The development and validation of the multidimensional fear-of-injection scale

Background

Adults and children alike can feel anxious and afraid of needles. As a result, some people avoid necessary medical injections, leading to health problems. Assessing the fear of injections should consider fear factors, avoidance behaviors, and physical symptoms. We have developed a single scale that measures each of these variables. Conventional fear-of-injection scales do not simultaneously measure the aforementioned components, and thus may not adequately capture the fear of injections. Furthermore, no scale has been developed in Japan to measure the fear of injections.

Method

A multidimensional fear-of-injection scale was developed in Study 1. The participants, 419 university students, were administered a questionnaire to check the reliability and validity of the scale. In Study 2, to establish the cut-off value of the scale, we conducted a questionnaire and analyzed the data of 771 university students. The outcome is the multidimensional fear-of-injection scale.

Results

The results from factor analysis showed that this scale has a four-factor structure (direct fear, indirect fear, physiological response, and avoidance behaviors). The results of the receiver operating characteristic analysis showed that a cut-off value of 35 points identifies people with a subjective fear of injections.

Conclusion

The multidimensional fear-of-injection scale is a comprehensive measure of the fear of injections and serves as an effective indicator for intervention and screening. Additionally, it provides a quantitative assessment of the fear of injection in Japan.

The effect of repeated methotrexate injections on the quality of life of children with rheumatic diseases

In clinical practice, the burden of repeated injections in children with rheumatic disease receiving disease-modifying anti-rheumatic drugs is significant. To investigate the nature and extent of impact on the quality of life after repeated injections, we conducted a literature review. Two relevant papers were identified, both about children with juvenile idiopathic arthritis (JIA) being administered methotrexate. The results suggest that the combination of needle fear, impact of methotrexate treatment, and procedural consequences, e.g., blood sampling, all contribute to the distress and the loss of quality of life of children with JIA. Remarkably, no studies examining fear of injections or injection pain in children with rheumatic diseases receiving biologicals were identified.Conclusion: Strategies to optimize administration of disease modifying anti-rheumatic drugs should be systematically investigated. What is Known: • Repeated parenteral administration of drugs is burdensome for children with rheumatic diseases. What is New: • Needle fear should be investigated systematically to optimize administration of disease-modifying anti-rheumatic drugs.

Initial validation of a virtual blood draw exposure paradigm for fear of blood and needles

Fear of blood, injections, and needles commonly prevents or delays individuals' receipt of health care, such as vaccines or blood draws. Innovative methods are needed to overcome these fears and reduce anxiety related to activities of this nature. The present study describes initial testing of an arm illusion paradigm that may prove useful during early phases of graded exposure for people with blood and needle fear. Seventy-four undergraduate students aged 18-29 years were tested. In line with study aims, results indicated that the virtual blood draw paradigm promoted strong perceptions of arm ownership and elicited significant changes in physiological indices (blood pressure, heart rate, electrodermal activity, respiratory rate) in response to key procedure elements (e.g., needle insertion). Further, bivariate correlations indicated that individual differences in self-reported blood and needle fear collected prior to the illusion paradigm were significantly associated with presyncopal symptoms reported following the procedure. In regression analyses, self-reported measures of blood and needle fear explained unique variance in presyncopal symptoms even after controlling for general state anxiety. These findings provide initial support for the virtual blood draw paradigm as a promising tool to help provide graded exposure to medical procedures involving needles and blood draw.