Validating a Child Youth Resilience Measurement (CYRM-28) for Adolescents Living With HIV (ALHIV) in Urban Malawi

Abstract

Resilience as a strength-based notion, measured across cultures, age groups, and sub-populations, contributes to understanding health and well-being. Yet, there is limited evidence of how the construct performs in resource-limited countries. We explored the psychometric properties of the CYRM-28 and validated the scale with adolescents living with HIV (ALHIV), a key sub-population. The participants included members of an advisory panel and 406 ALHIV, aged 15–19 years, attending an antiretroviral therapy and teen-club clinic in Blantyre, Malawi. This study employed a mixed-method study using an exploratory sequential design. The advisory panel discussed the CYRM-28, and select ALHIV then translated it into Chichewa, pilot-tested it using cognitive interviews, and back-translated it for clarity and appropriateness. The resultant CYRM-28 was tested using a survey with purposefully selected ALHIV. The overall median score was 123, with an interquartile range of 110–130. Minimum and maximum scores were 53 and 140. Cronbach’s alpha of 0.863 and Kaiser–Meyer–Olkin measure (0.866) confirmed internal consistency and the sample size adequacy, respectively. Bartlett’s tests of sphericity ( p < 0.001) informed factor analysis. Exploratory factor analysis determined possible dimensions of resilience and the sub-scales. The confirmatory factor analysis (CFA) confirmed the construct validity and supported a three-factor model consistent with the conceptualization of resilience as a multi-dimensional construct. Structural equation modeling was applied to perform CFA to measure model of resilience. Multiple fit indices showed a good fit for the model. The CYRM-28 has good internal consistency, test and re-test reliability, and moderate convergent validity which render it useful as a self-report resilience measure to inform and evaluate interventions for the health and well-being of adolescents in Malawi.

Adolescent Life Satisfaction Explained by Social Support, Emotion Regulation, and Resilience

“…Despite this discrepancy, it is commonly defined as the ability to overcome adversity, and to recover and gain strength from highly stressful events ( Campbell and Stein, 2007 ; Southwick et al, 2014 ; Masten, 2018 ). Although, there is a continuous debate on their feasibility, reliability, and validity in different settings ( Kaunda-Khangamwa et al, 2020 ), the most common way to assess resilience is through self-report measures such as the Connor-Davidson Resilience Scale ( Song et al, 2020 ). Resilience is widely believed to have a positive effect on life satisfaction ( Arslan, 2019 ; Ramos-Díaz et al, 2019 ; Yang et al, 2020 ), which is why it is considered an important source of subjective well-being ( Yildirim and Belen, 2019 ).…”

Measuring mental wellness among adolescents living with a physical chronic condition: a systematic review of the mental health and mental well-being instruments

“…Most studies (n = 18) were published after 2010, with only 4 studies published before 2010. Adolescents with Type 1 Diabetes (n = 7) [ 33 , 35 – 37 , 42 , 43 , 49 ] and HIV (n = 4) [ 30 , 31 , 38 , 41 ] constituted half of the total number of studies. Other conditions were Asthma [ 33 , 49 ] Cerebral Palsy [ 34 , 46 ], Cystic Fibrosis [ 35 , 40 , 51 ] and Chronic Pain [ 45 , 50 ] with two studies each: with single studies on Congenital Heart Disease [ 32 ], Sickle cell disease [ 33 ], Cancer [ 35 ], Adolescent Idiopathic Scoliosis [ 39 ], Juvenile Idiopathic Arthritis [ 44 ], Strabismus [ 47 ] and Short Stature [ 48 ], and Chronic Disease (unspecified by authors) [ 49 ].…”

“…Additionally, 3 of the studies [ 33 , 35 , 49 ] used samples of adolescents living with a various chronic illness, rather than looking at adolescents with a specific chronic illness, thereby suggesting that the instruments used in these studies were not symptom/disease specific. All four studies that were conducted in Africa involved ALHIV [ 30 , 31 , 38 , 41 ] while studies involving adolescents living with type 1 diabetes are mostly from European and American countries [ 33 , 36 , 37 , 42 , 43 , 49 ]. The KIDSCREEN [n = 5] and Strengths and Difficulties Questionnaire [n = 5] were the most frequently used measuring instrument.…”

Measuring Mental Wellness Among Adolescents Living With A Physical Chronic Condition: A Systematic Review of the Mental Health and Mental Wellbeing Instruments

“…Chronic Disease (unspeci ed by authors) [35]. Additionally, 3 of the studies [34,35,46] used samples of adolescents living with a various chronic illness, rather than looking at adolescents with a speci c chronic illness, thereby suggesting that the instruments used in these studies were not symptom/disease speci c. All four studies that were conducted in Africa involved ALHIV [47][48][49][50] while studies involving adolescents living with type 1 diabetes are mostly from European and American countries [34,35,[51][52][53][54]. The KIDSCREEN [n=5] and Strengths and Di culties Questionnaire [n=5] were the most frequently used measuring instruments…”

“…Five of the mental wellbeing instruments are aimed at measuring various constructs related to mental wellbeing. These are WHO-5 Wellbeing Index [51,52]; Child Youth Resilience Measurement (CYRM-28) [50]; Hunter Opinions and Personal Expectations scale (HOPES) [39]; Tennessee Self-Concept scale [48]; and the FACIT-Sp-12 Spiritual Wellbeing scale [46]. All these instruments were used in one study each.…”