Validating measures of stigma against those with mental illness among a community sample in Kilifi Kenya

Abstract

Background Stigma against persons with mental illness is a universal phenomenon, but culture influences the understanding of etiology of mental illness and utilization of health services. Methods We validated Kiswahili versions of three measures of stigma which were originally developed in the United Kingdom: Community Attitudes Toward the Mentally Ill Scale (CAMI), Reported and Intended Behaviors Scale (RIBS) and Mental Health Awareness Knowledge Schedule (MAKS) and evaluated their psychometric properties using a community sample (N = 616) in Kilifi, Kenya. Results Confirmatory factor analysis confirmed the one-factor solution for RIBS [root mean-squared error of approximation (RMSEA) < 0.01, comparative fit index (CFI) = 1.00, Tucker–Lewis index (TLI) = 1.01] and two-factor solution for MAKS (RMSEA = 0.04, CFI = 0.96, TLI = 0.95). A 23-item, three-factor model provided the best indices of goodness of fit for CAMI (RMSEA = 0.04, CFI = 0.90, TLI = 0.89). MAKS converged with both CAMI and RIBS. Internal consistency was good for the RIBS and acceptable for CAMI and MAKS. Test–retest reliabilities were excellent for RIBS and poor for CAMI and MAKS, but kappa scores for inter-rater agreement were relatively low for these scales. Results support validity of the original MAKS and RIBS scale and a modified CAMI scale and suggest that stigma is not an enduring trait in this population. The low kappa scores are consistent with first kappa paradox which is due to adjustment for agreements by chance in case of marginal prevalence values. Conclusions Kiswahili versions of the MAKS, RIBS and a modified version of the CAMI are valid for use in the study population. Stigma against people with mental illness may not be an enduring trait in this population.

Arabic validation of the “Mental Health Knowledge Schedule” and the “Reported and Intended Behavior Scale”

“…Pearson’s correlation between the MAKS and the RIBS was comparable to the one of the French and Kiswahili versions ( 18 , 21 ).…”

Effectiveness of participatory video in lowering stigma against people with mental, neurological and substance use disorders in Kenya

“…5 We employed globally validated stigma assessment tools, 4,36,37 which were also validated in our study setting. 15 However, our study does have limitations. The intervention comprised two key components: interactive educational participatory videos and in-person contact between the target audience and individuals with lived experience of mental illness.…”

“… 5 We employed globally validated stigma assessment tools, 4 , 36 , 37 which were also validated in our study setting. 15 …”

“… 26 All tools were translated to Kiswahili, back-translated into English and were validated for Kilifi populations and found to possess good psychometric properties. 15 The MAKS contains 12 questions: 6 measure general mental health knowledge and 6 measure knowledge about specific mental illnesses. The adapted and validated version of the CAMI used in this analysis contains 23 questions which measure 3 domains: authoritarianism, tolerance and sympathy.…”

“…Our present study had two aims: (a) to evaluate the effectiveness of a participatory video project in lowering stigma against people with mental, neurological and substance use disorders; and (b) to examine the sociodemographic correlates of stigma in Kilifi, Kenya. We used knowledge, attitudes and behaviour to conceptualise stigma and used validated tools 15 to measure the impact of the participatory video intervention on stigma scores immediately after the video exercises and 4 months later.…”