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Psychometric Properties of the Hypoglycemia Fear Survey-II for Adults With Type 1 Diabetes
Open accessAbstract
OBJECTIVE: To perform the first comprehensive psychometric evaluation of the Hypoglycemia Fear Survey-II (HFS-II), a measure of the behavioral and affective dimensions of fear of hypoglycemia, using modern test-theory methods, including item-response theory (IRT). RESEARCH DESIGN AND METHODS: Surveys completed in four previous studies by 777 adults with type 1 diabetes were aggregated for analysis, with 289 subjects completing both subscales of the HFS-II and 488 subjects completing only the Worry subscale. The aggregated sample (53.3% female, 44.4% using insulin pumps) had a mean age of 41.9 years, diabetes duration of 23.8 years, HbA1c value of 7.7%, and 1.4 severe hypoglycemic episodes in the past year. Data analysis included exploratory factor analysis using polychoric correlations and IRT. Factors were analyzed for fit, trait-level locations, point-measure correlations, and separation values. RESULTS: Internal and test-retest reliability was good, as well as convergent validity, as demonstrated by significant correlations with other measures of psychological distress. Scores were significantly higher in subjects who had experienced severe hypoglycemia in the past year. Factor analyses validated the two subscales of the HFS-II. Item analyses showed that 12 of 15 items on the Behavior subscale, and all of the items on the Worry subscale had good-fit statistics. CONCLUSIONS: The HFS-II is a reliable and valid measure of the fear of hypoglycemia in adults with type 1 diabetes, and factor analyses and IRT support the two separate subscales of the survey.
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“If FoH is identified and a person does not have symptoms of hypoglycemia, a structured program, Blood Glucose Awareness Training, delivered in routine clinical practice can improve A1C, reduce the rate of severe hypoglycemia, and restore hypoglycemia awareness (70,71).”
From Psychosocial care for people with diabetes: a position statement of the American Diabetes Association (2016) · cites this paper as [71]
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“If fear of hypoglycemia is identified and a person does not have symptoms of hypoglycemia, a structured program of blood glucose awareness training delivered in routine clinical practice can improve A1C, reduce the rate of severe hypoglycemia, and restore hypoglycemia awareness (382,383).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:Standards of Care in Diabetes—2023 (2023) · cites this paper as [383]
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Metadata
- Authors
- Gonder-Frederick, L. A., Schmidt, K. M., Vajda, K. A., Greear, M. L., Singh, H., Shepard, J. A., & Cox, D. J.
- Affiliations
- University of Virginia (US)
- Corresponding author
- Gonder-Frederick, Linda A.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2011-03-21
- Volume
- 34
- Issue
- 4
- Pages
- 801-806
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC3064031
- OpenAlex
- W2162727613
- Cited by
- 337
- References
- 23
- Citations by year
- 2026: 29 · 2025: 27 · 2024: 33 · 2023: 40 · 2022: 27 · 2021: 32 · 2020: 24 · 2019: 27 · 2018: 17 · 2017: 20 · 2016: 15 · 2015: 12 · 2014: 11 · 2013: 10 · 2012: 8
- FWCI
- 8.65
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01dk051562-23, 5r01dk028288-27)
- National Institute of Diabetes and Digestive and Kidney Diseases (R21DK080896, R01-DK-051562, R01-DK-028288)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Keywords
- fear of hypoglycemia, type 1 diabetes, psychometric properties, item response theory, factor analysis, test-retest reliability, convergent validity, severe hypoglycemia, adults with diabetes
- MeSH terms
- Adult, Diabetes Mellitus, Type 1, Fear, Female, Glycated Hemoglobin, Humans, Hypoglycemia, Male, Psychometrics
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