Comparative Analysis of Psoriasis Severity and Quality of Life in Urban and Rural Patients

Thesis Abstract

Psoriasis, a chronic inflammatory skin disease characterized by relapsing and remitting skin lesions, significantly impacts patients’ physical health and psychosocial well-being, yet little is understood about how the severity and quality of life (QoL) outcomes differ between urban and rural populations. This study aims to comparatively analyze psoriasis severity and its influence on quality of life among urban and rural patients, thereby elucidating contextual disparities and informing tailored management strategies. The primary objectives are to assess and compare psoriasis severity using the Psoriasis Area and Severity Index (PASI) and evaluate QoL through the Dermatology Life Quality Index (DLQI) in both demographic groups; additionally, it seeks to identify socio-demographic and environmental factors contributing to observed variations. Employing a cross-sectional analytical design, the study surveyed 400 psoriasis patients—200 from urban settings and 200 from rural areas—selected through stratified random sampling from dermatology clinics across a designated geographical region. Data collection instruments included standardized questionnaires the PASI for clinical assessment, the DLQI for QoL measurement, and a socio-demographic and environmental exposure questionnaire. The validity and reliability of these tools were established through pilot testing and Cronbach’s alpha coefficients exceeding 0.80. Data analysis involved descriptive statistics to profile participants, followed by inferential statistics including independent t-tests and chi-square tests to identify differences between groups. Multivariate regression analysis was employed to examine predictors of psoriasis severity and QoL, while analysis of covariance (ANCOVA) controlled for confounding variables. The theoretical underpinning draws on the Biopsychosocial Model to interpret the interplay between biological severity and psychosocial outcomes, and the Health Belief Model to contextualize health-seeking behaviors across settings. Expected findings include significant differences in psoriasis severity scores, with rural patients potentially exhibiting higher PASI scores owing to delayed treatment access or environmental factors, and corresponding differences in DLQI scores, reflecting greater QoL impairment in one group. Socio-demographic factors such as education level, income, and health literacy are anticipated to be significant predictors of disease severity and QoL. The study anticipates revealing that environmental exposures, healthcare access disparities, and social support networks distinctly influence disease outcomes in urban versus rural settings. This research contributes to the existing body of knowledge by providing empirically grounded insights into the contextual determinants of psoriasis severity and QoL, emphasizing the necessity for location-specific intervention strategies. It aims to fill gaps related to comparative rural-urban dermatological health disparities and advocates for equitable healthcare policies and community-based education programs. The study concludes that targeted psychosocial and clinical interventions, addressing environmental and socio-economic barriers, are critical to reducing disparities and improving health outcomes across diverse populations. Recommendations include integrating community health initiatives tailored to rural contexts, enhancing dermatology service accessibility, and promoting health literacy to support better disease management. Future research should explore longitudinal designs to evaluate intervention efficacy and investigate additional psychosocial variables influencing psoriasis management in varying socio-environmental settings.