Development and validation of the Epilepsy Self-Stigma Scale

Development of a postoperative visual function rehabilitation compliance assessment scale for children with congenital cataract: a reliability and validity study

OBJECTIVE

To develop a comprehensive compliance assessment scale for postoperative visual function rehabilitation in children with congenital cataracts and to assess its reliability and validity.

METHOD

Drawing on the Interactive Model of Health Behavior, we conducted a literature review and semi-structured interviews to create a pool of 36 items. The items underwent rigorous evaluation through the Delphi method, face validity checks, and item analysis, leading to a reduction to 18 items. To assess the scale's reliability and validity, we collected data from 225 parents of children with congenital cataracts. We employed SPSS version 25.0 for data analysis and evaluated construct validity using exploratory factor analysis, content validity, internal consistency reliability, and test-retest reliability.

RESULTS

The compliance scale for postoperative visual function rehabilitation in children with congenital cataracts comprises 5 dimensions and 18 items. Exploratory factor analysis extracted 5 common factors, with a cumulative variance contribution rate of 68.178%. Item-level content validity index ranged from 0.730 to 1.000, and the content validity index of the scale was 0.963. The total Cronbach's alpha coefficient, split-half reliability, and test-retest reliability of the scale were 0.855, 0.778, and 0.859, respectively.

CONCLUSIONS

The compliance assessment scale for postoperative visual function rehabilitation in children with congenital cataracts demonstrates acceptable reliability and validity. It serves as a valuable reference for developing standardized nursing programs for these children in clinical practice.

Validity and reliability study of the turkish version epilepsy self-stigma scale (ESSS-T)

AIM

We translated the Epilepsy Self-stigma Scale (ESSS) into Turkish and aimed to examine the Turkish version ESSS (ESSS-T) validity and reliability.

MATERIALS AND METHOD

From April to August 2023, patients with epilepsy (PWE) were recruited from the neurology outpatient clinic of Ataturk University Hospital in the eastern Turkish city of Erzurum (inclusion criteria: age 18 years or older and adequate reading and speaking ability in Turkish). We conducted our survey using a self-administered questionnaire. The questionnaire consisted of the ESSS-T after appropriate translation by back-translation, and self-esteem (the Rosenberg's Self-Esteem Scale, RSES), depression (the Neurological Disorders Depression Inventory for Epilepsy, NDDI-E), and general stigma (the Stigma Scale for Epilepsy, ESE) for construct validity. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to test factorial validity. Also, Cronbach's alpha coefficient was calculated to verify reliability.

RESULTS

Of the 126 patients, 106 agreed to give informed consent and responded to the questionnaire (84.1 % response rate). The results of EFA suggested the same three-factor structure as in the original version, but CFA showed some limitations in interpreting the three-factor structure and it may be safer to understand it as a unifactorial structure. The alpha coefficients were also validated by the ESSS-T. The alpha coefficients were α = 0.74 for the ESSS-T scale as a whole and α = 0.69-0.74 for each subscale, which were generally acceptable values.

CONCLUSION

The Turkish version of the ESSS proved valid and reliable. It is a measurement tool with a three-dimensional structure. It can be used to assess the self-stigmatization of patients with epilepsy in Turkey.

Tendency to Stigmatize Epidemic Diseases Scale: Scale Development and Validity Study

PURPOSES

The purpose of this study was to develop a scale to measure stigma during epidemics among adults in nursing care and validate its psychometric properties.

METHODS

The preliminary items of the Tendency to Stigmatize Epidemic Diseases Scale scale were developed through a literature review, the Delphi technique, and content validity analysis. A total of 723 adults living in Turkey responded to the questionnaire from June to December 2021. The collected data were analyzed by exploratory factor analysis and confirmative factor analysis using SPSS and AMOS programs.

RESULTS

The experts agreed on 51 scale items, and 24 items were removed following exploratory factor analysis. On the 27-item scale, a five-factor structure was found with an eigenvalue >1, explaining 59.2% of the total variance. The overall Cronbach's α value was 0.88.

CONCLUSIONS

This scale is a reliable and valid measurement tool for adults to determine their level of stigma during epidemics in nursing care. This scale helps develop interventions to improve the psychological health of adults in nursing care.

An online survey on differences in knowledge and stigma about epilepsy among the Tokyo metropolitan area and non-urban areas in Japan, a post-hoc study

PURPOSE

Extant research elucidating the domains of knowledge and bias on epilepsy has consistently underscored a deficiency in cognizance and an inclination toward bias within non-urban areas. Investigations into geographical disparities concerning epilepsy awareness and prejudice within the Japanese context remain conspicuously absent. To address this lacuna in the literature, we undertook a post-hoc analysis to elucidate the discernible regional differentials in epilepsy awareness and the associated stigma.

METHODS

From July to August 2021, we conducted an internet questionnaire survey for 310 people with epilepsy (PWE) and 213 ordinary people without epilepsy who registered on the database of the Japanese Research Company. We inquired PWE to answer the Epilepsy Self-Stigma Scale (ESSS), the Rosenberg Self-Esteem Scale (RSES), and the Epilepsy Knowledge Scale (EKS). We inquired to answer ordinary people without epilepsy EKS. We analyzed residential addresses separately for Greater Tokyo and non-urban areas by comparing the degree of knowledge of people with epilepsy and people without epilepsy.

RESULTS

The average knowledge of people with and without epilepsy in the Greater Tokyo area was 39.60 and 28.43 points, although in non-urban areas (nine regions from all over Japan except for the Greater Tokyo, Tokai region, and Kinki region), the knowledge averages were 38.44 and 28.66 points of 100. In addition, self-stigma was highest in the Greater Tokyo area: 22.99 and in non-urban areas: 22.77. An two-way ANOVA with knowledge as the dependent variable and epilepsy diagnosis status and region (Greater Tokyo area/non-urban areas) as the independent variables revealed no interaction between diagnosis and region (F(1,346) = 1.48, η2 = 0.003). Knowledge was significantly higher in PWE than in people without epilepsy, but we could not identify any significant difference between ESSS (t = 0.24, d = 0.03) and RSES (t = 1.16, d = 0.16) in the Greater Tokyo/non-urban areas.

CONCLUSIONS

We obtained specific information about regional differences in the level of knowledge and stigma about epilepsy in Japan. Because Japan underwent educational reforms after World War II and more than 90% of the population received equally advanced education, the results found no regional differences in knowledge and stigma about epilepsy. We believe collecting information about the respondents' birth and upbringing environment and conducting a thorough investigation is necessary in the future.

Assessment of self-stigma in epilepsy: Validation of the German version Epilepsy Self-Stigma Scale (ESSS-G)

OBJECTIVE

Self-stigma is the internalization of unfavorable public perceptions, which people with epilepsy (PWE) frequently experience. PWE with strong self-stigma have low self-esteem and are less likely to engage in treatment behavior. The Epilepsy Self-Stigma Scale (ESSS) has been developed and validated in Japan. We translated the ESSS into German for this study to examine its reliability and validity.

METHODS

We created the German version of ESSS (ESSS-G) based on the original Japanese version. From May to October 2022, we recruited out- and inpatients from Bethel Epilepsy Centre, University Hospital for Epileptology, for psychometric evaluation. Inclusion criteria were an age of ≥18 years, sufficient reading and speaking skills in German, and the ability to comprehend the German questionnaires. Participants also completed the Rosenberg Self-Esteem Scale (RSES), Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Generalized Anxiety Disorder 7 (GAD-7), Epilepsy Knowledge Scale, and items on "overall quality of life (QOL)" and "overall health" (items from QOLIE-31).

RESULTS

One hundred twenty-eight of 146 patients asked to participate granted informed consent and completed the study questionnaire (87.7% response rate). 115 cases were analyzed since 13 did not match the inclusion criteria. The analysis revealed a single factor explaining 49.2% of the total variance. All factor loadings were >0.40, and the reliability was high (Cronbach's α = 0.80). Higher ESSS total scores were associated with higher anxiety (GAD-7, r = 0.54, P < 0.001) and depression (NDDI-E, r = 0.45, P < 0.001), lower self-esteem (RSES, r = -0.41, P < 0.001), overall QOL (r = -0.40, P < 0.001), and overall health (r = -0.35, P < 0.001), but not with knowledge about epilepsy (r = 0.03, P = 0.770). In Germany, females, younger individuals, patients with earlier seizure onset, and those with generalized epilepsy had significantly higher self-stigma.

SIGNIFICANCE

The German version of the ESSS proved reliable and valid. It allows to evaluate the efficacy of treatment strategies in lowering self-stigma and conducting intercultural comparisons of epilepsy self-stigma.

The development of The Epileptic Seizure Parental Burden Scale: A validity and reliability study

OBJECTIVE

It is common for parents to shoulder the burden of care for their children with chronic diseases. However, there are no robust scales to measure the burden of care of parents of children with epilepsy. This study aimed to develop the "Epileptic Seizure Parental Burden Scale (ESPBS)" and evaluate its psychometric properties.

MATERIALS AND METHODS

This was a methodological study. The sample consisted of 333 voluntary parents of children with epilepsy. Data were analyzed using the Statistical Package for Social Sciences (SPSS v. 25) at a significance level of p < .05. Content validity, item-total correlation, explanatory factor analysis (EFA), confirmatory factor analysis (CFA), the "upper- and lower-27 percent rule," Cronbach's alpha coefficient, and the split-half reliability method were used for psychometric analysis.

RESULTS

The scale consisted of 15 items and two subscales. The Kaiser-Meyer-Olkin (KMO) was 0. 961, for which Bartlett's test of sphericity was significant (X2 = 5079.527, p < .001), indicating sampling adequacy and correlation between the items for factor analysis. The scale had item-total item correlations of 0.311 to 0.741. The Explanatory Factor Analysis (EFA) revealed a two-factor structure. According to the confirmatory factor analysis, x2/df, GFI, AGFI, CFI, and RMSEA were 2.012, 0.93, 0.91, 0.97, and 0.055, respectively. These values were very close to a good fit. The items had factor loadings of 0.508 to 0.890. The total scale explained 60.432% of the total variance. The scale had a Cronbach's alpha of 0.93. The split-half reliability indicated a significant (p < .001) and high (r = 0.890) correlation.

CONCLUSION

The Epileptic Seizure Parental Burden Scale (ESPBS) has high psychometric properties. It is a valid and reliable instrument that can measure the epileptic seizure burden of parents of children with epilepsy.

One-day psychosocial education program for people with epilepsy: A continuation study of the "Epi-school"

Psychosocial education programs for people with epilepsy (PWE) can improve epilepsy knowledge and quality of life (QOL), whereas the availability of these programs is limited in Japan compared to other developed countries. This study evaluated the feasibility and effectiveness of a one-day group psychosocial education program named the "one-day Epi-school" for PWE and their relatives. The previous program (Epi-school) required consistent participation in three sessions, resulting in problems with program continuation rates, with 45.5% of PWE completing the program. Therefore, the "one-day Epi-school" was designed to provide information about epilepsy and address psychosocial issues related to coexisting epilepsy symptoms, such as self-stigma and self-esteem, while allowing participants to accomplish these programs within a single day. The study recruited a sample of 32 PWE and their relatives from a psychiatric clinic. They completed assessments of knowledge, self-stigma, self-esteem, and quality of life before and after the program. The results exhibited a significant increase in epilepsy knowledge after the intervention for PWE and their relatives. However, we could not identify other significant changes. The participation completion rate was 100%. The post-participation questionnaire proved beneficial to interact with other PWE. The study suggests that a single intervention, e.g., the one-day Epi-school, may be insufficient for enhancing other factors, yet it can be an adequate opportunity for learning and interacting. It is also necessary to implement future studies with larger sample sizes, a control group, and prolonged follow-up periods for the program's value and validity.

Non-Motor Symptoms and Quality of Life in Patients with PRRT2-Related Paroxysmal Kinesigenic Dyskinesia

Background

Monoallelic pathogenic variants of PRRT2 often result in paroxysmal kinesigenic dyskinesia (PKD). Little is known about health-related quality of life (HrQoL), non-motor manifestations, self-esteem, and stigma in patients with PKD.

Objectives

We investigated non-motor symptoms and how they related to HrQoL in a genetically homogeneous group of PRRT2-PKD patients. We paid special attention to perceived stigmatization and self-esteem.

Methods

We prospectively enrolled 21 consecutive PKD patients with a pathogenic variant of PRRT2, and 21 healthy controls matched for age and sex. They were evaluated with dedicated standardized tests for non-motor symptoms, HrQoL, anxiety, depression, stigma, self-esteem, sleep, fatigue, pain, and psychological well-being.

Results

Patients reported an alteration of the physical aspects of HrQoL, regardless of the presence of residual paroxysmal episodes. Non-motor manifestations were frequent, and were an important determinant of the alteration of HrQoL. In addition, patients perceived a higher level of stigmatization which positively correlated with a delay in diagnosis (ρ = 0.615, P = 0.003) and the fear of being judged (ρ = 0.452, P = 0.04), but not with the presence of paroxysmal episodes (ρ = 0.203, P = 0.379).

Conclusions

Our findings have important implications for care givers concerning patient management and medical education about paroxysmal dyskinesia. PRRT2-PKD patients should be screened for non-motor disorders in routine care. A long history of misdiagnosis may play a role in the high level of perceived stigmatization. Improving knowledge about diagnostic clues suggestive of PKD is mandatory.

A study of factors influencing self-stigma in people with epilepsy: A nationwide online questionnaire survey in Japan

OBJECTIVE

Epilepsy carries a significant stigma. While there is some evidence that self-stigma accompanies a lack of knowledge about epilepsy, there are no studies in Japan. This study aimed to determine factors contributing to self-stigma in Japan.

METHODS

We conducted an online questionnaire survey. Three hundred and ten patients completed the questionnaire (mean age of 47.8 ± 11.9) in contrast to the total registered users on the questionnaire site as 28 315 from Jul 29 to Aug 2, 2021. We asked about demographic variables, satisfaction with treatment, limitations in life, support status, seizure frequency, the Epilepsy Self-Stigma Scale (ESSS), the Rosenberg Self-Esteem Scale (RSES), and the Epilepsy Knowledge Scale (EKS). We conducted the statistical analysis on self-stigma, self-esteem, knowledge of epilepsy, and seizure frequency associations by Spearman's rank correlation.

RESULTS

The mean value of the EKS was 40.19 ± 18.75, the ESSS was 17.69 ± 6.25, and the RSES was 26.02 ± 6.13. We identified a significant moderate negative correlation between self-esteem and self-stigma (P < .001, ρ = -.423), a significant weak positive correlation between self-esteem and knowledge (P = .005, ρ = .177), and a significant weak negative correlation between seizure frequency and self-stigma (P < .001, ρ = -.162). Of the 186 respondents who were working or studying, 91 (49%) participants had experienced any discrimination due to epilepsy. The use of psychosocial support, that is, participating in epilepsy self-help groups and educational programs, was 5.8%.

SIGNIFICANCE

There was no correlation between the strength of self-stigma and the knowledge, while there was a positive correlation between self-esteem and knowledge (P = .005, ρ = .177). There was a negative and weak correlation between seizure frequency and self-stigma (p < .001, ρ = -.162). These results suggest that sufficient knowledge may improve the self-esteem and thus reduce the self-stigma. In addition, short-term treatment for seizure control is insufficient to reduce self-stigma. The dissemination for people to enable sufficient epilepsy knowledge and positive perceptions of epilepsy by increasing self-efficacy throughout a lifetime may reduce self-stigma.

Development and validation of the Epilepsy Self-Stigma Scale

Objective

Self‐stigma is the internalization of negative public attitudes and is often experienced by patients with epilepsy (PWE). Greater self‐stigma is associated with lower self‐esteem and hinders therapeutic behavior. The study aims were to develop the Epilepsy Self‐Stigma Scale (ESSS) to assess self‐stigma in PWE and to examine the scale's reliability and validity.

Methods

We created a test scale based on items from an existing stigma scale and the results of a previous qualitative analysis we conducted. We recruited 200 outpatients from departments specializing in epilepsy (psychiatry, neurology, and pediatric neurology) at four facilities in Tokyo and Saitama prefecture, Japan, between September and December 2020. Participants also completed the Rosenberg Self‐Esteem Scale (RSES) and Beck Depression Inventory (BDI‐II).

Results

Questionnaires were returned from 102 participants (response rate: 51%). After excluding two participants with incomplete questionnaires, data for 100 participants were analyzed (53 women, 47 men; mean age [standard deviation]: 39.86 [17.45] years). Exploratory factor analysis extracted eight items loading on three factors: internalization of stigma, societal incomprehension, and confidentiality. Cronbach's α for all items and each factor demonstrated acceptable internal consistency (α = 0.76‐0.87). Test‐retest reliability was confirmed using data from 21 participants who completed the scale twice (r = 0.72 to 0.90). ESSS total scores and subscale scores correlated with RSES and BDI‐II scores (r = −0.30 to 0.55). The ESSS demonstrated substantial constructive validity. However, total scores did not significantly correlate with objective physician assessment of self‐stigma.

Significance

The results showed that the eight‐item ESSS has high reliability and validity. This scale could facilitate the examination of factors associated with self‐stigma in PWE, which could inform the development of effective interventions for reducing stigma.