Stigma towards people with tuberculosis: a cross-cultural adaptation and validation of a scale in Indonesia

Abstract

Introduction Tuberculosis (TB) remains a highly stigmatised disease that can cause or exacerbate mental health disorders. Despite increased awareness of the importance of reducing TB stigma, validated tools to measure TB stigma remain scarce. This study aimed to culturally adapt and validate the Van Rie TB Stigma Scale in Indonesia, a country with the second largest TB incidence worldwide. Methods We validated the scale in three phases: translation, cultural adaptation, and psychometric evaluation. We invited diverse experts to an interdisciplinary panel for the cross-cultural adaptation, then performed a psychometric evaluation of the scale: exploratory and confirmatory factor analyses, reliability analysis, and correlation analysis with Patient Health Questionnaire 9 [PHQ-9]. Results We culturally adapted the original scale's language and content during the translation and cultural adaptation phases. After psychometric evaluation with 401 participants in seven provinces of Indonesia, we removed two items. The new scale had two forms: (A) patient and (B) community perspective forms. Both forms had good internal consistency, with respective Cronbach's alpha values of 0.738 and 0.807. We identified three loading factors in Form A (disclosure, isolation, and guilty) and two loading factors in Form B (isolation and distancing). The scale showed correlation with PHQ-9 (Form A, rs = 0.347, p < 0.001; Form B, rs = 0). Conclusions The culturally adapted Indonesian version of Van Rie's TB Stigma Scale is comprehensive, reliable, internally consistent, and valid. The scale is now ready for applied scale-up in research and practice to measure TB-stigma and evaluate the impact of TB-stigma reduction interventions in Indonesia.

Codeveloping a community-based, peer-led psychosocial support intervention to reduce tuberculosis-related stigma in Indonesia: a mixed-methods participatory action study

“…10 Using various methods to estimate TB Stigma, 6 many studies have found that a substantial proportion of people with TB experience diverse forms of TB Stigma including enacted (experiences of being excluded, isolated, and/or discriminated against), anticipated (having perception, expectation, and/or fear of being stigmatized), or self (loss of self-esteem, loss of dignity, fear and/or shame) stigma. [11][12][13] In our previous study with more than 600 people with TB in Indonesia, we described that not only did 61% of people with TB experience moderate TB stigma but that such a stigma was also associated with depression and reduced QoL. 7 People with TB in our study also identi ed a substantial unmet need for peer support.…”

“…Firstly, individual counseling by either healthcare workers or research team member applied at the rst healthcare visit following TB diagnosis. At this point, the baseline status of people with TB's TB stigma levels, mental health, and quality of life will also be evaluated using tools validated in the Indonesian setting 7,12 and a verbal and written invitation to a group psychological counseling will be provided. Secondly, a monthly community-based group counseling will be held in an agreed communal space distinct from healthcare facilities and led by TB survivors.…”

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

“…Additionally, other versions of the TSS factor loadings were 0.52–0.80. 28 , 50 , 51 However, there is currently no available report on the factor loadings of the original Chinese version of the scale. Therefore, the high correlation coefficients between the adapted TSS and its factors also indicate the high internal consistency of the scale.…”

“…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 …”

“… 51 The fit indices for the Indonesian version of TSS were: TLI=0.798, CFI=0.849, RMSEA=0.088, SRMR=0.062. 28 However, the original Chinese version did not undergo confirmatory factor analysis (CFA), so fit indices are not available. Whereas after CFA in the present study, the fit of the two-factor model was also acceptable (TLI = 0.845, CFI = 0.888, RMSEA = 0.12, GFI = 0.912, SRMR = 0.038).…”