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. 2023 Feb;37(2):443-450.
doi: 10.1111/jdv.18641. Epub 2022 Oct 25.

Patient Unique Stigmatization Holistic tool in dermatology (PUSH-D): Development and validation of a dermatology-specific stigmatization assessment tool

Khaled Ezzedine  1   2 , Jason Shourick  3 , Christina Bergqvist  2 , Laurent Misery  4   5 , Bertrand Chuberre  6 , Delphine Kerob  7 , Bruno Halioua  5   8 , Gaëlle Le Fur  9 , Carle Paul  10 , Marie-Aleth Richard  11 , Charles Taieb  5   9
Affiliations

Patient Unique Stigmatization Holistic tool in dermatology (PUSH-D): Development and validation of a dermatology-specific stigmatization assessment tool

Khaled Ezzedine et al. J Eur Acad Dermatol Venereol. 2023 Feb.

Abstract

Background: The skin plays an important role in establishing interpersonal relationships, and thus visible skin disorders, which have a significant impact on physical appearance, influence other people's behaviours and attitudes.

Objective: To develop and validate a dermatologic-specific questionnaire to evaluate stigmatization in individuals with visible skin conditions.

Methods: Items were generated by a verbatim report based on qualitative interviews with patients with various dermatologic conditions. Subsequently, a study was implemented for psychometric analysis. A dermatology-specific stigmatization questionnaire (PUSH-D) was refined via item reduction according to inter-question correlations, consensus among experts and exploratory factor analysis. Internal consistency was determined by calculating Cronbach's α. Concurrent validity was determined by calculating the correlation between PUSH-D and the Dermatology Life Quality Index (DLQI) and the Rosenberg Self-Esteem Scale (RSES).

Results: From a primary list of 22 items, PUSH-D was reduced to a 17-item questionnaire, covering two pertinent dimensions based on the exploratory factor analysis. Construct validity was demonstrated, and PUSH-D showed good internal consistency (Cronbach's α = 0.9). PUSH-D correlated strongly with the DLQI 0.72 (p < 0.001) and moderately with the RSES 0.49 (p < 0.001).

Conclusion: PUSH-D allows a comprehensive view of the degree of stigmatization in visible skin disorders, as well as the comparability of stigmatization levels across various skin conditions.

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Conflict of interest statement

Bertrand Chuberre and Delphine Kerob are employed by L'Oréal. Khaled Ezzedine; Jason Shourick; Christina Bergqvist; Laurent Misery; Bruno Halioua; Gaëlle Le Fur; Carle Paul; Marie‐Aleth Richard and Charles Taieb have no conflict of interest to declare.

Figures

FIGURE 1
FIGURE 1
Confirmation of the unidimensionality of PUSHD using was a higher order factor analysis. Tucker–Lewis index = 0.968, RMSEA = 0.053, 95% Confidence Interval [0.05–0.056]), comparative fit index (CFI) = 0.976.
FIGURE 2
FIGURE 2
Bland and Altman plots for felt‐stigma, enacted stigma and total score.
See this image and copyright information in PMC

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