Systemic steroidophobia scale for pediatric rheumatology (SSS-PR): development and validation of a novel psychometric tool measuring clinician steroidophobia

Systemic corticosteroids are cornerstone therapies in pediatric inflammatory diseases. Despite their clinical importance, both parents and clinicians may harbor substantial concerns regarding steroid-related adverse effects. While “steroidophobia” has been extensively studied in the context of topical corticosteroids, no validated instrument exists to assess clinician-based attitudes toward systemic corticosteroid use. This study aimed to develop and validate novel psychometric tools to measure systemic steroidophobia among clinicians. A methodological, multicenter study was conducted between June and October 2025 among pediatric rheumatology specialists and fellows. Two draft instruments were developed: the Oral Corticosteroid Phobia Scale (21 items) and the Intravenous Corticosteroid Phobia Scale (22 items). Face and content validity were evaluated through expert review. Item analysis, exploratory and confirmatory factor analyses, internal consistency (Cronbach’s alpha), and test–retest reliability were performed. A total of 121 clinicians participated. After item reduction, the oral scale comprised 15 items and the intravenous scale 16 items, each demonstrating a two-factor structure. The Oral Corticosteroid Phobia Scale explained 63.5% of total variance (Cronbach’s alpha = 0.908), and the Intravenous Corticosteroid Phobia Scale explained 66.4% (Cronbach’s alpha = 0.935). Test–retest reliability was excellent (ICC = 0.902 and 0.930, respectively). Model fit indices indicated good construct validity. Lower phobia scores were observed among clinicians with longer pediatric rheumatology experience. The developed scales demonstrated acceptable validity and reliability for assessing clinician-based systemic steroidophobia. These tools may facilitate a more systematic and objective identification of attitudinal barriers toward corticosteroid use and may serve as formative educational instruments in residency training and continuing medical education. Further validation across different pediatric subspecialties and countries is warranted.