From: Incontinentia pigmenti burden scale: designing a family burden questionnaire
Score from 0 to 5 | ||
---|---|---|
1 | Have you ever felt that it is unfair when thinking about your child having incontinentia pigmenti? | |
2 | Have you noticed family tension due to your child’s incontinentia pigmenti? | |
3 | Have you noticed marital problems due to your child’s incontinentia pigmenti? | |
4 | Have you been embarrassed by the glances of others due to his/her incontinentia pigmenti? | |
5 | Due to your child’s incontinentia pigmenti, have you felt the need to keep to yourself? | |
6 | Have you experienced a feeling of guilt due to your child’s incontinentia pigmenti? | |
7 | Have you been forced to reconsider your future plans because of your child’s incontinentia pigmenti? | |
8 | Have you ever hesitated to buy any medication that is not covered by your insurance? | |
9 | Have you had to give up dental care due to your child’s incontinentia pigmenti? | |
10 | Have you behaved in a neglectful way toward your other children because of your child’s incontinentia pigmenti? | |
11 | Have you been distracted at work because of your child’s incontinentia pigmenti? | |
12 | Have you needed to miss work to take your child to the doctor? | |
13 | Have you had to stop working due to your child’s incontintentia pigmenti? | |
14 | Do you think you have “overprotected” your child due to his/her incontintentia pigmenti? | |
15 | Has your child’s incontintentia pigmenti upset your daily life? | |
16 | Has facing the required care support (psychologists, orthoptics, psychomotor therapy) made you feel mentally drained? | |
17 | Does the care that you have to give tire you out? | |
18 | Have you been hurt by the teasing your children have experienced from other children? | |
19 | Have you ever had the impression that your child’s incontintentia pigmenti is increasingly expensive? | |
20 | Have you had to dedicate a portion of your budget to cover the costs of care for your child? |