A systematic review and psychometric appraisal of instruments measuring tuberculosis stigma in Sub-Saharan Africa.

Bergman, Alanna; McNabb, Katherine C.; Farley, Jason E.

doi:10.1037/sah0000328

Cited by 4 publications

(5 citation statements)

References 45 publications

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“…By this approach, this review highlights that most TB-stigma intervention studies used tools that lacked appropriate validation. This finding is consistent with other published studies [36][37][38][39]. Using reliable, validated stigma measurement tools and methods is important and helps measure stigma accurately and consistently.…”

Section: Discussionsupporting

confidence: 91%

“…It also enables the comparison of impact evaluation of stigma reduction interventions across studies and contexts. There is a list of available tools that can be used and validated [19], including Van Rie's TB-Stigma Scale [40], one of the most adapted questionnaires to assess stigma [38], which may support researchers and implementers designing TB-stigma reduction programmes in the future.…”

Section: Discussionmentioning

confidence: 99%

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Interventions pathways to reduce tuberculosis-related stigma: a literature review and conceptual framework

et al. 2022

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Background Prevention of tuberculosis (TB)-related stigma is vital to achieving the World Health Organisation’s End TB Strategy target of eliminating TB. However, the process and impact evaluation of interventions to reduce TB-stigma are limited. This literature review aimed to examine the quality, design, implementation challenges, and successes of TB-stigma intervention studies and create a novel conceptual framework of pathways to TB-stigma reduction. Method We searched relevant articles recorded in four scientific databases from 1999 to 2022, using pre-defined inclusion and exclusion criteria, supplemented by the snowball method and complementary grey literature searches. We assessed the quality of studies using the Crowe Critical Appraisal Tool, then reviewed study characteristics, data on stigma measurement tools used, and interventions implemented, and designed a conceptual framework to illustrate the pathways to TB-stigma reduction in the interventions identified. Results Of 14,259 articles identified, eleven met inclusion criteria, of which three were high quality. TB-stigma reduction interventions consisted mainly of education and psychosocial support targeted predominantly toward three key populations: people with TB, healthcare workers, and the public. No psychosocial interventions for people with TB set TB-stigma reduction as their primary or co-primary aim. Eight studies on healthcare workers and the public reported a decrease in TB-stigma attributed to the interventions. Despite the benefits, the interventions were limited by a dearth of validated stigma measurement tools. Three of eight studies with quantitative stigma measurement questionnaires had not been previously validated among people with TB. No qualitative studies used previously validated methods or tools to qualitatively evaluate stigma. On the basis of these findings, we generated a conceptual framework that mapped the population targeted, interventions delivered, and their potential effects on reducing TB-stigma towards and experienced by people with TB and healthcare workers involved in TB care. Conclusions Interpretation of the limited evidence on interventions to reduce TB-stigma is hampered by the heterogeneity of stigma measurement tools, intervention design, and outcome measures. Our novel conceptual framework will support mapping of the pathways to impacts of TB-stigma reduction interventions. Graphical Abstract

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Interventions pathways to reduce tuberculosis-related stigma: a literature review and conceptual framework

et al. 2022

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“…However, such scales and tools need to be adapted, validated, piloted, and refined before scale-up in a specific community or population to ensure their accuracy, reliability, and robustness. One of the most widely used tools is Van Rie's TB Stigma scale [17,18]. This scale has showed good internal consistency and been validated in various languages and settings including Thailand [17], Portugal [19], Mexico [20], Turkey [21], and Vietnam [22].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

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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.

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“…In this study, we used the Chinese version of the TSS translated by Zhao et al 24 This version was specifically translated and adapted within the cultural context of China, making it more suitable for our research. 21 , 26 It is noteworthy that China, being the most populous developing country globally, adopting the Chinese version of the TSS scale can also serve as a reference for other countries in Asia. 27 As far as we know, the Chinese version of the TSS has not yet been validated in the population of Chinese medical students, nor has it been subjected to CFA.…”

Section: Introductionmentioning

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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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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A systematic review and psychometric appraisal of instruments measuring tuberculosis stigma in Sub-Saharan Africa.

Cited by 4 publications

References 45 publications

Interventions pathways to reduce tuberculosis-related stigma: a literature review and conceptual framework

Interventions pathways to reduce tuberculosis-related stigma: a literature review and conceptual framework

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

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

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