{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T17:21:58Z","timestamp":1758043318936,"version":"3.44.0"},"reference-count":19,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000},"content-version":"unspecified","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,8,12]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>This study aimed to develop a scale for nurses\u2019 knowledge, attitudes and practices regarding the prevention and treatment of subcutaneous lipohypertrophy associated with insulin injections and evaluate its reliability and validity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>A Delphi research and cross-sectional survey.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Medical, education and nursing experts from seven different regions conducted Delphi consultation by E-mail or Wechat, whereas clinical nurses from primary, secondary and tertiary general hospitals in different regions of Sichuan Province were conveniently selected for the questionnaire survey.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>A total of 16 female experts aged 35\u201358 years participated in the Delphi expert consultation process; 812 clinical nurses participated in the questionnaire survey.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Outcome measure<\/jats:title>\n                  <jats:p>Content validity, internal consistency reliability and construct validity of the scale.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The scale comprises 3 dimensions and 36 items, with a content validity index of 0.99, a Cronbach\u2019s \u03b1 coefficient of 0.93, a split-half reliability of 0.87 and a test\u2013retest reliability of 0.93. Exploratory factor analysis revealed a cumulative variance contribution rate of 53.38%, whereas confirmatory factor analysis indicated a \u03c72 degree of freedom 2 ratios of 2.65, a goodness-of-fit index of 0.86, a root mean square error of approximation of 0.06, a root mean square error of 0.04 and a comparative fit index of 0.90.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The developed scale demonstrated strong reliability and validity, enabling the assessment of nurses\u2019 knowledge, attitudes and practices regarding the prevention and treatment of lipohypertrophy associated with insulin injections.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-101485","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T04:40:49Z","timestamp":1757652049000},"page":"e101485","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Development and testing of a scale for nurses\u2019 knowledge, attitudes and practices regarding insulin injection-induced lipohypertrophy: A Delphi research and cross-sectional survey"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9127-2978","authenticated-orcid":false,"given":"Qin","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Day Surgery Ward, Sichuan Provincial People\u2019s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinyu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Day Surgery Ward, Sichuan Provincial People\u2019s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Min","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Sichuan Provincial People\u2019s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1584-9616","authenticated-orcid":false,"given":"Ping","family":"Jia","sequence":"additional","affiliation":[{"name":"Department of NICU, Sichuan Provincial People\u2019s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary Surgery, Neijiang People\u2019s Hospital, Neijiang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of NICU, Sichuan Provincial People\u2019s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Geriatric Cardiology, Sichuan Provincial People\u2019s Hospital, University of Electronic Science and Technology of China, Chengdu, China, Chengdu, Sichuan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,9,11]]},"reference":[{"unstructured":"Ji LN , Guo XHJ , Huang J . Technical Guidelines for diabetes drug injection in China (2016 edition). Chinese Journal of Diabetes. Chinese Journal of Diabetes 2017;79\u2013105.","key":"2025091121403060000_15.9.e101485.1"},{"key":"2025091121403060000_15.9.e101485.2","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1007\/s13300-018-0538-6","article-title":"Correction to: Insulin Injection Technique in China Compared with the Rest of the World","volume":"10","author":"Song","year":"2019","journal-title":"Diabetes Ther"},{"key":"2025091121403060000_15.9.e101485.3","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1016\/j.mayocp.2016.06.012","article-title":"Worldwide Injection Technique Questionnaire Study: Injecting Complications and the Role of the Professional","volume":"91","author":"Frid","year":"2016","journal-title":"Mayo Clin Proc"},{"doi-asserted-by":"crossref","unstructured":"Thewjitcharoen Y , Prasartkaew H , Tongsumrit P , et al . 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A mesh Meta-analysis of the relationship between 24 the number of insulin needle use and the occurrence of subcutaneous lipohypertrophy. Chinese General Practice 2020;4342\u20138.","key":"2025091121403060000_15.9.e101485.9"},{"key":"2025091121403060000_15.9.e101485.10","doi-asserted-by":"crossref","first-page":"1379","DOI":"10.1007\/s13300-021-01006-0","article-title":"Role of Structured Education in Reducing Lypodistrophy and its Metabolic Complications in Insulin-Treated People with Type 2 Diabetes: A Randomized Multicenter Case\u2013Control Study","volume":"12","author":"Gentile","year":"2021","journal-title":"Diabetes Ther"},{"unstructured":"Chinese Society of Diabetes . Guidelines for the Prevention and Treatment of Type 2 Diabetes in China of Chinese Medical Association (2020 edition). Chinese Journal of Diabetes Mellitus 2021;315\u2013409.","key":"2025091121403060000_15.9.e101485.11"},{"unstructured":"Zhang Q , Jia P , Wang L . Research progress on insulin injectionassociated subcutaneous Lipohypertrophy. Journal of Modern Nursing 2023;3356\u201360.","key":"2025091121403060000_15.9.e101485.12"},{"unstructured":"Wei L , Liang HH , Lu YM . The compilation and reliability and validity of the geriatric nursing ability evaluation scale for clinical nurses. Chinese Journal of Nursing 2019;1378\u201384.","key":"2025091121403060000_15.9.e101485.13"},{"key":"2025091121403060000_15.9.e101485.14","first-page":"378","article-title":"Sample Size Estimation in Quantitative Research in Nursing Studies","volume":"45","author":"Ni","year":"2010","journal-title":"Chinese Journal of Nursing"},{"unstructured":"Zhao QL . Development and Application of Nursing Evaluation Tool(2rd). Beijing, China: People\u2019s Medical Publishing House, 2014.","key":"2025091121403060000_15.9.e101485.15"},{"unstructured":"Du GP , Li P , Zhang SJ . 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