Background and Aim: The efficacy of insulin and other injectable therapies depends on injection technique. To develop and validate a brief self-administered injection technique assessment questionnaire.

Methods: The questionnaire was developed using an iterative process with people with diabetes (PWD) and healthcare professionals (HCP). Focus groups and 1:1 interviews were held with adults with T1D, T2D and HCPs separately to elicit views and refine the tool ready for broader distribution to target audience. Questions addressed ease of understanding, relevance, included questions and potential missing questions, feelings about diabetes and any discomfort or judgement felt. A user guide was developed with cognitive interviewing performed to ensure relevance, acceptability and understanding by potential users. Multiple Component Analysis assessed relationships between questions after extensive descriptive statistical analysis. Propensity score matching compared the questionnaire to the ITQ WW.

Results: Five HCPs and 16 PWD participated in the initial focus groups and interviews. Questions were reported to be clinically relevant by HCPs and simple to complete. PWD reported the 9-item questionnaire to be ’about the right length’, with questions relevant and the user guide easy to read and interpret. 268 participants completed the survey reviewing the questionnaire and provided feedback. A further 16 participants (10 HCPs and 6 PWD) took part in the cognitive interviews. The complete resource was finally reviewed by a further 23 PWD as a check of completeness and usability. Statistical analyses showed the questionnaire to depict similar trends to those assessed in the detailed questionnaire (ITQ WW), confirming the validity of this new questionnaire as a shorter, more straightforward tool.

Conclusions: The novel, brief questionnaire and user guide are clinically relevant, acceptable and easy to use both as a clinical resource and a self-assessment tool for people using injectable therapies.


K.D. Barnard: Advisory Panel; Self; Roche Diabetes Care, Sanofi-Aventis. Research Support; Self; BD, Novo Nordisk A/S, Roche Diabetes Care. E.T. Mahoney: Employee; Self; Becton, Dickinson and Company. D. Morel: Employee; Self; Becton, Dickinson and Company. S. Glezer: Employee; Self; Becton, Dickinson and Company. Employee; Spouse/Partner; Pfizer Inc. Stock/Shareholder; Self; Sanofi. Stock/Shareholder; Spouse/Partner; Sanofi.



Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at