Psychometric assessment of the EMIC Stigma Scale for Brazilians affected by leprosy

Abstract

Background The Stigma Scale of the Explanatory Model Interview Catalogue (EMIC-SS) is a useful option to investigate leprosy-related stigma, but its psychometric qualities are unknown in Brazil. This study investigated the factor structure, the convergent and known-groups validity, and the reliability of the EMIC-SS for Brazilians affected by leprosy. Methodology The Brazilian Portuguese version of the EMIC-SS was validated in 180 persons affected by leprosy at a Reference Center in Rio de Janeiro. Confirmatory factorial analysis (CFA) and Cronbach alpha were used to assess the EMIC-SS internal consistency. The Construct validity was tested using Spearman Correlation, Kruskal-Wallis, and Mann-Whitney tests comparing with the Participation Scale, Rosenberg Self-esteem Scale, Beck Depression Inventory, and a Sociodemographic Questionnaire. Test-retest reliability was evaluated with intra-class correlation (ICC). Main findings CFA confirmed the one- and two-dimensional models of the scale after retaining 12 of the 15 EMIC-SS items. The 12—item EMIC-SS was consistent (α = 0.78) and reproducible (ICC = 0.751, 95% Confidence Interval = 0.657–0.822, p < 0.0001). A significant correlation was observed between the EMIC-SS and the other scales confirming convergent validity. The EMIC-SS and its factors were able to differentiate several hypothesized groups (age, change of occupation, monthly family income, communicating others about the disease, and perception of difficulty to follow treatment) confirming the scale known-groups validity, both in its one and two-dimensional models. Conclusions/Significance Our study found support for the construct validity and reliability of the EMIC-SS as a measure of stigma experienced by people affected by leprosy in Brazil. However, future studies are necessary in other samples and populations with stigmatizing conditions to determine the optimal factor structure and to strengthen the indications of the validated scale.

Validation and Cultural Adaptation of Explanatory Model Interview Catalogue (EMIC) in Assessing Stigma among Recovered Patients with COVID-19 in Saudi Arabia

“…Furthermore, the association between the EMIC score and different sociodemographic factors was explored. The Arabic-translated EMIC showed a very good level of internal consistency with a Cronbach's alpha of 0.79, which is similar to the levels reported by Morgado et al in the revised (12-item) Portuguese version of the scale (0.78) [22]. Although two factors explained more than 60% of the responses' variance, which is consistent with previously published studies [22,30], the EMIC was used as a one-dimensional scale as recommended by Weiss et al [12,13], and it has also been found to be appropriate in multiple studies [17,22,30].…”

“…Construct validity of the Arabic-translated EMIC was examined using principal component analysis with varimax rotation. Although EMIC is used as a onedimensional scale, there are studies that have confirmed the potential of a two-dimensional model of the EMIC [22]. Therefore, factors with an eigenvalue of >1 were extracted [23].…”

“…Descriptive statistics using means, standard deviations, frequencies, and percentages were performed as appropriate. Multiple linear regression to explore the relationship between EMIC stigma score and different sociodemographic (e.g., age, gender, marital status, monthly income, employment status, region of residence, educational level, and health literacy) and medical characteristics (e.g., presence of comorbidities and family history of mental illness) was conducted [22,[25][26][27]. The minimum sample size was estimated to be 104 participants for multiple linear regression with up to nine independent variables and a medium effect size (Cohen's f 2 = 0.15) assuming a response rate of 50%.…”

“…The EMIC has also been validated to assess stigma toward healthcare providers and those with mental illnesses, such as depression and schizophrenia [14][15][16]. In addition, the EMIC scale is available in various languages but Arabic [22,[25][26][27][28][29][30]. However, this scale, as well as other infectious-disease stigma scales, do not exist in Arabic, which makes it difficult to explore the stigma associated with infectious diseases, such as COVID-19.…”

Cervical Cancer Screening Postpandemic: Self-Sampling Opportunities to Accelerate the Elimination of Cervical Cancer

“… 146 In addition, the causal relationship between cervical cancer and sexually transmitted HPV infection can result in perceived sexual promiscuity by the community and feelings of shame and blame in women who test positive for HPV. 147 , 148 Stigma associated with cervical cancer and HPV can influence women’s willingness to undergo an HPV test and their interpretation of screening results. 149 , 150 In some settings, there are pervasive misperceptions that the “type of women” who get cervical cancer are uneducated, sexually promiscuous, and cursed.…”