Developing a tool to measure tuberculosis-related stigma in workplaces in Indonesia: An internal validation study

Soemarko, Dewi Sumaryani; Halim, Frisca Aprillia; Kekalih, Aria; Yunus, Faisal; Werdhani, Retno Asti; Sugiharto, Agus; Mansyur, Muchtaruddin; Wingfield, Tom; Fuady, Ahmad

doi:10.1016/j.ssmph.2023.101337

Cited by 3 publications

(5 citation statements)

References 19 publications

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Section: Discussionmentioning

confidence: 99%

“…This study also found that the adapted TSS was categorized into two dimensions after conducting EFA, and the EFA of the Indonesian version of the TSS supported a two-factor model, but with a slightly different division of items, which may be due to the different cultural backgrounds in different regions. 28,52 Regarding model fit, Van Rie et al reported the following fit indices for the original scale; TLI = 0.94, CFI = 0.88, and RMSEA = 0.11. 20 According to the report, the fit indices for the Turkish version of TSS were: CFI=0.94, RMSEA=0.077, GFI=0.95, SRMR=0.079.…”

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confidence: 99%

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Psychometric Characteristics of the Chinese Version of the Tuberculosis Related-Stigma Scale in a Population of Medical Students and Its Correlation with Selected Demographic Characteristics

Yi,

Sun,

et al. 2024

RMHP

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Background As future health workers, medical students’ attitudes towards tuberculosis (TB) patients can impact TB control. However, in China, there is a lack of well-quantified assessment regarding the stigma among medical students towards TB patients. Therefore, this study aimed to validate the Chinese version of the Tuberculosis related-Stigma Scale (TSS) in medical students and to apply the scale to measure stigma and its determinants. Methods A total of 1035 eligible medical students participated in the cross-sectional questionnaire. Exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) were first conducted to test Chinese version of the TSS construct validity, and then internal consistency was assessed using Cronbach’s α. Finally, multiple linear regression analyses were conducted to identify predictors of stigma. Results EFA extracted two factors (“Social distance” and “Exclusionary sentiments”). The CFA further confirmed the two-factor construct. The internal consistency, convergent and divergent validity of the adapted Chinese version of the TSS was acceptable. Furthermore, Whether one has received TB health education and whether know a person with TB are associated with all dimensions of TB stigma, while differences in sex and place of residence play different roles in influencing the different dimensions of stigma. Conclusion The adapted Chinese version of the TSS can be used to assess the level of stigma among medical students in China towards tuberculosis patients. When implementing future interventions to reduce stigma associated with TB, special attention should be given to medical students from urban areas, of male gender, who have not received TB health education, and no know a person with TB. However, these two dimensions (“Social distance” and “Exclusionary sentiments”) are impacted by different determinants and should therefore be addressed separately when designing, implementing, and evaluating measures to reduce stigma.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Psychometric Characteristics of the Chinese Version of the Tuberculosis Related-Stigma Scale in a Population of Medical Students and Its Correlation with Selected Demographic Characteristics

Yi,

Sun,

et al. 2024

RMHP

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“…Related research from LMICs has shown that males are concerned by TB and related TB-stigma because they may collectively corrode their primary income earner status and hence their value and status more broadly within the household and community [47,52,[56][57][58]. Improving knowledge about TB at community level, reducing misperceptions about TB infectiousness and transmission within workplaces, and strengthening social protection and employment legislation could all contribute to preventing unnecessary job loss or unnecessarily prolonged time unable to work [5]. Moreover, gender and gendered norms, including perceptions of masculinity, should be considered in the design and delivery of psychosocial and economic interventions for people, and especially men, with TB [59].…”

Section: Plos Global Public Healthmentioning

confidence: 99%

“…TB is well recognized as a social infectious disease with determinants including poverty, limited healthcare access, and—the often overlooked—stigma [ 3 , 4 ]. People with TB, their families, and even social networks face persistent stigma from others including in the neighborhood and workplace [ 5 ]. Stigma is deeply rooted in myths, misconceptions, misunderstanding, and erroneous health beliefs concerning TB disease and those affected [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Stigma, depression, quality of life, and the need for psychosocial support among people with tuberculosis in Indonesia: A multi-site cross-sectional study

Fuady,

Arifin,

Yunita

et al. 2024

PLOS Glob Public Health

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Stigma towards people with tuberculosis (TB-Stigma) is associated with other psychosocial consequences of TB including mental illness and reduced quality of life (QoL). We evaluated TB-Stigma, depression, QoL, and the need for psychosocial support among adults with TB in Indonesia, a high TB burden country. In this primary health facility-based survey in seven provinces of Indonesia, from February to November 2022, we interviewed adults receiving (a) intensive phase treatment for drug-susceptible (DS) TB at public facilities, (b) treatment at private facilities, (c) those lost to follow up (LTFU) to treatment, and (d) those receiving TB retreatment. We used our previously validated Indonesian TB-Stigma Scale, Patient Health Questionnaire-9, and EQ-5D-5L to measure TB-Stigma, depression, and QoL. Additional questions assessed what psychosocial support was received or needed by participants. We recruited and interviewed 612 people, of whom 60.6% (96%CI 59.6–64.5%) experienced moderate TB-Stigma. The average TB-Stigma scores were 19.0 (SD 6.9; min-max 0–50; Form A-Patient Perspective) and 23.4 (SD 8.4, min-max 0–50; Form B-Community Perspective). The scores were higher among people receiving treatment at private facilities (adjusted B [aB] 2.48; 0.94–4.03), those LTFU (aB 2.86; 0.85–4.87), males (aB 1.73; 0.59–2.87), those losing or changing job due to TB (aB 2.09; 0.31–3.88) and those living in a rural area (aB 1.41; 0.19–2.63). Depression was identified in 41.5% (95% CI 37.7–45.3%) of participants. Experiencing TB-Stigma was associated with moderately severe to severe depression (adjusted odds ratio [aOR] 1.23; 1.15–1.32) and both stigma and depression were associated with lower QoL (aB -0.013; [-0.016]-[-0.010]). Informational (20.8%), emotional (25.9%) and instrumental (10.6%) support received from peers or peer-groups was limited, and unmet need for such support was high. There is a sizeable and intersecting burden of TB-Stigma and depression among adults with TB in Indonesia, which is associated with lower QoL. Participants reported a substantial unmet need for psychosocial support including peer-led mutual support groups. A community-based peer-led psychosocial support intervention is critical to defray the psychosocial impact of TB in Indonesia.

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“…We have since developed a referral pathway to address this issue, which has been successfully used during the subsequent ASCOT pilot trial [74]. The Van Rie Stigma Scale was also adapted to be more concise and to remove questions perceived as potentially insensitive but, in future research, we aim to formally validate the psychometric properties of the scale in Nepal, as we have done in other settings including Indonesia [95][96][97]. Similarly, the EQ-5D-5L tool is a simple tool appropriate for field studies, but as a consequence, it is also a rather 'blunt' tool for measuring physical changes in quality of life for drug-sensitive TB.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Stigma, depression, and quality of life among people with pulmonary tuberculosis diagnosed through active and passive case finding in Nepal: a prospective cohort study

Dixit,

Rai,

Aryal

et al. 2024

BMC Global Public Health

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Background The psychosocial consequences of tuberculosis (TB) are key barriers to ending TB globally. We evaluated and compared stigma, depression, and quality of life (QoL) among people with TB diagnosed through active (ACF) and passive (PCF) case-finding in Nepal. Methods We prospectively recruited adults with TB diagnosed through ACF and PCF in four districts of Nepal between August 2018 and April 2019. Participants were interviewed at 8–12 weeks (baseline) and 22–26 weeks (follow-up) following treatment initiation. TB stigma was measured using an adapted Van Rie Stigma Scale (0 = no stigma to 30 = highest stigma). Depression was measured using a locally-validated Patient Health Questionnaire (PHQ-9). Mild and major depression were indicated by PHQ-9 scores 5–9 and ≥ 10, respectively. QoL was measured using the EuroQoL 5-Dimension 5-level (EQ-5D-5L) from 0 to 1 (optimal QoL); and self-rated health from 0 to 100 (optimal self-rated health). Results We recruited 221 participants (111 ACF; 110 PCF) with a mean age of 48 years (standard deviation [SD] = ± 16), of whom 147/221 (67%) were men. The mean TB stigma score was 12 (SD = 7.3) at baseline and 12 (SD = 6.7) at follow-up. The most commonly perceived elements of TB stigma at baseline were that people with TB experienced guilt (110/221, 50%) and feared disclosure outside their household (114/221, 52%). Self-rated health and EQ-5D-5L scores increased from baseline to follow-up (69.3 to 80.3, p < 0.001; 0.92 to 0.9, p = 0.009). Nearly one-third of participants (68/221, 31%) had mild or major depression at baseline. The proportion of participants with major depression decreased from baseline to follow-up (11.5% vs. 5%, p = 0.012). There was a moderate, significant positive correlation between depression and stigma scores (r = 0.41, p < 0.001). There were no differences found in TB stigma, self-rated health, QoL, or prevalence of mild/major depression between ACF and PCF participants. Conclusions We found a substantial, persistent, and clustered psychosocial impact among adults with TB diagnosed through both ACF and PCF strategies in Nepal. These findings suggest an urgent need to develop effective, evidence-based psychosocial support interventions with the potential to be integrated with existing ACF strategies and routine TB service activities.

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Developing a tool to measure tuberculosis-related stigma in workplaces in Indonesia: An internal validation study

Cited by 3 publications

References 19 publications

Psychometric Characteristics of the Chinese Version of the Tuberculosis Related-Stigma Scale in a Population of Medical Students and Its Correlation with Selected Demographic Characteristics

Psychometric Characteristics of the Chinese Version of the Tuberculosis Related-Stigma Scale in a Population of Medical Students and Its Correlation with Selected Demographic Characteristics

Stigma, depression, quality of life, and the need for psychosocial support among people with tuberculosis in Indonesia: A multi-site cross-sectional study

Stigma, depression, and quality of life among people with pulmonary tuberculosis diagnosed through active and passive case finding in Nepal: a prospective cohort study

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