Validity study of the Turkish version of the barriers to insulin treatment questionnaire

  • Seyhan Citlik Saritas
  • Behice Erci
  • Ibrahim Sahin
  • Evrim Timocin
Original Article


The purpose of this study is to test the validity and reliability of the Barriers to Insulin Treatment Questionnaire and adapt the questionnaire for Turkish society. This was a cross-sectional study. The population of this study consisted of adult patients with type 2 diabetes who were using insulin and being monitored in the Endocrine and Outpatient Clinics of Inonu University Turgut Ozal Medical Centre. The sample of the study consisted of 348 patients. The data were collected by using the Barriers to Insulin Treatment Questionnaire (BITQ) and a survey including demographic characteristics. The 14 items of the questionnaire are scored between 1 and 10. BITQ has five factors as fear of injections and self-testing, expectations regarding positive insulin-related outcomes, expected hardship from insulin treatment, stigmatization by insulin injections, and fear of hypoglycemia. In order to test the construct validity of the questionnaire, Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were utilized. The reliability of BITQ was evaluated by its Cronbach’s alpha internal consistency coefficient, item total correlation, and test-retest reliability. It was determined that the Cronbach’s alpha reliability coefficients of the questionnaire factors ranged between 0.70 and 0.82, the scale item factor loadings varied from 0.54 to 0.86, and the item total correlation coefficients were between 0.30 and 0.52. CFA supported the 5-factor scale structure obtained as a result of EFA. Good fit index values were obtained as a result of CFA. According to the obtained results, it may be asserted that BITQ is valid and reliable in terms of its application in Turkish society.


Barriers to insulin treatment questionnaire Turkish adaptation Validity Reliability Diabetes mellitus 


Compliance with ethical standards

Conflict of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Informed consent

Informed consent was obtained from all participants included in the study.

Ethical approval

The population and sample of the study. The study was approved by the Scientific Research and Ethics Board of Inonu University Health Sciences Institute. Verbal information was provided to all participants in accordance with the principles of the Declaration of Helsinki. Additionally, the participants were informed about the research and notified that their personal data would be kept confidential.


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Copyright information

© Research Society for Study of Diabetes in India 2018

Authors and Affiliations

  1. 1.Internal Nursing Department, Faculty of NursingInonu UniversityMalatyaTurkey
  2. 2.Public Health Nursing Department, Faculty of NursingInonu UniversityMalatyaTurkey
  3. 3.Internal Medicine Department, Medical SchoolInonu UniversityMalatyaTurkey
  4. 4.Internal Medicine Department, Diabetes NurseInonu University HospitalMalatyaTurkey

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