1
|
Fuady A, Arifin B, Yunita F, Rauf S, Fitriangga A, Sugiharto A, Yani FF, Nasution HS, Putra IWGAE, Mansyur M, Wingfield T. Stigma, depression, quality of life, and the need for psychosocial support among people with tuberculosis in Indonesia: A multi-site cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002489. [PMID: 38190416 PMCID: PMC10773931 DOI: 10.1371/journal.pgph.0002489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/21/2023] [Indexed: 01/10/2024]
Abstract
Stigma towards people with tuberculosis (TB-Stigma) is associated with other psychosocial consequences of TB including mental illness and reduced quality of life (QoL). We evaluated TB-Stigma, depression, QoL, and the need for psychosocial support among adults with TB in Indonesia, a high TB burden country. In this primary health facility-based survey in seven provinces of Indonesia, from February to November 2022, we interviewed adults receiving (a) intensive phase treatment for drug-susceptible (DS) TB at public facilities, (b) treatment at private facilities, (c) those lost to follow up (LTFU) to treatment, and (d) those receiving TB retreatment. We used our previously validated Indonesian TB-Stigma Scale, Patient Health Questionnaire-9, and EQ-5D-5L to measure TB-Stigma, depression, and QoL. Additional questions assessed what psychosocial support was received or needed by participants. We recruited and interviewed 612 people, of whom 60.6% (96%CI 59.6-64.5%) experienced moderate TB-Stigma. The average TB-Stigma scores were 19.0 (SD 6.9; min-max 0-50; Form A-Patient Perspective) and 23.4 (SD 8.4, min-max 0-50; Form B-Community Perspective). The scores were higher among people receiving treatment at private facilities (adjusted B [aB] 2.48; 0.94-4.03), those LTFU (aB 2.86; 0.85-4.87), males (aB 1.73; 0.59-2.87), those losing or changing job due to TB (aB 2.09; 0.31-3.88) and those living in a rural area (aB 1.41; 0.19-2.63). Depression was identified in 41.5% (95% CI 37.7-45.3%) of participants. Experiencing TB-Stigma was associated with moderately severe to severe depression (adjusted odds ratio [aOR] 1.23; 1.15-1.32) and both stigma and depression were associated with lower QoL (aB -0.013; [-0.016]-[-0.010]). Informational (20.8%), emotional (25.9%) and instrumental (10.6%) support received from peers or peer-groups was limited, and unmet need for such support was high. There is a sizeable and intersecting burden of TB-Stigma and depression among adults with TB in Indonesia, which is associated with lower QoL. Participants reported a substantial unmet need for psychosocial support including peer-led mutual support groups. A community-based peer-led psychosocial support intervention is critical to defray the psychosocial impact of TB in Indonesia.
Collapse
Affiliation(s)
- Ahmad Fuady
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Primary Health Care Research and Innovation Center, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Bustanul Arifin
- Faculty of Pharmacy, Universitas Hasanuddin, Makassar, Sulawesi Selatan, Indonesia
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - Ferdiana Yunita
- Department of Community Medicine, Faculty of Medicine, Universitas Gunadarma, Depok, Indonesia
| | - Saidah Rauf
- Department of Nursing, Politeknik Kesehatan Kemenkes Ambon, Maluku, Indonesia
| | - Agus Fitriangga
- Department of Community Medicine, Faculty of Medicine, Universitas Tanjungpura, Pontianak, West Kalimantan, Indonesia
| | - Agus Sugiharto
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Finny Fitry Yani
- Department of Child Health, Faculty of Medicine, Universitas Andalas, Padang, West Sumatera, Indonesia
- Department of Paediatric, Dr. M. Djamil General Hospital, Padang, West Sumatera, Indonesia
| | - Helmi Suryani Nasution
- Department of Public Health, Faculty of Medicine and Health Sciences, Universitas Jambi, Jambi, Indonesia
| | - I. Wayan Gede Artawan Eka Putra
- Department of Public Health and Prevention Medicine, Faculty of Medicine, Universitas Udayana, Kota Denpasar, Bali, Indonesia
| | - Muchtaruddin Mansyur
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Tom Wingfield
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden
- Tropical and Infectious Disease Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, Liverpool, United Kingdom
| |
Collapse
|
2
|
Fuady A, Arifin B, Yunita F, Rauf S, Fitriangga A, Sugiharto A, Yani FF, Nasution HS, Putra IWGAE, Mansyur M, Wingfield T. Stigma towards people with tuberculosis: a cross-cultural adaptation and validation of a scale in Indonesia. BMC Psychol 2023; 11:112. [PMID: 37055814 PMCID: PMC10100612 DOI: 10.1186/s40359-023-01161-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 04/05/2023] [Indexed: 04/15/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Ahmad Fuady
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Pegangsaan Timur No 16, Jakarta, 10310 Indonesia
- Primary Health Care Research and Innovation Center, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430 Indonesia
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, 3015CN Rotterdam, The Netherlands
| | - Bustanul Arifin
- Faculty of Pharmacy, Universitas Hasanuddin, Makassar, Sulawesi Selatan 90245 Indonesia
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Centre Groningen (UMCG), Ant. Deusinglaan 1, 9713 AV Groningen, The Netherlands
- Department of Health Behaviour, Environment, and Social Medicine, and Centre of Health Behaviour and Promotion, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ferdiana Yunita
- Department of Community Medicine, Faculty of Medicine, Universitas Gunadarma, Depok, 16451 Indonesia
| | - Saidah Rauf
- Politeknik Kesehatan Kemenkes Maluku, Maluku, 97711 Indonesia
| | - Agus Fitriangga
- Department of Community Medicine, Faculty of Medicine, Universitas Tanjungpura, Pontianak, 78124 Indonesia
| | - Agus Sugiharto
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Pegangsaan Timur No 16, Jakarta, 10310 Indonesia
| | - Finny Fitry Yani
- Department of Child Health, Faculty of Medicine, Universitas Andalas, Padang, 25129 Indonesia
- Department of Paediatric, Dr. M. Djamil General Hospital, Padang, 25128 West Sumatera Indonesia
| | | | - IWayan Gede Artawan Eka Putra
- Department of Public Health and Prevention Medicine, Faculty of Medicine, Universitas Udayana, Bali, 80232 Indonesia
| | - Muchtaruddin Mansyur
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Pegangsaan Timur No 16, Jakarta, 10310 Indonesia
- South East Asian Ministers of Education Organization Regional Center for Food and Nutrition, Jakarta, 13120 Indonesia
| | - Tom Wingfield
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, L3 5QA UK
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institute, 171 76 Stockholm, Sweden
- Tropical and Infectious Disease Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, L7 8XP UK
| |
Collapse
|