{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T12:48:53Z","timestamp":1793450933787,"version":"4.5.0"},"reference-count":53,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2022,11,21]],"date-time":"2022-11-21T00:00:00Z","timestamp":1668988800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Becton, Dickinson and Company (BD), Franklin Lakes, NJ, USA","id":[{"id":"https:\/\/ror.org\/048vrgr14","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Needle phobia is an overlooked condition that affects virtually all medical procedures. Our study aimed to identify how commonly needle phobia is experienced, its underlying reasons, impacts, and potential mitigation strategies. A global survey was conducted in a general adult population using a questionnaire based on a targeted literature review that identified under-researched areas. The 21-item questionnaire was completed on a secure, web-based survey platform. Statistical analyses and models were utilized to identify relationships between participant characteristics and needle phobia. Of the 2,098 participants enrolled in the study, 63.2% (n = 1,325) reported experiencing needle phobia, and rated the intensity of their fear as 5.7 (\u00b12.6) on average on a scale from 0 (no fear) to 10 (very strong\/unreasonable fear or avoidance). According to the logistic regression model, other medical fears (odds coefficient = 2.14) and family history (1.67) were the most important factors associated with needle phobia. General anxiety (96.1%) and pain (95.5%) were the most common reasons for needle fear. Of the participants experiencing needle phobia, 52.2% stated avoiding blood draws, followed by 49.0% for blood donations, and 33.1% for vaccinations. While 24.3% of participants have seen a therapist, most have never sought help. The majority have shared their fear with nurses (61.1%) or physicians (44.4%); however, the provider helpfulness was rated as 4.9 (\u00b13.1) on average on a scale from 0 (unhelpful) to 10 (extremely helpful). Utilizing non-invasive alternatives (94.1%) and smaller needles (91.1%) were most commonly identified as potential device-related solutions to alleviate fear; distractions (92.1%) and relaxation techniques (91.7%) were the top non-device-related approaches. Our findings highlight the prevalent nature of needle phobia and provide insights into its etiology and effects on patient care. Clinician responses were not perceived as helpful, emphasizing the need to address needle phobia, and improve patient experience.<\/jats:p>","DOI":"10.1371\/journal.pone.0276814","type":"journal-article","created":{"date-parts":[[2022,11,21]],"date-time":"2022-11-21T13:44:57Z","timestamp":1669038297000},"page":"e0276814","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":119,"title":["Prevalence, causes, impacts, and management of needle phobia: An international survey of a general adult population"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8684-7100","authenticated-orcid":true,"given":"Kimberly","family":"Alsbrooks","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Hoerauf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,11,21]]},"reference":[{"key":"pone.0276814.ref001","unstructured":"Safely Using Sharps (Needles and Syringes) at Home, at Work and on Travel: U.S. Food and Drug Administration; 2021 [updated 11\/19\/2021; cited 2022 May 8]. Available from: https:\/\/www.fda.gov\/medical-devices\/consumer-products\/safely-using-sharps-needles-and-syringes-home-work-and-travel."},{"issue":"5","key":"pone.0276814.ref002","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1177\/193229680700100517","article-title":"Does needle size matter","volume":"1","author":"HS Gill","year":"2007","journal-title":"J Diabetes Sci Technol"},{"issue":"1","key":"pone.0276814.ref003","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1186\/s12913-019-4366-9","article-title":"Injection practices in 2011\u20132015: a review using data from the demographic and health surveys (DHS).","volume":"19","author":"T Hayashi","year":"2019","journal-title":"BMC Health Serv Res"},{"key":"pone.0276814.ref004","doi-asserted-by":"crossref","first-page":"678891","DOI":"10.3389\/fpsyt.2021.678891","article-title":"Cognitive Biases in Blood-Injection-Injury Phobia: A Review","volume":"12","author":"E Abado","year":"2021","journal-title":"Front Psychiatry"},{"issue":"10","key":"pone.0276814.ref005","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1097\/AJP.0000000000000272","article-title":"Far From \"Just a Poke\": Common Painful Needle Procedures and the Development of Needle Fear.","volume":"31","author":"CM McMurtry","year":"2015","journal-title":"Clin J Pain"},{"issue":"1","key":"pone.0276814.ref006","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.transci.2017.11.026","article-title":"An analysis of blood donation barriers experienced by North American and Caribbean university students in Grenada, West Indies","volume":"57","author":"BW Dean","year":"2018","journal-title":"Transfus Apher Sci"},{"key":"pone.0276814.ref007","doi-asserted-by":"crossref","first-page":"113681","DOI":"10.1016\/j.socscimed.2021.113681","article-title":"Motivations and deterrents toward blood donation in Kampala, Uganda.","volume":"272","author":"CM Murtagh","year":"2021","journal-title":"Soc Sci Med"},{"issue":"1","key":"pone.0276814.ref008","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1111\/jan.13818","article-title":"The fear of needles: A systematic review and meta-analysis.","volume":"75","author":"J McLenon","year":"2019","journal-title":"J Adv Nurs"},{"key":"pone.0276814.ref009","doi-asserted-by":"crossref","first-page":"21501327211007393","DOI":"10.1177\/21501327211007393","article-title":"Considering Needle Phobia among Adult Patients During Mass COVID-19 Vaccinations.","volume":"12","author":"AS Love","year":"2021","journal-title":"J Prim Care Community Health"},{"issue":"2","key":"pone.0276814.ref010","doi-asserted-by":"crossref","first-page":"143","DOI":"10.17925\/EE.2020.16.2.143","article-title":"Prevalence of Primary Non-adherence with Insulin and Barriers to Insulin Initiation in Patients with Type 2 Diabetes Mellitus\u2014An Exploratory Study in a Tertiary Care Teaching Public Hospital.","volume":"16","author":"SK Sharma","year":"2020","journal-title":"Eur Endocrinol"},{"issue":"1","key":"pone.0276814.ref011","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1093\/pubmed\/fdab007","article-title":"Prevalence and predictors of vaccine hesitancy in an urbanized agglomeration of New Delhi, India","volume":"44","author":"V Cherian","year":"2022","journal-title":"J Public Health (Oxf)."},{"key":"pone.0276814.ref012","doi-asserted-by":"crossref","first-page":"100977","DOI":"10.1016\/j.pmedr.2019.100977","article-title":"Perception about barriers and facilitators of the school-based HPV vaccine program of Manizales, Colombia: A qualitative study in school-enrolled girls and their parents","volume":"16","author":"V Cordoba-Sanchez","year":"2019","journal-title":"Prev Med Rep"},{"issue":"2","key":"pone.0276814.ref013","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1053\/ajkd.2003.50047","article-title":"Why patients with ESRD do not select self-care dialysis as a treatment option","volume":"41","author":"K McLaughlin","year":"2003","journal-title":"Am J Kidney Dis"},{"issue":"3","key":"pone.0276814.ref014","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1590\/S0100-72032013000300004","article-title":"Frequency of fear of needles and impact of a multidisciplinary educational approach towards pregnant women with diabetes","volume":"35","author":"AC Feitosa","year":"2013","journal-title":"Rev Bras Ginecol Obstet"},{"issue":"2","key":"pone.0276814.ref015","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1111\/jtm.12081","article-title":"The impact of injection anxiety on education of travelers about common travel risks","volume":"21","author":"LM Noble","year":"2014","journal-title":"J Travel Med"},{"issue":"7","key":"pone.0276814.ref016","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1017\/S0033291707000086","article-title":"The epidemiology of DSM-IV specific phobia in the USA: results from the National Epidemiologic Survey on Alcohol and Related Conditions","volume":"37","author":"FS Stinson","year":"2007","journal-title":"Psychol Med"},{"issue":"4","key":"pone.0276814.ref017","doi-asserted-by":"crossref","first-page":"319","DOI":"10.5005\/jp-journals-10005-1458","article-title":"Insulin Syringe: A Gimmick in Pediatric Dentistry","volume":"10","author":"G Kour","year":"2017","journal-title":"Int J Clin Pediatr Dent"},{"issue":"3","key":"pone.0276814.ref018","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1111\/acem.12601","article-title":"Arterial puncture using insulin needle is less painful than with standard needle: a randomized crossover study","volume":"22","author":"I Ibrahim","year":"2015","journal-title":"Acad Emerg Med"},{"issue":"3","key":"pone.0276814.ref019","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1185\/03007995.2014.993025","article-title":"Efficacy, safety and acceptability of the new pen needle 33G\u2009\u00d7\u20094\u2009mm. AGO 01 study","volume":"31","author":"M Valentini","year":"2015","journal-title":"Curr Med Res Opin"},{"key":"pone.0276814.ref020","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1186\/1471-2377-11-126","article-title":"An open-label, multicenter study to evaluate the safe and effective use of the single-use autoinjector with an Avonex\u00ae prefilled syringe in multiple sclerosis subjects","volume":"11","author":"JT Phillips","year":"2011","journal-title":"BMC Neurol."},{"issue":"2","key":"pone.0276814.ref021","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1007\/s40120-015-0036-y","article-title":"Patient Satisfaction with the New Interferon Beta-1b Autoinjector (BETACONNECT\u2122).","volume":"4","author":"T Ziemssen","year":"2015","journal-title":"Neurol Ther."},{"issue":"6","key":"pone.0276814.ref022","doi-asserted-by":"crossref","first-page":"e0253048","DOI":"10.1371\/journal.pone.0253048","article-title":"The prevalence and evidence-based management of needle fear in adults with chronic disease: A scoping review","volume":"16","author":"E Duncanson","year":"2021","journal-title":"PLoS One."},{"issue":"14","key":"pone.0276814.ref023","doi-asserted-by":"crossref","first-page":"S18","DOI":"10.12968\/bjon.2012.21.Sup14.S18","article-title":"\u2019Needle with ease\u2019: rapid stress management techniques","volume":"21","author":"P Mackereth","year":"2012","journal-title":"Br J Nurs"},{"issue":"4","key":"pone.0276814.ref024","doi-asserted-by":"crossref","first-page":"636","DOI":"10.2215\/CJN.11510720","article-title":"Integrating Patient Perspectives into Medical Device Regulatory Decision Making to Advance Innovation in Kidney Disease","volume":"16","author":"ME Tarver","year":"2021","journal-title":"Clin J Am Soc Nephrol"},{"issue":"2","key":"pone.0276814.ref025","first-page":"127","article-title":"Chi-Square Test","volume":"28","author":"L. Connelly","year":"2019","journal-title":"MEDSURG Nursing"},{"key":"pone.0276814.ref026","first-page":"50","article-title":"Analyzing Likert Data.","author":"HN Boone","year":"2012","journal-title":"The Journal of Extension"},{"key":"pone.0276814.ref027","doi-asserted-by":"crossref","first-page":"7","DOI":"10.5120\/ijca2017915495","article-title":"A Comparative Study of Categorical Variable Encoding Techniques for Neural Network Classifiers.","volume":"175","author":"K Potdar","year":"2017","journal-title":"International Journal of Computer Applications"},{"key":"pone.0276814.ref028","doi-asserted-by":"crossref","first-page":"1","DOI":"10.9734\/ajpas\/2019\/v5i230132","article-title":"Diagnosing Multicollinearity of Logistic Regression Model","author":"N Senaviratna","year":"2019","journal-title":"Asian Journal of Probability and Statistics"},{"key":"pone.0276814.ref029","author":"SGK Patro","year":"2015","journal-title":"Normalization: A Preprocessing Stage"},{"key":"pone.0276814.ref030","article-title":"A critical look at the current train\/test split in machine learning","author":"J Tan","year":"2021"},{"key":"pone.0276814.ref031","doi-asserted-by":"crossref","first-page":"11","DOI":"10.5120\/ijca2017913083","article-title":"Machine Learning: A Review on Binary Classification.","volume":"160","author":"R Kumari","year":"2017","journal-title":"International Journal of Computer Applications"},{"issue":"3","key":"pone.0276814.ref032","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1177\/0016986213490022","article-title":"What Are the Odds of That? A Primer on Understanding Logistic Regression.","volume":"57","author":"FL Huang","year":"2013","journal-title":"Gifted Child Quarterly"},{"key":"pone.0276814.ref033","article-title":"Grid Search, Random Search, Genetic Algorithm: A Big Comparison for NAS2019","author":"P Liashchynskyi"},{"key":"pone.0276814.ref034","doi-asserted-by":"crossref","first-page":"1586","DOI":"10.1109\/TKDE.2019.2912815","article-title":"Reliable Accuracy Estimates from k-Fold Cross Validation","volume":"32","author":"T-T Wong","year":"2020","journal-title":"IEEE Transactions on Knowledge and Data Engineering"},{"issue":"2","key":"pone.0276814.ref035","first-page":"169","article-title":"Needle phobia: a neglected diagnosis","volume":"41","author":"JG Hamilton","year":"1995","journal-title":"J Fam Pract"},{"issue":"5","key":"pone.0276814.ref036","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1017\/S0033291798007144","article-title":"The epidemiology of blood-injection-injury phobia","volume":"28","author":"OJ Bienvenu","year":"1998","journal-title":"Psychol Med"},{"issue":"3","key":"pone.0276814.ref037","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1080\/16506073.2016.1157204","article-title":"Exposure-based Interventions for the management of individuals with high levels of needle fear across the lifespan: a clinical practice guideline and call for further research","volume":"45","author":"CM McMurtry","year":"2016","journal-title":"Cogn Behav Ther"},{"key":"pone.0276814.ref038","doi-asserted-by":"crossref","unstructured":"Diagnostic and statistical manual of mental disorders: DSM-5. American Psychiatric A, American Psychiatric Association DSMTF, editors. Arlington, VA: American Psychiatric Association; 2013.","DOI":"10.1176\/appi.books.9780890425596"},{"key":"pone.0276814.ref039","doi-asserted-by":"crossref","first-page":"2377960818759442","DOI":"10.1177\/2377960818759442","article-title":"Fear of Injections and Needle Phobia Among Children and Adolescents: An Overview of Psychological, Behavioral, and Contextual Factors","volume":"4","author":"T Orenius","year":"2018","journal-title":"SAGE Open Nurs."},{"issue":"3","key":"pone.0276814.ref040","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1037\/a0015158","article-title":"One-session treatment of specific phobias in youth: a randomized clinical trial in the United States and Sweden","volume":"77","author":"TH Ollendick","year":"2009","journal-title":"J Consult Clin Psychol"},{"issue":"4","key":"pone.0276814.ref041","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1016\/j.cden.2010.06.012","article-title":"Needle phobia: etiology, adverse consequences, and patient management.","volume":"54","author":"CJ Sokolowski","year":"2010","journal-title":"Dent Clin North Am"},{"issue":"5","key":"pone.0276814.ref042","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1097\/NAN.0000000000000184","article-title":"Needle Phobia.","volume":"39","author":"LS Cook","year":"2016","journal-title":"J Infus Nurs"},{"key":"pone.0276814.ref043","doi-asserted-by":"crossref","first-page":"13","DOI":"10.33393\/dti.2021.2342","article-title":"The role of patient preferences in adherence to treatment in chronic disease: a narrative review","volume":"15","author":"S Losi","year":"2021","journal-title":"Drug target insights"},{"key":"pone.0276814.ref044","doi-asserted-by":"crossref","first-page":"108366","DOI":"10.1016\/j.diabres.2020.108366","article-title":"Willingness of people with Type 2 diabetes to start insulin therapy: Evidence from the South African Tshwane Insulin Project (TIP).","volume":"168","author":"P Ngassa Piotie","year":"2020","journal-title":"Diabetes Res Clin Pract"},{"issue":"4","key":"pone.0276814.ref045","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1016\/j.jbtep.2012.03.006","article-title":"The role of painful events and pain perception in blood-injection-injury fears","volume":"43","author":"NB Smith","year":"2012","journal-title":"J Behav Ther Exp Psychiatry"},{"issue":"6","key":"pone.0276814.ref046","doi-asserted-by":"crossref","first-page":"e0156118","DOI":"10.1371\/journal.pone.0156118","article-title":"Understanding Vaccine Hesitancy in Canada: Results of a Consultation Study by the Canadian Immunization Research Network.","volume":"11","author":"E Dub\u00e9","year":"2016","journal-title":"PLoS One"},{"issue":"6","key":"pone.0276814.ref047","doi-asserted-by":"crossref","first-page":"2200","DOI":"10.1111\/cts.13077","article-title":"COVID-19 vaccine hesitancy: Race\/ethnicity, trust, and fear.","volume":"14","author":"DE Willis","year":"2021","journal-title":"Clin Transl Sci"},{"issue":"4","key":"pone.0276814.ref048","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1001\/jama.2021.11042","article-title":"Potential COVID-19 Endgame Scenarios: Eradication, Elimination, Cohabitation, or Conflagration","volume":"326","author":"A Kofman","year":"2021","journal-title":"Jama"},{"issue":"4","key":"pone.0276814.ref049","doi-asserted-by":"crossref","first-page":"132","DOI":"10.15585\/mmwr.mm7104e2","article-title":"COVID-19 Incidence and Death Rates Among Unvaccinated and Fully Vaccinated Adults with and Without Booster Doses During Periods of Delta and Omicron Variant Emergence\u201425 U.S. Jurisdictions, April 4-December 25, 2021","volume":"71","author":"AG Johnson","year":"2022","journal-title":"MMWR Morb Mortal Wkly Rep."},{"issue":"26","key":"pone.0276814.ref050","doi-asserted-by":"crossref","first-page":"3779","DOI":"10.1016\/j.vaccine.2018.05.053","article-title":"Safety, tolerability, acceptability and immunogenicity of an influenza vaccine delivered to human skin by a novel high-density microprojection array patch (Nanopatch\u2122).","volume":"36","author":"GJP Fernando","year":"2018","journal-title":"Vaccine"},{"issue":"4","key":"pone.0276814.ref051","doi-asserted-by":"crossref","first-page":"e20190095","DOI":"10.1590\/0034-7167-2019-0095","article-title":"Nursing process for a patient with needle phobia: a case study","volume":"73","author":"AB Mendon\u00e7a","year":"2020","journal-title":"Revista brasileira de enfermagem"},{"key":"pone.0276814.ref052","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.3389\/fpsyg.2018.01534","article-title":"Large-Group One-Session Treatment: A Feasibility Study of Exposure Combined With Applied Tension or Diaphragmatic Breathing in Highly Blood-Injury-Injection Fearful Individuals.","volume":"9","author":"A Wannemueller","year":"2018","journal-title":"Front Psychol"},{"issue":"3","key":"pone.0276814.ref053","doi-asserted-by":"crossref","first-page":"351","DOI":"10.5606\/tftrd.2020.3917","article-title":"A comparison of dry needling and kinesiotaping therapies in myofascial pain syndrome: A randomized clinical study","volume":"66","author":"N Y\u0131lmaz","year":"2020","journal-title":"Turk J Phys Med Rehabil"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0276814","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T03:03:34Z","timestamp":1728443014000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0276814"}},"subtitle":[],"editor":[{"given":"Carmen","family":"Concerto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,11,21]]},"references-count":53,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0276814","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,21]]}}}