Frequency of fear of needles and impact of a multidisciplinary educational approach towards pregnant women with diabetes

Abstract

PURPOSE: To evaluate the frequency of fear of needles and the impact of a multidisciplinary educational program in women with pre-gestational and gestational diabetes taking insulin during pregnancy. METHODS: The short Diabetes Fear of Injecting and Self-testing Questionnaire (D-FISQ), composed by two subscales that access fear of self injection (FSI) and fear of self testing (FST), was administered twice during pregnancy to 65 pregnant women with pre-gestational and gestational diabetes: at the first endocrine consult and within the last two weeks of pregnancy or postpartum. An organized multidisciplinary program provided diabetes education during pregnancy. Statistical analysis was carried out by Wilcoxon and McNemar tests and Spearman correlation. A p<0.05 was considered to be significant. RESULTS: Data from the short D-FISQ questionnaire shows that 43.1% of pregnant women were afraid of needles in the first evaluation. There was a significant reduction in scores for FSI and FST subscales between the first and second assessments (first FSI 38.5% compared with second 12.7%, p=0.001; first FST 27.7% compared with second FST 14.3%, p=0.012). CONCLUSIONS: The fear of needles is common in pregnant women on insulin therapy and an organized multidisciplinary educational diabetes program applied during pregnancy reduces scores of such fear. ResumoOBJETIVO: Avaliar a frequência do medo de agulhas e o impacto de um programa educacional multidisciplinar em mulheres com diabetes pré-gestacional e gestacional em uso de insulinas durante a gravidez. MÉTODOS: O questionário Diabetes Fear of Injecting and Self-testing Questionnaire (D-FISQ) resumido, composto por duas subescalas que acessam o medo de injeções (FSI) e o medo da automonitoração (FST), foi administrado duas vezes durante a gestação de 65 mulheres com diabetes pré-gestacional e gestacional: na primeira consulta endocrinológica e dentro das últimas duas semanas de gestação ou pós-parto. Durante a gravidez, as gestantes foram submetidas a um programa multidisciplinar sistematizado para prover educação em diabetes. A análise estatística foi realizada por meio dos testes de Wilcoxon e McNemar e a correlação de Spearman. Valor p<0,05 foi considerado como significativo. RESULTADOS: A aplicação do questionário D-FISQ resumido indicou que 43,1% das gestantes apresentavam medo de agulhas na primeira avaliação. Houve significativa redução nos escores das subescalas FSI e FST entre a primeira e segunda avaliação (primeiro FSI 38,5% comparado com o segundo 12,7%, p=0,001; primeiro FST 27,7% comparado com segundo FST 14,3%, p=0,012). CONCLUSÃO: O medo de agulhas é frequente em gestantes em uso de terapia com insulina, e um organizado programa multidisciplinar educacional em diabetes aplicado durante a gestação reduz os escores do medo.

The fear of needles: A systematic review and meta‐analysis

“…For some patients with long-standing type 1 diabetes, it may be difficult to discern whether the fear emanates from the injection itself or from anticipation of a hypoglycaemic event. Fear of selfinjection for pregnant women with gestational diabetes was also shown to be quite prevalent-38.5% at 27 weeks gestation (Feitosa, Sampaio, Batista, & Pinheiro, 2013).…”

Recognition of and steps to mitigate anxiety and fear of pain in injectable diabetes treatment

“… 22 In a study of needle fear in pregnant women with pregestational and gestational diabetes, 43% exhibited fear of needles at baseline; however, a multifaceted diabetes education program, including instruction on self-injections and self-monitoring, was successful in reducing injection fear ( P =0.001) and fear of self-testing ( P =0.012). 23 Injection-related fear is associated with poor glycemic control, increased risk of mortality, and other comorbidities. 24 Thus, the prompt mitigation of anxiety about and fear of pain, and, if possible, the actual pain itself, is of great importance to the success of diabetes therapy.…”

Insulin injection and finger sticking fear in diabetic people

“…[30] Feitosa ve ark.nın (2013) pre-gestasyonel ve gestasyonel diyabeti olan 65 gebe diyabetli kadında iğne korkusu sıklı-ğı ve iğne korkusuna multidisipliner eğitim yaklaşımının etkisini araştırdıkları çalışmasında, gebe diyabetli kadınlar-da sıklıkla iğne korkusunun olduğu ve iyi organize edilmiş multidisipliner diyabet eğitim programının iğne korkusunu azalttığı sonucuna varmışlardır. [26] Berlin ve ark.nın (1997) çalışmasında da, düzenli yapılan diyabet eğitim programlarının fobik semptomları ortaya çıkarmada yarar sağlayacağı, sonuçta alınacak önlemlerle kan şekeri kontrolünün daha iyi olacağı vurgulanmıştır. [13] Bu noktada diyabet eğitmenlerine ve özellikle diyabet hemşiresine önemli görevler düşmektedir.…”

“…Ancak, karmaşık bakım ve tedavi gerektiren diyabette bireylerin yukarıda sıralanan yaşam tarzı değişikliklerini yapmada zorlandıkları, uyum güçlüğü yaşadıkları, özellikle insülin tedavisine başlamada, sürdürmede ve önerilen şekilde kan şekeri takibini yapmada korku ve endişenin önemli yer tuttuğu görülmektedir. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] …”