68	0.495
Unmarried	42 (42.0)	5.76 (2.74)
Education level
Literate/primary school (5 years)	39 (39.0)	6.44 (3.23)	–1.08	0.281
Secondary school or greater (≥6 years)	61 (61.0)	5.95 (3.20)
Employment status
Working	20 (20.0)	5.65 (2.56)	–0.68	0.498
Not working	80 (80.0)	6.26 (3.34)
Income level
Adequate	20 (20.0)	5.35 (2.25)	2.16	0.339
Moderate	45 (45.0)	6.16 (3.42)
Inadequate	35 (35.0)	6.57 (3.35)
Comorbidity
Yes	76 (76.0)	6.07 (2.90)	−0.38	0.703
No	24 (24.0)	6.38 (4.06)
Dialysis frequency
Twice weekly	8 (8.0)	7.00 (3.16)	–1.05	0.294
3 times weekly	92 (92.0)	6.07 (3.21)
Residual urine output
Yes	12 (12.0)	6.08 (3.03)	–0.14	0.886
No	88 (88.0)	6.15 (3.24)
Vascular access
AVF	87 (87.0)	6.39 (3.30)	–2.73	0.006
Catheter	13 (13.0)	4.46 (1.66)
Injection fear
Yes	48 (48.0)	8.46 (3.32)	–9.15	<0.001
No	52 (52.0)	4.00 (0.01)
Intensity of injection fear (n = 48)
No	52 (52.0)	4.00 (0.01)	89.23	<0.001
Mild	31 (31.0	6.97 (1.96)
Medium	11 (11.0)	9.18 (2.09)
High	6 (6.0)	14.83 (2.86)
Intensity of anxiety
Medium	32 (32.0)	6.06 (4.47)	–2.70	0.007
High	68 (68.0)	6.18 (2.43)

Note: AVF, arteriovenous fistula; HD-FIQ, Hemodialysis Fear of Injecting Questionnaire; M, mean; SD, standard deviation;

† Group differences were measured by the Mann–Whitney U test, except for income level and intensity of injection fear (Kruskal–Wallis test, χ²).

Table 3.

Means, SDs, ranges, medians, and comparison of the HD-FIQ scores by various parameters (n = 100).

Variables	M (SD)	Range	Median	HD-FIQ
Variables	M (SD)	Range	Median	r^†	P
Age (years)	62.99 (16.34)	21–96	63.00	0.14	0.157
Dialysis vintage (months)	88.61 (85.03)	1–396	60.00	–0.40	<0.001
Intensity of injection fear (VAS)	2.62 (2.19)	1–9	1.00	0.96	<0.001
STAI-S	61.87 (6.50)	50–75	63.00	0.33	0.001

Note: HD-FIQ, Hemodialysis Fear of Injecting Questionnaire; M, mean; SDs, standard deviations; STAI-S, State Scale of the State-Trait Anxiety Inventory; VAS, visual analog scale;

† Spearman’s correlation coefficient was used to calculate P-values.

Table 4.

Item means, SDs, CITC, CAID, component loading, and inter-item correlation matrix of the HD-FIQ (n = 100).

Item No	M (SD)	CITC	CAID^a	Component loading^†	Item 1 r^*	Item 2 r^*	Item 3 r^*
1	1.57 (0.86)	0.88	0.89	0.94	–
2	1.69 (0.88)	0.87	0.89	0.93	0.80	–
3	1.44 (0.83)	0.87	0.89	0.93	0.71	0.72	–
4	1.50 (0.88)	0.83	0.90	0.91	0.70	0.67	0.75

Note: CAID, Cronbach’s alpha if item deleted; CITC, corrected item-total correlation; HD-FIQ, Hemodialysis Fear of Injecting Questionnaire; M, mean; SDs, standard deviations;

a Cronbach’s alpha: 0.89;

† Component loadings were computed using principal components analysis;

* Pearson’s correlation coefficient was used to calculateP-values (P < 0.001; 2-tailed).

Table 5.

Comparison of the HD-FIQ test-retest scores and correlation (n = 30).

Item	First interview M (SD)	Second interview M (SD)	t^a	P-value	ICC (95% CI)
HD-FIQ	7.43 (4.56)	7.50 (4.44)	–0.528	0.601	0.94 (0.92–0.98)^*

Note: CI, confidence interval; HD-FIQ, Hemodialysis Fear of Injecting Questionnaire; ICC, intraclass correlation coefficient, average measure; M, mean; SD, standard deviation;

a Paired-samples t-test was used to calculate the P-value;

* P < 0.001 (2-tailed).

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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

Accepted on: Nov 6, 2025