Bangladesh Journal of Medical Science Vol. 22 No.

02 April’23

Original article
Development of DOB Social Isolation Scale: Validity and Reliability
Durat, Gülgün1, Ilcioglu Kevser2, Hamlaci Baskaya, Yasemin3
Abstract:
Objectives: The situation in which an individual disconnects their communication from their
environment and avoids collective activities is called “social isolation”.Based on the literature
reviewed, the measurement tools’ validity and reliability studies that were previously made were
not sufficient in measuring the concept of social isolation. The study was conducted to develop
a scale to evaluate social isolation. Methods: This methodologically was conducted with 584
university students between February and June 2019. The draft of the Social Isolation Scale
was reviewed in the literature, and an item pool of 31 items in 5-point Likert type was created.
Suggestions from 11 experts were evaluated. Finally, a scale with 28 items was prepared, and
the items were corrected in terms of language and expression in line with expert opinion. The
data were collected via a questionnaire prepared by the researchers. Results: The mean age of
the students was detected as 20.45 ± 2.33. Ten items were removed from the scale because their
factor load was under 0.500. It was determined that the scale consists of eighteen items and the
sole factor. The internal consistency coefficient (Cronbach’s alpha) of the scale was calculated
as 0.912. Conclusion: This study demonstrates that the “DOB Social Isolation Scale” is a valid
and reliable measurement instrument. Developed to measure social isolation, the DOB Social
Isolation Scale is an adaptable scale to different cultures. The scale provides an advantage for
healthcare professionals in determining social isolation.
Keywords: social isolation; scale development; validity and reliability

Bangladesh Journal of Medical Science Vol. 22 No. 02 April’23 Page : 403-409

DOI: https://doi.org/10.3329/bjms.v22i2.65003

Introduction: will be disliked when they try and communicate with

Humans need others to survive, maintain their health, others 1.
and help to establish one of their most basic needs, The extant literature includes various definitions of
communication. However, it is getting harder and the concept of social isolation. The situation in which
harder to establish and maintain social relationships in an individual disconnects their communication from
today’s societies due to individualization. Therefore, their environment and avoids collective activities
the number of socially isolated, lonely people and is called “social isolation” 1. Social isolation is
having problems adapting to society is steadily also defined as the lack of social and interpersonal
increasing. Many people say they feel anxious in relationships or the inability to maintain existing
social situations. Some also say that they do not like relationships in a competent manner 2. Dury
crowded places and that it is difficult for them to go (2014) defines social isolation as a state in which
to such places and communicate as they think they the individual lacks a sense of belonging, social

1. Durat Gülgün, Assoc. Prof, Sakarya University, Department of Nursing, Faculty of Health Sciences,
Sakarya, Turkey, Email: gdurat@ sakarya.edu.tr
2. Ilcioglu Kevser, Asst. Prof, Sakarya University, Department of Nursing,Faculty of Health Sciences,
Sakarya, Turkey, E-mail: [email protected]
3. Hamlaci Baskaya, Yasemin, Asst. Prof, Sakarya University, Department of Midwifery, Faculty of Health
Sciences, Sakarya, Turkey, E-mail: [email protected]

Correspondence: Yasemin Hamlaci Baskaya, Sakarya University Faculty of Health Sciences 54187,
Sakarya, Turkey. E-mail: [email protected]

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participation, and valuable relationships with other minimizes socialization. People’s excessive use of
people 3. According to Carpenito-Moyet (2012), it is social media platforms weakens their skills of face-
a state of an individual or a group who has the need to-face communication 14.
or desire to be with others or perceives so but cannot The coronavirus (COVID-19) epidemic that broke
establish a relationship 4. out in China at the end of 2019 and affected the whole
Social isolation is categorized as objective and world can be given as an example of the crises that
subjective social isolation. Objective social isolation caused further social isolation. On the one hand, the
is true social isolation, while subjective social epidemic has caused many deaths worldwide, and
isolation is defined as loneliness. Objective social on the other, stress and social isolation in individual
isolation means feeling very lonely and away from and social dimensions. Although there are many
other people; however, subjective social isolation, medical studies on the coronavirus epidemic, few
in other words, perceived loneliness, is defined as studies have examined the effect of this epidemic
feeling lonely often because there are few close on social isolation 12,13,15. Isolation and being
friends with whom a person can share their problems restricted significantly affect human physiology
1
. in several aspects 16. During the pandemic period,
isolation of individuals, fear of infection, quarantine,
Loneliness is associated with the quality of the
stigmatization, and the potential to be overloaded
relationships rather than quantity 5. It is quite normal
with excessive and false information have created
for individuals to want to be alone from time to time.
risks of anxiety and depression, caused chronic
While the desire to be alone is voluntary and depends stress, and led to a great burden on mental health17,18.
on the individual, social isolation is a negative and
involuntary situation where the individual cannot In line with the information above, it was found in
choose 6. Social isolation results from a lack of the literature that the measurement tools’ validity
social belonging, a decrease in responsibility for and reliability studies which were previously
other people, a very low level of social interaction, made were not sufficient in measuring the concept
relationship quality, and dissatisfaction. Studies have of social isolation, and these tools were used to
shown that people suffering from social isolation have examine different concepts such as loneliness and
low health levels. For example, it is reported that they social phobia, which are related to social isolation
benefit less from interventions such as cardiovascular but do not exactly correspond to it. Therefore, an
surgery 2. Neri et al. (2012) examined the relationship easy-to-use scale that can evaluate the concept of
between age, gender, environment, and health status social isolation defined in the way demanded in the
literature is needed. This study was conducted to
with social isolation 7. Studies report that there may
develop a measurement tool for the evaluation of
be a relationship between social isolation and mental
social isolation.
health, distress, dementia, suicide, and early death
8–10
. Santini et al. (2020) examined the relationships Materials and methods:
between social disconnection, perceived isolation, Phase One
and depression in adults 11.
Scope of the Scale
The literature review shows that social isolation begins
The draft of the Social Isolation Scale was reviewed
in childhood and adolescence and continues into
in the literature, and an item pool of 31 items in
adulthood, triggered by various stressors. Physical,
5-point Likert type was created. The instructions of
mental, and social reasons come together to create
the scale draft developed were sent to the lecturers of
the social withdrawal of a person. Factors such as
various nursing departments and medical faculties in
technology and internet addiction, serious illnesses,
our country and experts of the subject to evaluate the
surgical operations, divorce, job loss, traffic accidents,
comprehensibility of the items in terms of language
sudden death, economic crises, and infectious diseases
and expression and whether they cover the subject
can be causes of social isolation 12,13. to be measured. The scale draft prepared before the
Today, with the development of technology, the time application was checked for accuracy by having it
people of all age groups spend on the Internet has read by a faculty member from the Turkish language
increased greatly. As a result, serious changes occur and literature department regarding compliance with
in people’s mutual communication. The widespread the Turkish language rules. Since other scales work
use of the Internet replaces socialization and in the elderly under the social isolation scale in the

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literature, 19,20, the scale we developed was named obtained from the Sakarya University Rectorate
“DOB Social Isolation Scale” using the authors’ (Number: 044 / E.38346). The students included in
surnames’ initials. Experts were asked to evaluate the the study were informed about the research, and their
measurement degree of each item in the scale (1 = Not verbal and written consents were obtained.
suitable, 2 = Much correction, 3 = Less correction, Statistical Analysis
4 = Very suitable), between 1-4 points. Suggestions
from 11 experts were evaluated. Finally, a scale with The study was carried out on 584 subjects. The
28 items was prepared, and the items were corrected data were completed by transferring to IBM SPSS
Statistics 23 and IBM SPSS AMOS 23 programs.
in terms of language and expression in line with
While evaluating the study data, frequency
expert opinion. Expert opinions were evaluated with
distribution (number, percentage) for categorical
Kendall’s W cohesion analysis (number of experts:
variables and descriptive statistics (mean, standard
11, Kendall’s W, p> 0.05).
deviation) for numerical variables were given. For
Phase Two the validity of the scale, exploratory factor analysis,
Population and sample selection for scale drafting and confirmatory factor analysis, and for reliability,
Cronbach’s alpha value was used for the results given
The universe of the research consists of students
in the tables.
studying at Sakarya University between February and
June 2019. The study sample was planned to consist Results:
of at least 180 students who accepted to participate in Introductory Characteristics of the Students
the study, 10 times the scale item, met the inclusion
The mean age of the students participating in the
criteria, and 584 students were reached during the
study is 20.45 ± 2.33, and 78.4% are female. While
study. The students were informed about the purpose
the students who do not smoke are 75.5%, those who
of the study, and their verbal consent was obtained.
do not consume alcohol are 89.2%. 42.8% of the
Phase Three students live in a metropolitan area for most of their
Validity and reliability analysis of the scale lives, while 41.4% have a protective family structure.
The students stated that they spent most of their free
Exploratory and confirmatory factor analysis after time by phone (97.8%) and computer (94.8%).
Kendall’s W fit analysis were applied for expert
opinion for the content validity in the validation phase Validity and Reliability Analysis of the Scale
of the DOB Social Isolation Scale, while Cronbach’s Construct Validity
alpha internal consistency analysis method was Factor analysis was performed at the construct
applied in the reliability phase. validity stage of the scale. While applying the factor
­-Factor analysis: To determine the suitability of analysis, the sample size should be sufficient to
the data for factor analysis, the Kaiser-Meyer-Olkin ensure correlation reliability, and Kaiser Meyer Olkin
(KMO) Sample Fit Test and Bartlett’s Sphericity test, (KMO) and Bartlett tests were used to determine
which shows the correlation of the items with each that this competence is achieved. According to our
other, were applied before the factor analysis. Then, study results, the KMO test result was found to be
exploratory and confirmatory factor analysis was 0.939, and Bartlett’s sphericity test was found to be
applied for the construct validity of the scale. significant (p <0.001) (Table 1).
-Reliability analysis (Cronbach alfa): Asone of Table 1. KMO and Bartlett Results
the most frequently used criteria, Cronbach’s alpha Kasiyer Meyer Olkin (KMO) 0,939
reliability coefficient, which is the measure of
X2 4279,402
internal consistency, was used criteria to evaluate the
Bartlett Sphericity Test Sd 153
reliability of the scale.
p 0,000***
Ethical Clearance:
*:p<0,05 **:p<0,01 ***:p<0,001
Ethical approval of the study was obtained from
Sakarya University Faculty of Medicine Clinical Exploratory Factor Analysis (EFA)
Research Ethics Committee (Number: 71522473 Due to the applied factor analysis, the number of
/ 050.01.04 / 38). In order to carry out the study at items decreased from 28 to 18. As a result of the
Sakarya University, the necessary permission was content validity of these 18 items, it was seen that

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they were collected in one factor, and all factor loads

were above 0.500. The variance level of the items
that make up the one-dimensional structure produced
from EFA is 40.992%. Explanation rates, distribution
of items, and factor loadings for this single factor are
given below (Table 2).
Table 2. The factor analysis results of DOB Social
Isolation Scale items
Variance
Items Factor Loads Value
Description Ratio
SIS12 0,758
SIS26 0,744
SIS20 0,739
SIS23 0,693
SIS3 0,689
SIS18 0,687
SIS6 0,673
SIS22 0,665
SIS21 0,664
40,992 7,379
SIS8 0,635
SIS7 0,634
SIS10 0,617
SIS13 0,581
SIS11 0,571
SIS2 0,541
SIS19 0,531
SIS1 0,514
SIS25 0,502

Confirmatory Factor Analysis (CFA)

Figure 1. Single Sub-Dimensional 1st Order CFA
CFA analyzed the single factor structure of the Model (SIO Means DOB Social Isolation Scale)
DOB Social Isolation Scale consisting of 18 items.
The data obtained for the fit index as a result of the Reliability Studies
analysis are RMSEA = 0.07, CFI = 0.92, GFI = 0.91 Internal Consistency
and SRMR = 0.05 (Table 3). Cronbach’s alpha reliability coefficient, one of the
Table 3. Findings related to the confirmatory factor most frequently used criteria, was calculated to
analysis evaluate the scale’s reliability. These values are
Indexes Good Fit Acceptable Fit Model Result
generally higher than the acceptable value of 0.70
(Table 4).
χ2/df 0≤χ2/df≤3 3≤χ2/df≤4 3,542
GFI 0.95≤GFI≤1 0.90≤GFI≤0.95 0,914 Discussion:
IFI 0.95≤IFI≤1 0.90≤IFI≤0.95 0,919 Measuring social isolation is important for public
TLI 0.95≤TLI≤1 0.90≤TLI≤0.95 0,907 health. Social isolation is a health problem that
CFI 0.95≤CFI≤1 0.90≤CFI≤0.95 0,919 can affect all age groups and must be intervened.
RMSEA 0≤RMSEA≤0.05 0.05≤RMSEA≤0.08 0,066
However, some obstacles include the length of the
SRMR 0≤SRMR≤0.08 0.05≤SRMR≤0.10 0,0473
scales developed in diagnosing social isolation and
their application only to the advanced age group.
In addition, the path diagram showing the standard Therefore, a new scale was developed in our study to
load values distribution related to the single factor evaluate social isolation. Scales developed on social
structure obtained with DFA is given in Figure 1.

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Table 4. Item Reliability Analysis of the DOB Social Isolation Scale

Cronbach’s Alpha Value
Questions Item-Total Correlation Cronbach’s Alpha
If the item is removed
SIS1 0,458 0,911
SIS2 0,487 0,910
SIS3 0,636 0,906
SIS6 0,613 0,907
SIS7 0,576 0,908
SIS8 0,577 0,908
SIS10 0,560 0,908
Social Isolation Sclae

SIS11 0,517 0,909

SIS12 0,706 0,904
0,912
SIS13 0,525 0,909
SIS18 0,627 0,906
SIS19 0,477 0,911
SIS20 0,684 0,905
SIS21 0,604 0,907
SIS22 0,606 0,907
SIS23 0,638 0,906
SIS25 0,450 0,911
SIS26 0,691 0,905

isolation in the literature are mostly long scales factor analysis, the sample size should be sufficient
designed to measure more than one structure or scale to ensure correlation reliability, and Kaiser Meyer
applied, especially to the elderly population. Since Olkin (KMO) and Bartlett tests are used to determine
some scales are embedded in other scales or have that this competence is achieved. The result of the
poor psychometric properties, they are insufficient to KMO test performed varies between 0 and 1, and it
diagnose social isolation and confusion. DOB Social is expected to be approximately 1. For good factor
Isolation Scale is a measurement tool designed to analysis, the KMO value is recommended to be
measure whether a person is socially isolated. The above 0.60. For the sample size to be suitable for
items in the scale were prepared in a way to include factor analysis, the KMO test should be greater than
many aspects of social isolation. The DOB Social 0.50, and the Barlettsphericity test result should be
Isolation Scale fills an important gap in the literature statistically significant 22–24. In this context, according
regarding the measurement of social isolation with to our study results, the KMO test result was found
these features. to be 0.939, and Bartlett’s sphericity test was found
In order to develop scales, it is recommended to use to be significant (p <0.001) (Table 1). These results
various sources such as literature review, consulting showed that the sample size was suitable for factor
experts for the compatibility of the items, evaluating analysis 25. In the EFA evaluation made for the scale’s
the scale draft in terms of compliance with the construct validity, it was ensured that the statements
Turkish language rules, and collecting data from a with a factor load above 0.400 were included in the
heterogeneous sample group21. Our study started scale. It has been reported that the factor load value,
with a literature review on social isolation to develop which explains the relationship between the items
a scale. Although there are many scales related to in the scale and the factors, is at least 0.30 in single
social phobia and loneliness, there are a limited factor scales23. In this direction, it was determined
number of scales with validity and reliability for that the factor loads obtained as a result of the
evaluating social isolation. analysis made were sufficient. It was determined that
18 items explaining 40,992% of the total variance
Factor analysis was performed at the construct were collected in a single factor. The scale consisting
validity stage of the scale. While applying the of 18 items in total and a single sub-dimension was

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named the DOB Social Isolation Scale. results show that the DOB Social Isolation Scale is a
Another important step of reliability analysis is internal valid and reliable measurement tool to evaluate social
consistency. Internal consistency is the reliability that isolation. Developed to measure social isolation, the
determines that all items of the scale can measure the DOB Social Isolation Scale is an adaptable scale to
measured variable. The alpha coefficient measures different cultures. The scale provides an advantage
the internal consistency of the items in the scale, and for healthcare professionals in determining social
the Cronbach’s Alpha Reliability Coefficient was isolation. For the DOB Social Isolation Scale to be
calculated for the internal consistency reliability in used in many countries, conducting international,
our study. It has been reported that an alpha coefficient cross-sectional, multi-center validity-reliability
of 0.60 and higher proves the internal consistency studies in cooperation with international researchers
22
. However, the consistency increases as the alpha will greatly contribute to the literature.
reliability coefficient approaches 1 and decreases as Source of fund: (if any): None
it approaches 025. According to our study results, Conflict of Interest: No conflict of interest
the overall reliability coefficient of the DOB Social
Isolation Scale was calculated as 0.91. According Ethical clearence:   Ethical approval of the study
to this result, it is understood that the whole scale was obtained from Sakarya University Faculty
provides internal consistency. of Medicine Clinical Research Ethics Committee
(Number: 71522473 / 050.01.04 / 38).
Conclusion and suggestions
Authors’s contribution:  
One of the most important limitations of this study
is that the research results consist of data from the Data gathering and idea owner of this study: Gülgün
research group. Therefore, it may not be possible Durat, Kevser Ilcioglu, Yasemin Hamlacı Başkaya  
to generalize the research results to all university Study design: Gülgün Durat
students or people of all age groups. To increase the Data gathering: Kevser Ilcioglu, Yasemin Hamlacı
generalizability of the validity and reliability results Başkaya  
of the DOB social isolation scale, it should be tested on
a sample of other age groups. Despite its limitations, Writing and submitting manuscript: Gülgün Durat,
this study is one of the few studies investigating social Kevser Ilcioglu, Yasemin Hamlacı Başkaya  
isolation in young people, and it is important to guide Editing and approval of final draft: Gülgün Durat,
future studies to define social isolation. The study Kevser Ilcioglu, Yasemin Hamlacı Başkaya  

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