Development and Validation of the Scale of Hypoglycemia Self-Care Behavior in Type 2 Diabetes

Abstract Background Inappropriate dietary, exercise, and medication self-care behaviors among persons with diabetes can easily trigger hypoglycemia. Clinically, it is necessary to quickly identify high-risk groups for hypoglycemic events to provide targeted hypoglycemia education. However, there is currently a lack of precise tools to assess self-care behaviors related to hypoglycemia. Objectives To develop and validate a hypoglycemia self-care behavior scale for evaluating the behaviors of persons with diabetes in handling and preventing hypoglycemic events. Methods A cross-sectional study with purposive sampling was conducted to recruit 300 persons with type 2 diabetes who had experienced hypoglycemic events from a medical center and a primary care clinic in southern Taiwan. Data were collected using a structured questionnaire from December 2021 to September 2023. Results The original hypoglycemia self-care behavior scale, comprising 26 items, was reduced to 17 items, measuring six factors after exploratory factor analysis. Subsequently, the scale was further refined to 10 items covering four factors through structural equation modeling. The validity and reliability were assessed during this process, and the developed scale was subsequently verified for both. Factor loadings ranged from .50–.97, explaining 76% of the total variance. The four factors included “hypoglycemia recognition and carbohydrate supplementation,” “prevention of hypoglycemia during exercise,” “carbohydrate assessment,” and “seeking medical assistance.” The hypoglycemia self-care behavior scale—developed and validated through structural equation modeling—demonstrates satisfactory model fit, convergent validity, and discriminant validity. Internal consistency was within the range of .73–.94, indicating strong reliability. Discussion The hypoglycemia self-care behavior scale not only functions as a tool for the rapid assessment of self-care behaviors during hypoglycemic events by clinical health care professionals but can also serve as reference for hypoglycemia-related health education.