Development and Initial Validation of the Insulin Injection Behavior Assessment Tool (IIBAT) for Adolescents with Type 1 Diabetes Mellitus
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Abstract
Objective: To develop and initially validate an Insulin Injection Behavior Assessment Tool (IIBAT) for adolescents with type 1 diabetes mellitus (T1DM), based on the Five Rights framework of medication administration. Methods: This cross-sectional pilot study involved the construction of the tool based on literature review, clinical guidelines, and expert input. Five experts evaluated content validity using the Content Validity Index (CVI). Pilot testing was conducted with 34 adolescents with T1DM to assess clarity, feasibility, and reliability. A ceiling effect analysis was also performed. Results: The initial version of the IIBAT consisted of 24 items across three domains: preparation, storage/transportation, and adverse effect management. Content validity was strong (I-CVI = 0.80–1.00; S-CVI = 0.83), and no significant ceiling effect was found (2.94%). Corrected item–total correlations ranged from –0.30 to 0.60. Conclusion: The refined IIBAT demonstrated strong content validity and feasibility for assessing insulin injection behaviors in adolescents with T1DM. The removal of two low-performing items improved the conceptual alignment of the final 22-item version, supporting its use as a developmentally appropriate tool for clinical assessment and educational intervention.
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