Development and Validation of a Scale to Measure Adolescent Sexual and Reproductive Health Stigma: Results From Young Women in Ghana

Abstract

Young women’s experiences with sexual and reproductive health (SRH) stigma may contribute to unintended pregnancy. Thus, stigma interventions and rigorous measures to assess their impact are needed. Based on formative work, we generated a pool of 51 items on perceived stigma around different dimensions of adolescent SRH and family planning (sex, contraception, pregnancy, child-bearing, abortion). We tested items in a survey study of 1,080 women ages 15 to 24 recruited from schools, health facilities, and universities in Ghana. Confirmatory factor analysis (CFA) identified the most conceptually and statistically relevant scale, and multivariable regression established construct validity via associations between stigma and contraceptive use. CFA provided strong support for our hypothesized Adolescent SRH Stigma Scale (chi-square p value < 0.001; root mean square error of approximation [RMSEA] = 0.07; standardized root mean square residual [SRMR] = 0.06). The final 20-item scale included three subscales: internalized stigma (six items), enacted stigma (seven items), and stigmatizing lay attitudes (seven items). The scale demonstrated good internal consistency (α = 0.74) and strong subscale correlations (α = 0.82 to 0.93). Higher SRH stigma scores were inversely associated with ever having used modern contraception (adjusted odds ratio [AOR] = 0.96, confidence interval [CI] = 0.94 to 0.99, p value = 0.006). A valid, reliable instrument for assessing SRH stigma and its impact on family planning, the Adolescent SRH Stigma Scale can inform and evaluate interventions to reduce/manage stigma and foster resilience among young women in Africa and beyond.

Sexually transmitted infection testing awareness, uptake and diagnosis among urban refugee and displaced youth living in informal settlements in Kampala, Uganda: a cross-sectional study

“…Young women who reported greater adolescent SRH-related stigma were less likely to both know about STI testing services and to have been tested for STI. This finding builds on Hall’s19 work that demonstrated adolescent SRH-related stigma was associated with reduced contraceptive use among young women in Ghana, to suggest the importance of recognising adolescent SRH-related stigma as a barrier to STI testing and awareness. Stigma associated with premarital sex and pregnancy may be reproduced within social contexts and affect young women’s access and use of SRH services 25.…”

“…These multilevel factors can be integrated into STI testing interventions. For instance, health facilities can implement training and policies to reduce adolescent SRH-related stigma19 to improve service quality for refugee and displaced youth 5. Community-level interventions12 such as social marketing campaigns and social media influencers can address HIV-related and adolescent SRH-related stigma in Kampala’s informal settlements.…”

“…We assessed adolescent SRH-related stigma19 using two subscales validated with a sample of urban refugee youth in Uganda: sexual activity and pregnancy stigma (eg, People behave differently toward a young person whom they know has had sex ) (Cronbach’s α: full sample=0.82, women=0.84, men=0.74); and modern family and abortion stigma (eg, Modern family planning is not acceptable for unmarried women ) (Cronbach’s α: full sample=0.68, women=0.73, men=0.51) 20. Response options used a three-point Likert scale (disagree, neutral, agree).…”

Analysis of characteristics of vulvo-vaginal infections in 14- to 18-year-old girls in late puberty

“…Vulvo-vaginal infection is a common gynecological disease, with various infection types and conditions for people in different regions and ages. 19,20 In our study, female patients in late puberty were more susceptible to BV and VVC infections than TV infection. TV is a vaginitis caused by indirect or direct contact of exogenous TV.…”

Exploring associations between adolescent sexual and reproductive health stigma and HIV testing awareness and uptake among urban refugee and displaced youth in Kampala, Uganda

“…28 We used the 19-item Adolescent SRH Stigma Scale focused on adolescent engagement in sex, pregnancy, childbearing, abortion, STI, and family planning (Cronbach α = 0.74). 25 This scale had three subscales: internalised stigma; enacted stigma; and stigmatising lay attitudes. Response options were on a three-point Likert scale (disagree, neutral, agree).…”