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ADAPTING A STIGMA SCALE FOR ASSESSMENT OF TUBERCULOSIS-RELATED STIGMA AMONG ENGLISH/SWAHILI-SPEAKING PATIENTS IN AN AFRICAN SETTING.

ABSTRACT: Objective:To adapt a validated instrument that quantitatively measures stigma among English/Swahili speaking TB (tuberculosis) patients in Kenya, a high burden TB country. Methods:Following ethical approval, we elicited feedback on the English and Swahili translated Stigma Scale for Chronic Illness (SSCI) tools through cognitive interviews. We assessed difficulties in translation, differences in meaning, TB contextual relevance, patients' acceptability to the questions, and issues in tool structure. The interviews were audio recorded, transcribed and translated. Open coding and thematic analysis of the data was conducted by two independent researchers. Results:Between May and September 2015 we conducted a qualitative study among 20 adult TB patients attending 11 health facilities in Nairobi County, Kenya. Most questions were understood in both English and Swahili, deemed relevant in the context of TB and acceptable to TB patients. Key areas of adaptation of the SSCI included adding questions addressing fear of infecting others and death, HIV stigma, and intimate, family and workplace relationship contexts. Questions were revised for non-redundancy, specificity and optimized sequence. Conclusion:The adapted 8-item SSCI appears to be a useful tool that may be administered by health workers in English or Swahili to quantify TB stigma among TB patients in Kenya.

SUBMITTER: Marangu D

PROVIDER: S-EPMC5793924 | biostudies-literature | 2017 Nov

REPOSITORIES: biostudies-literature

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ADAPTING A STIGMA SCALE FOR ASSESSMENT OF TUBERCULOSIS-RELATED STIGMA AMONG ENGLISH/SWAHILI-SPEAKING PATIENTS IN AN AFRICAN SETTING.

Marangu Diana D Mwaniki Hannah H Nduku Salome S Maleche-Obimbo Elizabeth E Jaoko Walter W Babigumira Joseph J John-Stewart Grace G Rao Deepa D

Stigma and health 20171101 4

<h4>Objective</h4>To adapt a validated instrument that quantitatively measures stigma among English/Swahili speaking TB (tuberculosis) patients in Kenya, a high burden TB country.<h4>Methods</h4>Following ethical approval, we elicited feedback on the English and Swahili translated Stigma Scale for Chronic Illness (SSCI) tools through cognitive interviews. We assessed difficulties in translation, differences in meaning, TB contextual relevance, patients' acceptability to the questions, and issues ...[more]

PMID: 29399635

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Project description:Lesbian, bisexual and queer (LBQ) women experience pervasive sexual stigma that harms wellbeing. Stigma is a multi-dimensional construct and includes perceived stigma, awareness of negative attitudes towards one's group, and enacted stigma, overt experiences of discrimination. Despite its complexity, sexual stigma research has generally explored singular forms of sexual stigma among LBQ women. The study objective was to develop a scale to assess perceived and enacted sexual stigma among LBQ women. We adapted a sexual stigma scale for use with LBQ women. The validation process involved 3 phases. First, we held a focus group where we engaged a purposively selected group of key informants in cognitive interviewing techniques to modify the survey items to enhance relevance to LBQ women. Second, we implemented an internet-based, cross-sectional survey with LBQ women (n=466) in Toronto, Canada. Third, we administered an internet-based survey at baseline and 6-week follow-up with LBQ women in Toronto (n=24) and Calgary (n=20). We conducted an exploratory factor analysis using principal components analysis and descriptive statistics to explore health and demographic correlates of the sexual stigma scale. Analyses yielded one scale with two factors: perceived and enacted sexual stigma. The total scale and subscales demonstrated adequate internal reliability (total scale alpha coefficient: 0.78; perceived sub-scale: 0.70; enacted sub-scale: 0.72), test-retest reliability, and construct validity. Perceived and enacted sexual stigma were associated with higher rates of depressive symptoms and lower self-esteem, social support, and self-rated health scores. Results suggest this sexual stigma scale adapted for LBQ women has good psychometric properties and addresses enacted and perceived stigma dimensions. The overwhelming majority of participants reported experiences of perceived sexual stigma. This underscores the importance of moving beyond a singular focus on discrimination to explore perceptions of social judgment, negative attitudes and social norms.

Project description:BackgroundDespite bearing the largest HIV-related burden, little is known of the Health-Related Quality of Life (HRQoL) among people living with HIV in sub-Saharan Africa. One of the factors contributing to this gap in knowledge is the lack of culturally adapted and validated measures of HRQoL that are relevant for this setting.AimsWe set out to adapt the Functional Assessment of HIV Infection (FAHI) Questionnaire, an HIV-specific measure of HRQoL, and evaluate its internal consistency and validity.MethodsThe three phase mixed-methods study took place in a rural setting at the Kenyan Coast. Phase one involved a scoping review to describe the evidence base of the reliability and validity of FAHI as well as the geographical contexts in which it has been administered. Phase two involved in-depth interviews (n = 38) to explore the content validity, and initial piloting for face validation of the adapted FAHI. Phase three was quantitative (n = 103) and evaluated the internal consistency, convergent and construct validities of the adapted interviewer-administered questionnaire.ResultsIn the first phase of the study, we identified 16 studies that have used the FAHI. Most (82%) were conducted in North America. Only seven (44%) of the reviewed studies reported on the psychometric properties of the FAHI. In the second phase, most of the participants (37 out of 38) reported satisfaction with word clarity and content coverage whereas 34 (89%) reported satisfaction with relevance of the items, confirming the face validity of the adapted questionnaire during initial piloting. Our participants indicated that HIV impacted on their physical, functional, emotional, and social wellbeing. Their responses overlapped with items in four of the five subscales of the FAHI Questionnaire establishing its content validity. In the third phase, the internal consistency of the scale was found to be satisfactory with subscale Cronbach's α ranging from 0.55 to 0.78. The construct and convergent validity of the tool were supported by acceptable factor loadings for most of the items on the respective sub-scales and confirmation of expected significant correlations of the FAHI subscale scores with scores of a measure of common mental disorders.ConclusionThe adapted interviewer-administered Swahili version of FAHI questionnaire showed initial strong evidence of good psychometric properties with satisfactory internal consistency and acceptable validity (content, face, and convergent validity). It gives impetus for further validation work, especially construct validity, in similar settings before it can be used for research and clinical purposes in the entire East African region.

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Dataset Information

ADAPTING A STIGMA SCALE FOR ASSESSMENT OF TUBERCULOSIS-RELATED STIGMA AMONG ENGLISH/SWAHILI-SPEAKING PATIENTS IN AN AFRICAN SETTING.

Publications

ADAPTING A STIGMA SCALE FOR ASSESSMENT OF TUBERCULOSIS-RELATED STIGMA AMONG ENGLISH/SWAHILI-SPEAKING PATIENTS IN AN AFRICAN SETTING.

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