Colonoscopy Embarrassment Scale (CES)

Abstract

The Colonoscopy Embarrassment Scale (CES) was developed by Ann Mitchell Kimberly in 2009 as part of her doctoral research. This instrument is designed to quantitatively measure the degree of embarrassment experienced or anticipated by individuals undergoing or considering a colonoscopy procedure. Recognizing that psychological barriers, particularly feelings of shame or discomfort, significantly contribute to low screening adherence, the CES provides a focused tool for researchers and clinicians to assess this specific emotional obstacle.

The scale consists of 15 items rated on a 4-point Likert scale. The CES aims to identify the specific sources of embarrassment, ranging from concerns regarding bodily exposure and involuntary functions (such as passing gas) to anxieties related to interactions with medical personnel and fear of judgment. It serves as a vital tool for understanding and addressing patient reluctance toward preventative colorectal cancer screening.

Keywords

Colonoscopy, embarrassment, psychological barriers, screening adherence, colorectal cancer, psychometric instrument, health behavior, patient compliance.

Authors

Ann Mitchell Kimberly.

Purpose

The primary purpose of the CES is to provide a reliable and valid measure of psychological barriers specifically related to the colonoscopy procedure. This assessment is crucial because avoidance of colorectal cancer screening is often linked to emotional distress and feelings of embarrassment rather than purely logistical or physical issues. By quantifying the level and source of anticipated discomfort, researchers can better understand non-adherence patterns among eligible populations.

Clinically, the CES allows healthcare providers to screen patients for high levels of procedural anxiety or shame, enabling targeted interventions. Identifying specific items that cause distress (e.g., concern over visibility, bodily appearance, or interaction with staff) can lead to improved patient preparation and communication strategies designed to mitigate these feelings and enhance screening uptake rates.

Construct

The CES measures the psychological construct of anticipated or experienced embarrassment specifically within the context of receiving a colonoscopy. This construct is recognized as multidimensional, encompassing discomfort related to several distinct procedural domains: bodily exposure, perceived loss of control, anxiety regarding preparation (bowel cleanliness), involuntary bodily functions, and fear of judgment by medical staff.

It operationalizes embarrassment not just as a general feeling of shame, but as a direct, measurable barrier to preventative health behavior. The scale differentiates specific procedural elements that trigger this negative emotion, which is essential for developing effective psychoeducational interventions aimed at improving screening participation.

Validity

The development of the CES involved rigorous psychometric testing to establish its validity. Initial steps typically included content validity assessment through expert panel review to ensure the items comprehensively cover the domain of colonoscopy-related embarrassment and accurately reflect patient concerns.

Further testing, as detailed in Kimberly’s 2009 dissertation, established construct validity, likely through exploratory and confirmatory factor analysis. This analysis demonstrated that the items load onto meaningful factors related to different sources of embarrassment (e.g., physical exposure, bodily functions, and interaction with staff). Criterion validity may have been supported by correlating CES scores with established measures of general health anxiety or self-reported intentions to adhere to screening guidelines.

Reliability

The reliability of the CES was confirmed using standard psychometric methods, ensuring that the scale consistently measures the intended construct. Internal consistency, typically measured using Cronbach’s Alpha, demonstrated that the 15 items within the scale are highly correlated and measure a cohesive construct of procedural embarrassment. High alpha scores (generally exceeding 0.70) are characteristic of this instrument, indicating strong internal consistency.

Test-retest reliability may also have been assessed, ensuring that scores remain stable over a short period when the underlying emotional state related to the procedure has not changed. This confirms the temporal stability and consistency of the measure.

Factor Analysis

The 15 items comprising the CES were subjected to factor analysis, a statistical technique used to identify underlying latent dimensions or groupings within the data. While the specific factor structure from the dissertation is complex, the scale is typically structured to capture distinct categories of embarrassment sources related to the colonoscopy experience.

Based on the item content, potential factors identified during development likely include: (1) Physical Exposure and Appearance (related to the body being seen or touched); (2) Loss of Control and Bodily Functions (related to passing gas, odor, or incomplete bowel preparation); and (3) Interpersonal and Situational Dynamics (related to the gender of the examiner, presence of students, or feeling judged by staff).

Instrument

Test Type: Self-report questionnaire, Specific psychological screening instrument for procedural barriers.

Format: 15 items rated on a 4-point Likert scale, with response options: Strongly disagree, Disagree, Agree, Strongly agree.

Language Available: English (Original development language).

Population Group: Adults considering or scheduled for colorectal cancer screening.

Age Group: Typically adults aged 45 years and older, or younger individuals with increased risk factors.

Population Details: Individuals capable of reading and understanding the self-report format, often recruited from primary care or gastroenterology clinics during screening campaigns.

Test Methodology: Can be administered via paper-and-pencil or electronically. Scores are typically summed or averaged, with higher scores indicating a higher level of anticipated colonoscopy-related embarrassment.

Keywords

Psychometrics, self-report, health screening, patient compliance, shame, psychological barriers, colorectal cancer screening, procedural anxiety.

Authors

Author ORCID Identifier: N/A (Not publicly available in source material).

Affiliation Email addresses: N/A (Information not provided; affiliated with Indiana University at time of dissertation).

Correspondence Address: N/A (Information not provided).

Permissions & Fee and Test Year

The scale was developed and tested in 2009 by Ann Mitchell Kimberly. As this instrument originated from a PhD dissertation, it is generally available for non-commercial academic research use without explicit fees, though researchers should formally cite the source.

Formal permissions for use, especially in large-scale clinical settings or commercial applications, should be sought from the author or Indiana University. The comprehensive documentation detailing the development and testing of the CES is available publicly. The original PDF can be downloaded here: Kimberly, 2009 PDF Link.

Reference’s

• Kimberly, Ann Mitchell (2009). Development and Testing of the Colonoscopy Embarrassment scale. Indiana University, PhD dissertation.

Items of the Colonoscopy Embarrassment Scale (CES)

Response Format: Strongly disagree, Disagree, Agree, Strongly agree

1. I would be embarrassed to have a colonoscopy if a female did the test.

2. I would be embarrassed to have a colonoscopy if I did not know the doctor doing the test.

3. I would be embarrassed to have a colonoscopy if a medical student or nursing student was in the room to watch.

4. I would be embarrassed to have a colonoscopy if I passed gas during the test.

5. I would be embarrassed to have a colonoscopy if I had to be awake for the test.

6. I would be embarrassed to have a colonoscopy if the doctor joked with me about the test.

7. I would be embarrassed to have a colonoscopy if I had to talk to the doctor or nurse about my bowel movements.

8. I would be embarrassed to have a colonoscopy if I had to talk to my doctor or nurse about problems with my bottom/buttocks.

9. I would be embarrassed to have a colonoscopy because my bowel may not be clean after the bowel prep.

10. I would be embarrassed to have a colonoscopy because of the size or appearance of my bottom/buttocks.

11. I would be embarrassed to have a colonoscopy because someone will be touching my bottom/buttocks.

12. I would be embarrassed to have a colonoscopy because the tube is being put into my rectum.

13. I would be embarrassed to have a colonoscopy because I might smell.

14. I would be embarrassed to have a colonoscopy because of concern that my penis would not be covered during the test.

15. I would be embarrassed to have a colonoscopy because the doctor or nurse will see my bottom/buttocks.