Development and Validation of the Isotretinoin Hesitancy Scale for Acne Vulgaris: A Preliminary Study

Oral isotretinoin is the most effective systemic treatment for acne patients who fail to respond to other forms of therapies. However, hesitations and concerns regarding its side effect profile may detain the patients from treatment. This study aimed to develop and validate the Isotretinoin Hesitancy Scale (IHS) among acne patients.

A cross-sectional study was conducted with 100 acne patients who had not used isotretinoin previously. A 22-item scale was created based on the related literature and expert opinions. The items of the scale related to beliefs and worries about isotretinoin were formatted with response options: agree, indecisive, and disagree. In this study, construct validity was tested with exploratory factor analysis, and reliability was tested with internal consistency and split-half reliability.

The results of exploratory factor analysis indicated a three-factor solution with a total of 14 items, explaining 57% of the total variance. The first factor (Hesitancy Related to Reversible Adverse Effects: 6 items) accounted for 30% of the variance, the second factor (Hesitancy Related to Irreversible Adverse Effects: 4 items) accounted for 16% of the variance and the third factor (Isotretinoin-related Anxiety: 4 items) accounted 11% of the variance. The internal consistency of the three factors was calculated as 0.79, 0.78, and 0.72, respectively. The Cronbach's alpha score of the total scale was found to be 0.81, and split-half reliability was found to be 0.87.

The IHS is the first scale that provides a valid and reliable assessment of isotretinoin hesitancy in acne patients. Eliminating isotretinoin hesitancy may reduce acne-related clinical and psychosocial consequences.