Table 1.
Studies Examining FOH: Characteristics and Results
| Source | Sample size | Age Range of Child | HFS Version | HFS M±SD^ | Results |
|---|---|---|---|---|---|
| Gonder-Frederick, Fisher, et al. (2006) [38] | 129 adolescent-parent dyads | 12–17 | HFS-P (25 items) HFS-C (25 items |
Parent T=66.44±14.47 Adolescent T=65.24±13.24 Parent W=36.9±11.62 Adolescent W=33.87±11.61 Parent B=29.55±6.01 Adolescent B=31.36±7.38 |
Adolescent FOH and parent FOH not correlated. For adolescents, higher trait anxiety and more frequent episodes of severe hypoglycemia predicted higher FOH; for parents, whether adolescent carried rescue carbs predicted lower parent FOH. |
| Patton, Dolan, Henry, et al. (2007) [32] | 24 parents | 2–8 | HFS-P-YC | T=81±14.1 W=44.3±11.1 B=33.7±5.3 |
HFS-P-YC includes an added question about fear related to their child having a low blood glucose while the parent is driving. Lower SES was associated with higher parent Total and Worry scores. HFS-P-YC Behavior scores positively correlated with A1C. |
| Patton, Dolan, et al. (2008) [31] | 81 mothers, 64 fathers | 2–8 | HFS-P-YC | Mother T=75±17.2 Mother W=42±13.5 Mother B=33±6.2 Father T=66.5±18 Father W=38±13.4 Father B=29±6.5 |
HFS-P adapted for use with young children to include age appropriate activities. Good internal consistency and test-retest reliability; Mothers had higher scores on HFS-P-YC Total and Behavior subscales than fathers. Mothers’ HFS-P-YC Worry significantly correlated with frequency of hypoglycemic events. FOH not related to A1C. |
| Haugstvedt, Wentzel-Larsen, et al. (2010) [42] | 103 Norwegian mothers and 97 fathers | 1–15 | HFS-P (25 items; translated into Norwegian) | Mother T=70.9±12.6 Mother W=37.7±8.9 Mother B=33.2±6.2 Father T=66.1±11.7 Father W=36±8.5 Father B=30.1±6 |
Higher HFS-P Worry related to higher A1C and higher frequency of hypoglycemic events. HFS-P Behavior scores higher in parents of children on MDI than pump. Mothers’ scores on the HFS-P Worry and Behavior were higher than fathers’ scores. |
| JDRF CGM Study Group [53] | 228 children/adolescents and 223 parents | <18 | HFS Worry | Child W=25.7±16.6 (CGM) Child W=25.9±14.9 (BGM) Parent W= 41.5±16 (CGM) Parent W=42.2±19.8 (BGM) |
No differences in HFS Worry between CGM group and BGM group (finger stick). Parents reported more worry than children. |
| Gonder-Frederick, Nyer, et al. (2011) [5] | 259 children/adolescents; 250 parents | 6–18; age groups: 6–8, 9–11, 12–18 | HFS-P and HFS-C+ | Child T=1.52±0.57*** Child W=1.10±0.73 Child B=2.17±0.63 Parent T=1.90±0.57 Parent W=1.75±0.63 Parent B=2.38±0.60 |
Demonstrated reliability and validity of the HFS-P and HFS-C in younger children and across age groups. HFSwC Worry scores in 9–11 year olds equaled 12–18 year olds, but were higher than 6–8 year olds. HFS-P Behavior scores (for children 6–8 and 9–11) were higher than parents’ scores of children 12–18. Child and parent FOH significantly correlated across all age groups. FOH not related to A1C. |
| Patton, Dolan, et al. (2011) [55] | 39 parents | 2–7 | HFS-P-YC (26 items) | T=78.6±18.4 | More frequent parental stress and more difficulty with parenting stress were associated with higher FOH. |
| Markowitz, Pratt, et al. [56] | 28 children/adolescents and their parents | 8–17 | HFS (23 items) | Child T=15.8±12.2 (BGM) Child T=17.9±14.1 (CGM) Parent T=23.1±17.2 (BGM) Parent T=18.8±20 (CGM) |
Parents reported higher FOH than their children. No differences in FOH between CGM and BGM groups. |
| Freckleton, Sharpe, & Mullan (2013) [41] | 71 mothers | 2–12 | HFS-P+ | — | HFS-P Behavior and Worry not associated with A1C. Higher scores on HFS-P Behavior was associated with higher daily blood glucose levels. |
| Johnson, Cooper, et al. (2013) [40] | 196 Australian children/adolescents; 325 parents | 2–18 | HFS-P and HFS-C+ | — | Higher FOH associated with lower diabetes-specific QOL in both children/adolescents and parents. Children/adolescents with higher FOH had higher A1Cs. FOH not related to A1C for parents. Parents with higher FOH associated with more episodes of severe hypoglycemia, but not for children/adolescents. |
| Barnard, Wysocki, et al. (2014) [50] | 16 adolescents and parents | 12–18 | HFS* (23 items) |
Parent T=65.7±1.4 Adolescent T=60.1±1.2 |
Artificial pancreas study. Adolescent scores declined throughout course of the study, whereas parent scores increased. |
| Shepard, Vajda, et al. (2014) [37] | 259 children/adolescents; 250 parents | 6–18 | HFS-P and HFS-C (25 items) | Same sample as Gonder-Frederick, Nyer, et al. (2011) | Factor analyses revealed two subscales within Worry: Helplessness and Social Consequences and two subscales within Behavior: Maintain High Blood Glucose and Avoidance. High HFS-C scores on Maintain High Blood Glucose was associated with higher mean blood glucose levels and more hyperglycemic readings, but not A1C. Higher HFS-C Avoidance scores with fewer hypoglycemic episodes. |
| Al Hayek, Robert, et al. (2015) [26] | 187 Saudi Arabian adolescents | 13–18 | HFS-C (32 items) | W=2.16±1.08 (13–15 years) W=2.49±0.70 (16–18 years) B=1.96±0.73 (13–15 years) B=2.55±0.63 (16–18 years) |
Females had higher scores on the HFS-C than males. Older age, MDI, longer type 1 diabetes duration, higher frequency of hypoglycemia, and hypoglycemia generally and in front of friends was associated with higher HFS-C scores. |
| Amiri, Vafa, & Gonder-Frederick (2015) [27] | 61 Iranian children | 6–12 | HFS-C (32 items) | T=55.9±17.9 (age ±9) T=38.2±16.4 (age±10) W=31.1±14.7 (age ±9) W=16.9±11.4 (age±10) B=24.8±7.7 (age ±9) B=21.4±7.5 (age±10) |
No relationship between FOH and A1C. |
| Haugstvedt, Wentzel-Larsen, et al. (2015) [28] | 176 parents | 6–15 | HFS-P (25 items; translated into Norwegian) | — | Factor analysis revealed support for the HFS-P Worry subscale. However, support for the Behavior subscale was weak. Further refinement of the scale was recommended. |
| Ziegler, Liberman, et al. (2015) [51] | 40 adolescents | 10–18 | HFS-C** | T=1.33±0.41**** W=1.04±0.53 B=1.78±0.49 |
It appears that the HFS scores were collapsed between all participants, 19 of whom were >18 years. FOH was low at baseline; however, HFS Worry decreased after four nights of using the artificial pancreas system. |
Note. Some versions of the HFS have been modified by adding and/or deleting items.
JDRF CGM = Juvenile Diabetes Research Foundation Continuous Glucose Monitoring; BGM = Blood Glucose Monitoring; HFS = Hypoglycemia Fear Survey; HFS-C = Hypoglycemic Fear Survey-Child; HFS-P = Hypoglycemic Fear Survey-Parents; HFS-P-YC = Hypoglycemic Fear Survey-Parents of Young Children; T = Total Score; W = Worry Score; B = Behavior Score
^
For longitudinal studies, only baseline scores are reported.
+
Number of items not specified
*
This study cited the adult version of the HFS; thus, it is assumed that the adult and not the child version was used.
**
Not clear if HFS was translated or administered in English
***
Mean item scores: In the article, means and standard deviations are provided for each age group. For the purposes of this review, we collapsed the means and standard deviations across groups and averaged them.
****
Mean item scores