Academic journal article Journal of Nursing Measurement

Validation of the Dutch Version of the Itching Cognitions Questionnaire

Academic journal article Journal of Nursing Measurement

Validation of the Dutch Version of the Itching Cognitions Questionnaire

Article excerpt

The purpose of this study was to examine the reliability and validity of the Dutch Itching Cognitions Questionnaire (ICQ). This by origin German questionnaire, the Juckreiz Kognitons Fragebogen consists of two subscales: catastrophizing and helpless coping and problem-focused coping, and measures itch-related coping. The results were compared with the German and Japanese validation studies. The Dutch ICQ was completed by 171 patients with chronic pruritic skin diseases. Reliability was evaluated by determining internal consistency, mean inter-item correlation, and item-total correlation. Cronbach's alpha was .90 (catastrophizing and helpless coping) and .81 (problem-focused coping). The mean inter-item correlations for the subscales were .48 (catastrophizing and helpless coping) and .30 (problem-focused coping). The item-total correlations range from .57 to .76 (catastrophizing and helpless coping) and from .32 to .57 (problem-focused coping).

Confirmatory factor analysis indicated a good fit of the model and support construct validity. Concurrent validity was determined by examining correlations of the ICQ with intensity of itching and scratching, depression, and anxiety. The correlations of the subscale catastrophizing and helpless coping with intensity of itching and intensity of scratching are .28 (p , .01) and .32 (p , .01), respectively. The correlation between the subscale problem-focused coping and intensity of itching is .23 (p , .01). No significant correlation exists between problem-focused coping and intensity of scratching. Correlations between both subscales and anxiety and depression vary from .33 to .58 (p , .01). It was concluded that the Dutch version of the ICQ is a reliable and valid instrument.

Keywords: dermatology; itch; itching cognitions questionnaire; reliability; validity

Itch is an unpleasant sensation which provokes the desire to scratch (Magerl, 1996; Rees & Laidlaw, 1999; Savin, 1998; Wahlgren, 1995; Yosipovitch & Fleischer, 2003). According to Bernard (1994), itching is the most characteristic and distressing symptom of skin diseases. Atopic dermatitis is a chronic intensely pruritic skin disease with a prevalence of 10%-20% in children and 1%-3% in adults (Darsow et al., 2005; Leung & Bieber, 2003). Itch is a common symptom in 63.8%-84% of patients with psoriasis (Sampogna et al., 2004; Yosipovitch, Goon, Wee, Chan, & Goh, 2000). There is no effective, universal antipruritic drug available. Therapy should primarily be directed at the underlying cause (Hägermark & Wahlgren, 1995). Itch can have a great impact on quality of life and can lead to depression, agitation, anxiety, difficulty concentrating, sleeping disorders, decreased sexual desire/sexual functioning, changed eating habits, exhaustion, feelings of powerlessness, restlessness, or sadness (Bernard, 1994; van Os-Medendorp, Eland-de Kok, Grypdonck, Bruijnzeel-Koomen, & Ros, 2006; Yosipovitch et al., 2002; Yosipovitch & Hundley, 2004).

Itch is often so distressing that patients scratch themselves until their skin is bleeding. Scratching maintains the skin lesions, increases inflammation, and stimulates nerve fibers, leading to more itching and scratching. When the patient stops scratching, the healing of the skin causes itch again. This can lead to the vicious itch-scratch-itch cycle (Ehlers, Stangier, & Gieler, 1995; Hägermark & Wahlgren, 1995; Yosipovitch, Greaves, & Schmelz, 2003).

Successful treatment of itch requires interruption of this vicious cycle (Yosipovitch et al., 2003; Yosipovitch & Hundley, 2004). Therefore, interventions directed at changing behaviors might be helpful. Literature shows that interventions such as relaxation and habit reversal training to prevent scratching and to increase the patient's coping with the distressing itch have been proved to be effective (Ehlers et al., 1995).

Ehlers, Stangier, Dohn, and Gieler (1993) constructed and validated the Juckreiz- Kognitions Fragebogen (Itching Cognitions Questionnaire [ICQ]) to measure this itchrelated coping. …

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