Newly Developed Questionnaire Evaluates Quality of Life for Patients with Hair and Scalp Conditions

Image Credit: © dermnetnz.org

A new exploratory Hair & Scalp CARE (Condition and Affective Response Evaluations) questionnaire has been developed to assess how hair and scalp issues impact quality of life and psychological well-being.¹ Factors like damage, age-related changes or thinning, and other dermatological conditions of the scalp can impact a patient’s self-esteem.

For example, up to 75% of men and women with alopecia reported having low self-esteem due to their disease.² The American Hair Loss Association has reported that about $3.5 billion is spent on hair loss prevention every year in the United States.³ Although measurements such as the Dermatology Life Quality Index (DLQI), the BeautyQoL, the Scalpdex, and the Skindex exist, “there is a clear need for scientifically validated metrics that can quantify the impact of hair and scalp health on psychological wellbeing,” according to the authors.

Approximately 1184 American participants completed a 23-question online survey between November 2021 and February 2022. Patients were between the ages of 18 and 55. Most were female, comprising nearly 75% of the total cohort. A diverse sample was established, including an equal number of African American, Caucasian, and Hispanic consumers.

Each surveyor was required to have used at least 1 deodorant product and 1 hair product in the last 6 months. They also shared further demographic information, hair type, and any scalp conditions, if applicable. The 14-item Sleep Health Index (SHI) and 10-item Perceived Stress Scale (PSS) were also used. Exploratory factor analysis and confirmatory factor analysis helped to develop the tool.

The final Hair & Scalp CARE questionnaire includes 21 questions on physical impairment, interpersonal relationships, and internal emotions. Each participant is able to respond to each item with 1 of 5 answers: “Never,” “Rarely,” “Sometimes,” “Often,” and “All the time.” These were also assigned a numerical value from 1 to 5, with “All the time” receiving a score of 1 and “Never” receiving a score of 5.

“Items included in the final scale alluded to hair and scalp issues and needs, the associated feelings and how these needs influenced the participants' behaviour in their daily lives,” the authors wrote.

The mean Hair & Scalp CARE score was 72.01. Men had a higher average compared to women (77.62 and 70.12, respectively), indicating a higher emotional well-being. Those with reported scalp conditions had significantly lower scores (p < 0.001).

It was found that higher Hair & Scalp CARE scores correlated with lower PSS scores and higher SHI scores (p < 0.001). Thus, healthier hair and scalp are connected to better sleep health and less perceived stress. This trend was noted in both male and female participants.

The tool can be further tested with an even larger sample size in different countries and languages to “ensure international validation and cross-cultural applicability.” Additionally, hair and scalp conditions were self-reported and not explicitly confirmed by a dermatologist. Objective measurement methods, along with self-reporting, would support these insights.

Overall, the new Hair & Scalp CARE tool is valid and convenient. The authors hope that it can be used in further academic and commercial research, especially when developing new hair and scalp care products and proving their efficacy and positive impact on psychological well-being.

References

1. Newton-Fenner A, Hirst WM, Jones T, et al. Development of the Hair & Scalp CARE questionnaire: Measuring the impact of hair and scalp issues on psychological wellbeing in healthy populations. Int J Cosmet Sci. Published online April 22, 2025. doi:10.1111/ics.13070

2. van der Donk J, Passchier J, Knegt-Junk C, et al. Psychological characteristics of women with androgenetic alopecia: a controlled study. Br J Dermatol. 1991;125(3):248-252. doi:10.1111/j.1365-2133.1991.tb14749.x

3. Park AM, Khan S, Rawnsley J. Hair Biology: Growth and Pigmentation. Facial Plast Surg Clin North Am. 2018;26(4):415-424. doi:10.1016/j.fsc.2018.06.003