Development and validation of the Measuring Needle Fear (MNF) screening tool for identification of needle fear in pre-dialysis and dialysis patients

Overview

Abstract

Background: Needle fear is an under-recognised burden among haemodialysis recipients which can influence treatment choice and therapy engagement.

Objective: This study aimed to develop and validate a tool to identify needle fear in pre-dialysis or dialysis cohorts.

Methods: The Measuring Needle Fear (MNF) tool was developed using deductive and inductive methods, with items grouped into four domains to ensure comprehensive symptom coverage. Content validity was assessed using the Content Validity Index (CVI), and reliability using Gwet's AC1 coefficient and Cronbach's alpha. Exploratory factor analysis (EFA) was performed using Principal Axis Factoring with oblimin rotation, supported by the Kaiser-Meyer-Olkin statistic and Bartlett's test. Discriminative ability and the optimal cut-off point were evaluated using ROC analysis.

Results: A total of 120 participants completed the questionnaire. Test-retest reliability was excellent for most MNF items (30 items; AC1 = 0.81-1.00) and good for the remainder (nine items; AC1 = 0.61-0.80). EFA identified three factors - Fear, Avoidance and Embarrassment - with excellent sampling adequacy (KMO = 0.908) and a significant Bartlett's test (p < 0.001). Internal consistency was high (Cronbach's alpha = 0.895). ROC analysis demonstrated excellent discrimination (AUC = 0.959), with a score ⩾5 identifying 31% of patients as likely to experience needle fear.

Conclusion: The Measuring Needle Fear tool is a validated, reliable method for identifying needle fear in pre-dialysis and dialysis patients, supporting early detection and enabling timely, targeted support.