Translation and validation of the Short HIV Stigma scale in Brazilian Portuguese

Abstract

Background HIV-related stigma, or the degree to which people living with HIV endorse negative stereotypes associated with HIV, is associated with poor continuum of care outcomes. We translated the 12-item Short HIV Stigma scale and evaluated its psychometric properties in a Brazilian context with regard to construct validity and reliability. Methods The first step included translation, back-translation, evaluation, peer review, and pre-testing of the Short HIV Sigma scale developed by Reinius et al. (Health Qual Life Outcomes 15(1):115, 2017). The second step involved piloting the scale in three convenience samples of adults recruited online through advertisements on different platforms: Grindr (October/2019) and Hornet (February–March/2020), geospatial network apps for sexual encounters for gay, bisexuals and other men who have sex with men, and social media apps (Facebook and WhatsApp, October/2019). The psychometric evaluation included confirmatory factor analysis, differential item functioning using the Multiple-Indicator Multiple-Cause model, and correlations between subscale scores and antiretroviral treatment use and adherence. Reliability was assessed using Cronbach’s alpha, and ordinal alpha and omega from the polychoric correlation matrix. Results In total, 114, 164, and 1824 participants completed the measure items through Grindr, social media, and Hornet, respectively. We confirmed a 4-factor structure with factors for personalized stigma (3 items), disclosure concerns (3 items), concerns with public attitudes (3 items), and negative self-image (3 items). Small differential item functioning with respect to sample was found for one item (“I feel guilty because I have HIV”), which did not substantively influence estimates of latent factor scores. Grindr and Hornet’s participants scored significantly higher than social media participants on all factors except personalized stigma. Higher subscale scores correlated with antiretroviral treatment use among participants from Hornet and with lower treatment adherence in participants from Grindr and Hornet. Reliability as measured by Cronbach’s alpha, ordinal alpha and omega were 0.83, 0.88 and 0.93 for the entire scale. Discussion The Brazilian Portuguese version of the Short HIV Stigma scale had satisfactory psychometric properties with present results suggesting that scores from different samples may be compared without concern that measurement differences substantively influence results though further studies with greater representation of women and heterosexual men are warranted.

Psychometric Properties of the Berger HIV Stigma Scale: A Systematic Review

“…Twenty-four of the included studies [ 20 , 22 , 23 , 39 , 40 , 45 , 63 , 69 , 70 , 91 , 92 , 93 , 95 , 97 , 107 , 111 , 118 , 121 , 144 , 146 , 147 , 171 , 178 , 184 ] were development and/or validation studies of the HSS and/or its abbreviated versions. The remaining studies were observational or experimental studies that used the HSS to assess HIV-related stigma in different contexts.…”

“…For internal consistency, all the studies, except a 4-item scale in one study [ 127 ] and some subscales in ten studies [ 23 , 52 , 68 , 69 , 91 , 111 , 170 , 172 , 176 , 189 ], reported Cronbach’s alphas of above the recommended acceptable threshold of 0.70 [ 191 ]. Two studies [ 34 , 95 ] reported the internal consistency of the HSS using McDonald’s omega instead of Cronbach’s alpha and reported good reliability ( Table 1 and Supplementary Table S2 ).…”

“…Two studies [ 34 , 95 ] reported the internal consistency of the HSS using McDonald’s omega instead of Cronbach’s alpha and reported good reliability ( Table 1 and Supplementary Table S2 ). In one study [ 111 ], Cronbach’s alpha (0.83), ordinal alpha (0.88), and omega alpha (0.93) were reported as measures of internal consistency. For test–retest reliability, the intraclass correlations in all the studies were above the recommended cut-off score of 0.40 [ 191 ], except for the concern with public attitudes subscale in the 17-item HSS used in Puerto Rico, which reported an intraclass correlation coefficient of 0.27 [ 92 ].…”

Validity, reliability, and measurement invariance of an adapted short version of the HIV stigma scale among perinatally HIV infected adolescents at the Kenyan coast

“…Therefore, we can confidently compare means and conclude that any difference between the unidimensional HSS-10 across sex and age groups comes from a real difference in HIV stigma and not from the measure's group-specific properties. Although various studies have used the 40–item HIV stigma scale [ 19 ] and the 12-item HIV stigma scale [ 20 , 44 ] to assess stigma and reported their psychometric properties, no study has been found to report the measurement invariance of the tool. Therefore, future research involving HIV stigma assessment tools should use robust psychometric analytical models involving measurement invariance.…”

Translation and validation in Brazilian Portuguese of the reactions to homosexuality scale

“…We performed translation of RHS items to Brazilian Portuguese following established guidelines (Beaton et al, 2000). Details of translation procedures were described elsewhere (Luz et al, 2020;Torres et al, 2021). A qualitative pretesting of the translated items was conducted with a small convenience sample to ensure item comprehensibility before moving into the reliability and construct validity step.…”