New Patient-Reported, Quality of Life Assessment Tool Developed for Acne Patients

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A new, 19-item version of the Quality of Life Relevance-Acne was developed to assess patient-reported life quality evaluations, according to recent findings, with 3 elements of the assessment being socioemotional, symptom-related, or stigma/suicidality-related.¹

The investigators who developed this instrument had sought to design an acne-specific, health-related quality of life (HRQoL) tool that would be based upon a predetermined set of the most relevant acne-related topics. This research was led by Pavel V. Chernyshov, MD, PhD, from the department of dermatology and venereology at the National Medical University in Kiev, Ukraine.

Chernyshov and colleagues wrote that while there existed various forms of acne-specific instruments to help patients evaluate their QoL with acne vulgaris, there had not been a single intstrument to address each and every QoL domain.

“Participating members of the EADV Task Forces on QoL and Patient Oriented Outcomes and Acne, Rosacea and Hidradenitis Suppurativa initiated data collection in nine European countries and formed the list of the most relevant topics for acne patients,” Chernyshov and colleagues wrote. “The aim of this study was to develop a new acne-specific 100 HRQoL instrument based on the list of the most relevant topics for acne patients.”²

Background and Methods

The research team combined the topics considered to be most relevant with the results of factor analyses, theraby creating a prototupe of an acne-specific instrument. Those with acne were questioned about how clear and relevant the items included were and a set of experts on acne and QoL measurements carried out discussions on the inclusion of items, resulting in a list of 21 such elements.

There was then a separate discussion formed by the expert group on a system of scoring for the newly-made acne-specific HRQoL tool. Following this action, another set of patients with acne filled in the new 21-item design of the new acne-specific instrument.

The research team evaluated a pool of 21 total items and randomly divided their determined sample into 2, with the team’s initial subsample being given an exploratory factor analysis (EFA), removing elements that had factor loadings under 0.40. The assessment of model fit used a set of several indices such as Root Mean Square Error of Approximation (RMSEA) and Tucker Lewis Index (TLI).

In the second subsample, the investigators confirmatory factor analysis (CFA) was done through the use of the Mean-and Variance-adjusted Weighted Least Square (WLSMV) estimator, as well as a polychoric correlation matrix to confirm the factor solution. The indices of the instrument’s internal consistency were evaluated for the whole sample and mean scores and skewness/kurtosis of each dimension were also assessed for the purposes of identifying floor and/or ceiling effects.

Findings

There were a total of 715 individuals included in the research with acne, and the research team had assessed the subjects’ views on the instrument’s item clarity as well as the effects of these items on their own lives over the prior 2 weeks. The investigators wrote that the response rate had a range between 99.70% - 87.83%, adding that subjects averaged 22.66 years in age.

The first few evaluations of the instrument’s clarity and impact resulted in the team’s refining the questionnaire using discussions among the experts. There were 29 items that received modification, resulting in the inclusion of newer instrument elements such as "My acne caused suicidal thoughts" and "Unsolicited advice about my acne."

The team implemented a 4-point Likert scale for the purposes of scoring. The additional analyses carried out by the investigators on 1502 individuals, with an average age of 24.27 years, were shown to have indicated the use of a 3-factor model for their questionnaire, categorizing certain elements into "Socioemotional," "Symptoms," and "Stigma and Suicidal thoughts."

The team added that the questionnaire showed solid internal consistency in all 3 of the subscales.

“We hope that our new acne-specific HRQoL questionnaire contains the most important and relevant items for acne patients worldwide,” they wrote. “A promising and innovative approach is to create new QoL instruments by international groups of specialists, rather than within individual countries, as in the case of the European KIDSCREEN/DISABKIDS project or the InToDermQoL questionnaire and its epidermolysis bullosa-specific module.”

References

1. ^{Chernyshov PV, Sampogna F, Raimondi G, Zouboulis CC, Boffa MJ, Marron SE, Manolache L, Pustišek N, Bettoli V, Koumaki D, Bewley AP, Dreno B, Tomas-Aragones L, Development of the acne-specific quality of life questionnaire Quality of Life Relevance-Acne, JAAD International (2024), doi: https://doi.org/10.1016/j.jdin.2024.03.007.}
2. ^{Marron SE, Chernyshov PV, Tomas-Aragones L. Quality-of-Life Research in Acne Vulgaris: Current Status and Future Directions. Am J Clin Dermatol. 2019;20(4):527-538.}