Psychometric Properties and Dimensionality of the Greek Version of the Hypoglycemic Confidence Scale

Background and purpose: The prevalence of type 1 diabetes mellitus (T1D) is rising at an alarming rate and is projected to continue increasing in the coming years. The primary approach to preventing diabetes-related complications in individuals with T1D is the exogenous administration of insulin. However, this method can sometimes lead to hypoglycemia, a condition with a wide range of symptoms, including loss of consciousness, seizures, coma, and, in severe cases, death. This study aims to present the psychometric properties of the Greek translation of the Hypoglycemic Confidence Scale (HCS). The HCS measures an individual's sense of personal strength and comfort based on the belief that they possess the necessary resources to manage and prevent hypoglycemia-related complications. Methods: We conducted a forward and backward translation, along with a cultural adaptation, of the HCS into Greek. The psychometric properties of the scale were evaluated through confirmatory factor analysis. To assess the reliability, we calculated the intraclass correlation coefficient, while internal consistency was measured using Cronbach's alpha. Construct validity was evaluated through convergent and divergent validity, comparing the HCS-Gr with the Diabetes Quality of Life Brief Clinical Inventory (DQoL-BCI) and hemoglobin A1C levels. Differential validity was assessed using the known-groups method. Results: Ninety-seven adults with T1D, aged between 18 and 57 years (mean age: 38.6 ± 11.7), completed the HCS-Gr. The two structures of the HCS-Gr demonstrated strong internal consistency, with Cronbach's α values of 0.87 for the eight-item version and 0.86 for the nine-item version. Convergent validity was supported by moderate negative correlations between both HCS-Gr versions and the DQoL-BCI subscales and total score. The HCS-Gr also showed satisfactory test-retest reliability and differential validity, confirming its robustness as a psychometric tool. Conclusions: The HCS-Gr is a valid and reliable tool for assessing confidence (or self-efficacy) in managing hypoglycemic situations among individuals with T1D in Greece.