Adaptation and validation of a TB stigma scale for adolescents in Lima, Peru

Abstract

BACKGROUND: TB-related stigma contributes to poor clinical outcomes and reduced wellbeing for affected individuals. Adolescents may be particularly susceptible to TB-related stigma due to their heightened sensitivity to peer acceptance, yet few studies have evaluated TB-related stigma in this group. Without a validated scale, it remains challenging to measure TB-related stigma in adolescents.METHODS: We adapted and validated the Van Rie TB Stigma Scale (VTSS) for adolescents on treatment for rifampicin-susceptible TB in Lima, Peru. The modified stigma scale was administered within a larger survey, which measured other psychosocial factors, including depression, adverse childhood experiences (ACEs), and social support. Data analysis included factor analysis, internal consistency, and convergent validity.RESULTS: From October 2020 to September 2021, 249 adolescents (individuals aged 10–19 years) completed the survey. Preliminary confirmatory factor analysis led to removal of two items. The final 10-item scale demonstrated good internal consistency (Cronbach’s α = 0.82) and adequate model fit (χ2/df = 2.0; root mean square error of approximation: 0.06; comparative fit index: 0.94; Tucker-Lewis Index: 0.92: standardized root mean square residual: 0.05). Stigma was positively correlated with ACEs (γ = 0.13), depression (γ = 0.39), and suicidal ideation (γ = 0.27), and negatively correlated with social support (γ = –0.19).CONCLUSION: This adolescent TB stigma scale may serve as a practical tool to measure TB-related stigma and evaluate the impact of stigma-reduction interventions in adolescents.

Psychosocial needs of adolescents living with TB in Peru and South Africa

“…Adolescents were recruited between 2020 and 2022 at local health centers: in Lima, adolescents with rifampicin-susceptible TB of any anatomic site who were within the first 5 weeks of treatment were eligible for the study; in Cape Town, adolescents were eligible if they had newly diagnosed pulmonary TB with any drug susceptibility pattern and were within 14 days of treatment initiation. Comprehensive psychosocial surveys, which included scales that were previously validated (PHQ-9 for depression, 8 AUDIT for alcohol use, 9 an adapted Van Rie Scale for TB-related stigma 10 ) or newly developed (caregiver support, TB knowledge) were conducted between Weeks 3 and 5 of therapy in Peru and after 8 weeks of therapy in South Africa. The surveys were self-administered in Peru and interviewer-administered in South Africa.…”