The development of the social isolation risk scale (SIRS) to identify risk for social isolation in head and neck cancer survivors

Introduction: The purpose of this manuscript is to report on the development of the SIRS (Social Isolation Risk Scale), a brief screening tool to identify HNC survivors at risk for social isolation through assessing for the presence of multiple potential causes from which this risk might arise. Method: The development of the SIRS occurred in two phases. During the first phase, item generation, the research team leveraged inductive and deductive methods to generate an exhaustive pool of potential scale items based on those in the extent literature and on the opinions of experts in HNC. During the second phase of development, item refinement, we conducted one-to-one interviews with 22 socially isolated HNC survivors. During analyses, items endorsed by 7 or more participants on the checklist were retained. Retained items were reorganized from most impactful to least impactful. General items (i.e., those concerns that were not specific to only HNC survivors, e.g., chemotherapy fatigue) were removed. The remaining items were reorganized so that items with similar content were placed together. Results: The item generation phase yielded 39 potential items for the SIRS. These 39 items were reviewed during the item refinement phase by a sample of N = 22 HNC survivors. On average, they were 66.41 years old (SD = 9.04 years), and mostly male (n = 17, 77%). Participants were an average of 3.18 years (SD = 4.81 years) since completing treatment. Of the 39 items, 29 were endorsed by 7 or more HNC survivors and retained. Of the list of 29 items, 16 additional items were removed, as they were not specific to HNC. The remaining 13 items, which were reorganized so that items of similar content were adjacent to each other, composed the SIRS. The stem questions and the Likert-scale response options used during the item refinement phase were retained for the final SIRS. Conclusion: As a first of its kind, SIRS is a brief screening tool for use in busy clinical environments to characterize risk for social isolation in HNC survivors. It was developed through rigorous psychometric methodology including both item generation and refinement phases.