Dermatology, Eczema

Dermatitis Family Impact Questionnaire (DFI): A Full Guide for Researchers and Clinicians

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Introduction

The Dermatitis Family Impact Questionnaire (DFI), developed in 1998 by V. Lawson, M. S. Lewis-Jones, A. Y. Finlay, P. Reid, and R. G. Owens, is a pivotal tool for assessing the quality of life (QoL) impact of atopic eczema on families of affected children. Published by Cardiff University’s Department of Dermatology, the DFI has garnered over 550 citations, reflecting its widespread use in dermatological research (Lawson et al., 1998). Specifically, it targets parents of children up to 15 years and 11 months, offering insights into the emotional, social, and practical burdens of managing a child’s skin condition.

Consequently, this article explores the DFI’s features, applications, and significance for researchers and clinicians, emphasizing its role in advancing family-centered care.

Key Features of the Dermatitis Family Impact Questionnaire (DFI)

Purpose and Use

The DFI’s primary goal is to measure how atopic dermatitis affects the QoL of parents and family members. By focusing on family dynamics, it complements patient-centric tools like the Dermatology Life Quality Index (DLQI). Moreover, it’s widely used in clinical settings to monitor treatment outcomes and in research to evaluate interventions’ broader impacts.

Target Population

The DFI is designed for adults aged 16 and older who are parents of children with atopic eczema (up to 15 years and 11 months), the DFI addresses a specific yet critical demographic. Thus, it captures the unique challenges faced by families managing chronic skin conditions.

Structure

The DFI comprises 10 questions, covering critical areas such as:

Housework and daily chores
Food preparation
Sleep disturbances
Family leisure activities
Shopping and financial expenditure
Tiredness and emotional distress
Relationships
Impact of assisting with treatment

Each question uses a four-point Likert scale (0–3), ensuring straightforward yet comprehensive data collection.

Scoring Method

The DFI employs a four-point Likert scale, with scores ranging from 0 to 30. A score of 0 indicates no impact on family life, while a score of 30 represents the maximum effect on family life. Although there isn’t a single validated cut-off score, studies provide useful benchmarks for interpretation. For instance, a DFI score of 9.6 or higher can indicate a significant impact on family quality of life. Additionally, some studies suggest that a score of 3 or higher may reflect a noticeable impact on mothers’ quality of life. These thresholds help clinicians and researchers identify families requiring targeted support, enhancing the DFI’s utility in tailoring interventions.

Administration Format

The DFI takes less than 5 minutes to administer, making it highly efficient. It can be conducted via:

Paper-based forms
Digital (Online) platforms
In-person interviews

Its self-administered format, requiring no specialized training, enhances its practicality for busy clinical environments.

Applications of Dermatitis Family Impact Questionnaire (DFI)

The DFI serves multiple purposes in clinical and research settings:

Monitoring: Tracks changes in family QoL over time, especially post-treatment.
Treatment Planning: Guides clinicians in designing family-focused interventions.
Research: Supports clinical trials evaluating dermatological treatments’ family-level effects.

Languages and Availability

The DFI is available in multiple languages, including:

Arabic
English
Mandarin Chinese
Spanish
French
Portuguese
Japanese
Along with: Czech, Dutch, Greek, Italian, Norwegian, Polish, Swedish, Ukrainian.

This multilingual accessibility enhances its utility in global research and clinical practice.

The DFI is free for non-commercial use, such as academic research and clinical practice, making it accessible to researchers and clinicians worldwide. However, commercial use requires explicit permission from Cardiff University’s Department of Medicine.

Additionally, the DFI operates under a proprietary license with restricted access, meaning its distribution and use are controlled to ensure proper application and attribution. Consequently, users must contact Cardiff University to obtain approval for any commercial or modified applications, ensuring compliance with the questionnaire’s licensing terms.

Reliability and Validity

The DFI is highly reliable and valid, with robust psychometric properties. Notably, its Cronbach’s alpha ranges from 0.85 to 0.92 across studies, indicating strong internal consistency. Furthermore, test-retest reliability scores (0.80–0.88) confirm its stability over time. Validation studies, such as the original 1998 study and subsequent research, affirm its sensitivity to changes in disease severity and family QoL.

Validation Study:

- - Original Validation Study (link)

Limitations and Considerations

However, despite its strengths, the DFI has a few limitations:

Self-report: Respondents may underreport issues due to social desirability bias.
Recall Bias: The one-week recall period may miss longer-term impacts.
Psychometric Limitations: Confounding factors, such as which parent completes the questionnaire, may affect results.
Cultural Bias: Some translations may require further adaptation for cultural nuances.

Limited Validation Studies: While robust, the DFI has fewer validation studies compared to broader tools like the DLQI.
Confounding Biases: Factors such as which parent completes the questionnaire can skew results.
Social Desirability Bias: Respondents may underreport issues to present themselves favorably.

Additional Resources

For more information on the DFI and to access the full questionnaire, visit the following resources:

Access the DFI: DFI Questionnaire PDF
Contact: Cardiff University’s Department of Medicine, dermatology@cardiff.ac.uk, +44 (0)29 2074 7747

Frequently Asked Questions (FAQ)

Who can use the DFI?
Researchers, clinicians, and healthcare providers use the DFI for parents of children with atopic eczema.
How long does it take to complete the DFI?
The DFI takes less than 5 minutes, making it practical for clinical and research use.
How is the DFI administered?
It can be administered via paper, digital platforms (online), or interview (in-person), offering flexibility.
Is there any cost to using the DFI?
The DFI is free for non-commercial use; commercial use requires permission from Cardiff University.

A word from ResRef about Dermatitis Family Impact Questionnaire (DFI)

The Dermatitis Family Impact Questionnaire (DFI) is a valuable tool in both clinical and research settings for evaluating the profound effects that dermatitis can have on the lives of families. By focusing on how a child’s skin condition impacts family functioning, emotional well-being, and overall quality of life, the DFI helps clinicians gain insights into the broader context of dermatological conditions beyond the physical symptoms. Moreover, the DFI contributes to a growing understanding of quality of life issues for patients with chronic conditions, highlighting the need for integrated care approaches that involve both healthcare providers and families. Overall, the DFI is an essential instrument for fostering better health outcomes and improving the quality of life for those affected by dermatitis and their families.

References

Lawson V, Lewis-Jones MS, Finlay AY, Reid P, Owens RG. The family impact of childhood atopic dermatitis: the Dermatitis Family Impact Questionnaire. Br J Dermatol. 1998 Jan;138(1):107-13. doi: 10.1046/j.1365-2133.1998.02034.x. PMID: 9536231. (link)