Medical Embarrassment Questionnaires (MEQ)

Abstract

The Medical Embarrassment Questionnaires (MEQ) represent a specialized class of self-report questionnaires designed to quantify the psychological phenomenon of medical embarrassment. This experience is highly prevalent, affecting up to 80% of individuals, and serves as a significant barrier to timely healthcare. The MEQ, particularly the 53-item version developed by Consedine and colleagues in 2007, is crucial for assessing how various aspects of medical encounters—such as physical exposure, discussion of private bodily functions, and fear of judgment—contribute to patient discomfort and subsequent healthcare avoidance behaviors. The instrument aims to differentiate between these specific sources of embarrassment, allowing for targeted clinical and public health interventions.

Keywords

Medical embarrassment, health psychology, treatment avoidance, self-report scale, psychometric development, judgment concern, bodily functions, patient-provider relationship.

Authors

Nathan S. Consedine, Yulia S. Krivoshekova, Christine R. Harris.

Purpose

The primary purpose of the Medical Embarrassment Questionnaires (MEQ) is to systematically measure the frequency, severity, and overall impact of medical embarrassment. The scale was developed to move beyond a generalized concept of discomfort by identifying specific situational and psychological factors that contribute to a patient’s feeling of shame or humiliation in a healthcare setting. By quantifying these experiences, researchers and clinicians can better understand the psychological mechanisms that lead to patients delaying or avoiding crucial medical care, thereby addressing a fundamental issue in public health compliance.

Construct

The core construct measured by the MEQ is Medical Embarrassment, which is conceptualized as a multidimensional experience rather than a singular emotion. The scale successfully differentiates between distinct components of this construct, most notably Bodily Embarrassment and Judgment Concern. Bodily Embarrassment pertains to discomfort arising from physical exposure, intrusive examinations (e.g., genital or rectal exams), and the necessity of discussing private bodily functions. Judgment Concern, conversely, relates to social anxiety, including the fear of being criticized, scolded, viewed as a hypochondriac, or perceived as intellectually inadequate by medical staff. The MEQ assesses how these factors collectively influence health behavior.

Validity

The validity of the MEQ is strongly supported by its established links to behavioral outcomes. Studies have confirmed the scale’s predictive validity by demonstrating that elevated scores on the MEQ correlate significantly with patients’ tendencies to delay or actively avoid seeking necessary medical care. This confirms the instrument’s utility as a predictor of poor health outcomes resulting from psychosocial barriers. Furthermore, the detailed psychometric development established robust construct validity by successfully differentiating between the theoretically separable factors of bodily discomfort and concern over social judgment, confirming that the scale measures the intended distinct facets of medical embarrassment.

Reliability

Although specific Cronbach’s Alpha coefficients are detailed in the original validation papers, the Medical Embarrassment Questionnaire is recognized for its high internal consistency and reliability across its subscales. The rigorous item refinement and selection process undertaken during its psychometric development ensured that the instrument provides stable and consistent measurement of both Bodily Embarrassment and Judgment Concern. This reliability allows the MEQ to be effectively used in longitudinal studies and comparative research across diverse patient populations.

Factor Analysis

The development of the MEQ by Consedine et al. (2007) involved extensive factor analytic procedures. Initially, items were theoretically grouped into nine potentially separable categories of embarrassment, including concern about the body, genital examinations, bodily functions, being ill, public exposure, being viewed as a hypochondriac, feeling intellectually inadequate, embarrassment by pain, and concern about not taking care of one’s health. However, structural analysis ultimately confirmed a more parsimonious two-factor model: Bodily Embarrassment and Judgment Concern. This two-factor structure provides a robust and empirically supported framework for interpreting the scores.

Instrument

Test Type: Self-report questionnaire

Format: 53 items rated on a 5-point Likert scale (1 = Not at all/never to 5 = Very much/always). The scale includes several reverse-coded items (indicated by ‘R’ in the scoring key).

Language Available: English (Primary validation language)

Population Group: General patient population, studied across various demographics and clinical settings.

Age Group: Primarily validated for use with adults and older adolescents.

Population Details: The MEQ has been successfully adapted and utilized in specific health domains, such as assessing embarrassment related to colorectal cancer screening.

Test Methodology: The instrument is self-administered. Scoring requires careful attention to the reverse-coded items before calculating mean scores for the distinct factors (Bodily Embarrassment and Judgment Concern).

Keywords

Patient delay, healthcare avoidance, health literacy, social desirability, Likert scale, physical examination, psychological barriers, clinical assessment.

Authors

Author ORCID Identifier: N/A (Please consult the primary publication for current contact information)

Affiliation Email addresses: N/A (Please consult the primary publication for current contact information)

Correspondence Address: N/A (Please consult the primary publication for current contact information)

Permissions & Fee and Test Year

The Medical Embarrassment Questionnaire (MEQ) was formally introduced and validated in 2007. Information regarding current usage fees, licensing, and formal permissions should be sought directly from the corresponding author, Nathan S. Consedine, or the publisher, the British Journal of Health Psychology. The instrument is generally available for academic research purposes.

Reference’s

• Consedine, Nathan S., Krivoshekova, Yulia S. and Harris, Christine R. (2007). Bodily embarrassment and judgment concern as separable factors in the measurement of medical embarrassment: Psychometric development and links to treatment-seeking outcomes. British Journal of Health Psychology, 12(3), 439–462.
• Consedine, N. S., Ladwig, I., Reddig, M. K., & Broadbent, E. A. (2011). The many faeces of colorectal cancer screening embarrassment: Preliminary psychometric development and links to screening outcome. British Journal of Health Psychology, 16, 559-579.

The original PDF of the 2007 instrument and methodology can be downloaded here: http://ch‎arris.ucsd.edu/articles/ConsedineEtAl2007.pdf

Items of the Medical Embarrassment questionnaires (MEQ)

Consedine et al, 2007

1. Showing my body to a stranger, even to a doctor, is humiliating
2. I am uncomfortable when a doctor has to examine my sexual organs or rectum because I worry about my own cleanliness
3. I feel shy when I have to describe my bodily functions to a doctor or a nurse
4. If I get sick I tend to hide from others, even from close people, because I am embarrassed to be sick or ill
5. I worry that my body looks unpleasant and will disgust the doctor or a nurse during a check-up
6. Walking in the waiting area with a urine sample is humiliating
7. When I have health symptoms, I avoid the doctor because I worry that my concerns will turn out to be nothing
8. I feel embarrassed when doctors use complicated medical words and I don’t understand them
9. I am afraid that I will embarrass myself if something hurts in the doctor’s office
10. I worry that doctors will scold me for the bad state of my health
11. It is embarrassing for me when a doctor or a nurse has to touch me
12. having my sexual/reproductive organs or rectum examined is humiliating for me
13. Describing my bowel movements to a doctor is awkward for me
14. I feel I must have done something wrong when I am ill
15. It is embarrassing for me when a doctor examines my body
16. I find waiting for treatment in a public area embarrassing
17. Minor pains, aches, or discomforts are not a good enough reason to go bothering a doctor
18. When a doctor describes some medical options and I don’t understand, I feel humiliated
19. It is embarrassing for me to admit that I fear pain
20. I avoid going to the doctor because I often wait too long and feel awkward knowing that I should have gone sooner
21. I am generally comfortable showing my body to a doctor
22. having my breasts/vagina (F) or penis (M) examined by a medical professional does not bother me
23. Talking with a doctor about how frequently I use the bathroom and the nature of my faeces or stool is difficult for me
24. Talking about illness or being sick is not a problem for me
25. Seeing my body during medical examinations makes me feel silly
26. I worry about what other people in the waiting room may think of me
27. Even a minor symptom makes me feel that I should go to a doctor because I think that it could be a sign of something serious
28. I would never disobey a doctor’s recommendation just because the procedure is possibly painful
29. I am embarrassed about the condition that I have let my body get to
30. Being naked in front of the doctor or a nurse is embarrassing
31. It is embarrassing for me when a doctor who is not of my sex touches my sexual/reproductive organs during examination
32. Describing the colour or consistency of my stool to a doctor is exceptionally embarrassing for me
33. I feel self-conscious when others know that I am in poor health
34. I do not find it embarrassing to see acquaintances and friends in the doctor’s office
35. I only go to the doctor when I am very sick, because I worry that they will think I am faking it
36. I find it difficult to ask a doctor to explain something again, repeat themselves, or use words that I can understand
37. I am very comfortable telling a doctor that something hurts
38. I am comfortable when a doctor tells me that I am not looking after myself
39. Exposing just about any part of my body for a check up is awkward
40. I feel degraded when I have to show my sexual and reproductive organs or rectum to a doctor
41. The thought that a doctor might ask for stool or urine samples is humiliating for me
42. I worry that other people will judge me when I’m sick
43. I feel self-conscious and fear that other people may overhear discussions about my health
44. I feel shy showing my body to doctors
45. It is awkward for me to describe medical symptoms when they involve my private parts
46. I don’t want a doctor or nurse to think that I am one of those people who constantly complain about their health
47. I feel stupid when a doctor tells me that my symptoms are not as serious as I thought they were
48. I worry that the doctor is going to criticize some of the unhealthy things that I do
49. having my body touched during medical check ups is not a problem for me
50. I worry about what doctors are thinking when they examine my genitals
51. Answering questions about my bodily fluids (e.g. describing the colour of my mucus) makes me self-conscious
52. I worry that doctors will think I’m silly if I come in with a minor complaint
53. I fear that the doctor will think badly of me because my own behaviours probably contributed to my health problems

Note: ‘R’ item indicates a reverse-coded item.