Development and psychometric properties of the Chinese version of the Impaired Awareness Hypoglycemia Assessment Scale

Hsiu Hui Weng, Jia Ling Wu, Hsiang Ju Cheng, Shu Tin Yeh, Hua Fen Chen, Chung Yi Li

Research output: Contribution to journalArticlepeer-review


Objectives: This study was conducted to translate Clark’s and Gold’s questionnaires on impaired awareness of hypoglycemia (IAH) from English to Chinese (Clarke-TW and Gold-TW, respectively) and evaluate their reliability and validity. Methods: A bilingual expert group translated and back-translated the original questionnaires to develop the Clarke-TW and Gold-TW questionnaires. Convenient sampling was performed across 19 pharmacies, clinics, and public health centers in Tainan between September to November 2022. Thus, we recruited 898 patients (age ≥ 20 years) with type 2 diabetes who had received insulin injection or oral sulfonylureas over the previous 3 months. Face-to-face interviews were conducted with these individuals. IAH prevalence, internal consistency, test–retest reliability, and construct validity were evaluated for both questionnaires. Results: The bilingual expert group confirmed the content validity of the two questionnaires. For Clark-TW, the Kuder–Richarson-20 coefficient was 0.481 and the 4-week test–retest intraclass correlation coefficient was 0.660. The intraclass correlation coefficient for Gold-TW was 0.653. IAH prevalence measured using Clarke-TW and Gold-TW exhibited no association with sex (p = .32 and .70, respectively) or employment status (p = .08 and .29, respectively). However, routine self-monitoring of blood glucose and a retinal examination in the previous year were significantly associated with reduced IAH prevalence regardless of the measurement tool used (p < .001); this finding supports the questionnaires’ known-group validity. Factor analyses identified two factors from Clarke-TW; principal axis factoring indicated that the two-factor model fit was adequate. Conclusions: Both Clarke-TW and Gold-TW have moderate test–retest reliability and satisfactory construct validity. The overall IAH prevalence measured using Clarke-TW and Gold-TW was 36.1% (95% confidence interval: 32.9%-39.3%) and 49.4% (95% confidence interval: 46.1%-52.3%), respectively. Both questionnaires are straightforward and convenient and can be used in community surveys to estimate IAH prevalence among patients with diabetes.

Original languageEnglish
Pages (from-to)530-541
Number of pages12
JournalTaiwan Journal of Public Health
Issue number5
Publication statusPublished - 2023 Oct

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health


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