Cultural adaptation of the Tuberculosis-related stigma scale to Brazil

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

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.

Assessment of validity and reliability of the tuberculosis related stigma scale in Colombian patients

OBJECTIVE

To know the dimensionality and internal consistency of the Tuberculosis-Related Stigma Scale in patients living with tuberculosis in Santa Marta, Colombia.

METHOD

One hundred and twenty-two patients between the ages of 18 and 75 participated (M = 40.3, SD = 14.9), 63.9% were men, 44.3% were single, 69.7% had low income, 80.3% had pulmonary tuberculosis, and 13.1% had co-infection with HIV. The Tuberculosis-Related Stigma Scale was applied; it comprises perceived and internalised stigma subscales. The internal structure was explored by confirmatory factor analysis (EFA). Internal consistency was measured with Cronbach's alpha and McDonald's omega. Besides, the differential functioning of the scales according to gender was explored with Kendall's tau-b coefficient.

RESULTS

CFA did not show excellent goodness-of-fit indicators for the perceived stigma scale (Satorra-Bentler's chi-square of 184.48, degree of freedom of 44, p = .001, RMSEA of 0.16, 95%CI 0.14-0.19, CFI of 0.77, TLI of 0.72, and SRMR of 0.08) and internalised (Satorra-Bentler's chi-square of 189.14, degree of freedom of 54, p = .001; RMSEA of 0.14, 95%CI 0.12-0.17, CFI of 0.82, TLI of 0.78, and SRMR of 0.07). The alpha and omega coefficients were 0.89 and 0.91 for both scales. Non-gender differential functioning was observed; Kendall's tau-b was between 0.00 and 0.15.

CONCLUSIONS

The Tuberculosis-Related Stigma Scale has an excellent internal consistency but poor goodness-of-fit indicators of unidimensionality. Evaluating the scale's psychometric performance is recommenced in future research.

Adaptation and validation of the Van Rie tuberculosis stigma scale in Vietnam

OBJECTIVES

Tuberculosis (TB) stigma contributes to diagnostic delay, disease concealment, and reduced wellbeing for affected individuals. Despite the availability of several TB stigma scales, most high-TB burden countries do not have a culturally validated version available. This study evaluated the Van Rie TB stigma scale (VTSS) among people with TB in Vietnam.

METHODS

This study consisted of two phases. In phase 1, the VTSS was culturally and linguistically adapted to the Vietnamese context. In phase 2, people with TB were invited to complete a survey containing the VTSS, a depression scale, and a quality of life scale. The data analysis included confirmatory factor analysis (CFA), exploratory factor analysis (EFA), construct validity, and floor or ceiling effects.

RESULTS

In phase 1, items were reworded from the third person to the first person. The TB/HIV co-infection items (items 7 and 11) were the least relevant for people with TB (62% and 73% relevance, respectively). In phase 2, the CFA demonstrated adequate goodness-of-fit indices (GFI = 0.88, CFI = 0.96, RMSEA = 0.058); however several of the item factor loadings were low. The EFA demonstrated good internal consistency (α = 0.85) and revealed one dominant factor. Construct validity was low.

CONCLUSIONS

The VTSS demonstrated good psychometric properties in Vietnam. Depending on the purpose of the scale, the HIV co-infection items and item 10 could be considered for removal.

A Clinical-Epidemiological and Geospatial Study of Tuberculosis in a Neglected Area in the Amazonian Region Highlights the Urgent Need for Control Measures

Tuberculosis (TB) is an infectious communicable disease, which despite global efforts, still needs special attention in regions with difficult access. This study aims to describe the spatial and epidemiological trends of TB incidences from 2013 to 2018 in Marajó Island, the Amazonian region, Pará, Brazil. We have obtained secondary data from the Brazilian TB databases and performed geospatial and statistical analyses on the data for new TB cases, relapses, and re-admissions. From 2013 to 2018, 749 new cases were reported, in which the diagnostics (culture) was not performed for 652 (87.2%) patient samples, the drug resistance test (DST) was performed for nine (1.2%) samples, and one (0.13%) was multidrug-resistant TB (MDR-TB). The rapid molecular testing (RMT) was performed on 40 (5.3%) patient samples, with results indicating that eight (20%) were susceptible to rifampicin and two (5%) were rifampicin resistant. Overall, the cure rate was 449 (66.7%), while relapses and re-admissions were 41 and 44, respectively. On the geospatial distribution, the municipality of Soure stands out with a high number of incidences, relapses, and re-admissions. Spatially, the eight MDR cases were randomly distributed. Our data highlight the urgent need for TB control measures in this region, by introducing the Xpert-Ultra^® MTB/RIF (Cepheid, Sunnyvale, CA, USA) and Ogawa-Kudoh.

DISABKIDS® in Brazil: advances and future perspectives for the production of scientific knowledge

Objective:

to map the Brazilian scientific production related to the stages of the methodological process for the use of DISABKIDS^® instruments and/or forms adapted to Brazil.

Method:

scoping review, with searches conducted on10 electronic databases, plus Google Scholar and contacts with researchers, without restriction of period or language.

Results:

the mapping identified 90 scientific studies involving 46 instruments. Of these, 11 (23.9%) included the elaboration and/or cultural adaptation of the DISABKIDS^® instruments to measure the Quality of Life of children or adolescents with chronic conditions and 35 (76.1%) used the Generic Measures and/or Specific Modules for the semantic validation of other instruments.

Conclusion:

this scoping review allowed a comprehensive evaluation of the use of the DISABKIDS^® instrument and forms, in relation to the validation of the instrument adapted to Brazil, presenting a positive advance in the scenario with the development of academic/scientific projects in the country, incorporating the method recommended by the literature for the elaboration, cultural adaptation and validation of instruments and for the systematized and standardized recording of the perception and understanding of the target population about the measure of interest, using DISABKIDS^® forms adapted for this purpose.

Validity and reliability of the tuberculosis-related stigma scale version for Brazilian Portuguese

Background

Stigma associated with tuberculosis (TB) has been an object of interest in several regions of the world. The behaviour presented by patients as a result of social discrimination has contributed to delays in diagnosis and the abandonment of treatment, leading to an increase in the cases of TB and drug resistance. The identification of populations affected by stigma and its measurement can be assessed with the use of valid and reliable instruments developed or adapted to the target culture. This aim of this study was to analyse the initial psychometric properties of the Tuberculosis-Related Stigma scale in Brazil, for TB patients.

Methods

The Tuberculosis-Related Stigma scale is a specific scale for measuring stigma associated with TB, originally validated in Thailand. It presents two dimensions to be assessed, namely Community perspectives toward tuberculosis and Patient perspectives toward tuberculosis. The first has 11 items regarding the behaviour of the community in relation to TB, and the second is made up of 12 items related to feelings such as fear, guilt and sorrow in coping with the disease. A pilot test was conducted with 83 TB patients, in order to obtain the initial psychometric properties of the scale in the Brazilian Portuguese version, enabling simulation of the field study.

Results

As regards its psychometric properties, the scale presented acceptable internal consistency for its dimensions, with values ≥0.70, the absence of floor and ceiling effects, which is favourable for the property of scale responsiveness, satisfactory converging validity for both dimensions, with values over 0.30 for initial studies, and diverging validity, with adjustment values different from 100%.

Conclusion

The results found show that the Tuberculosis-Related Stigma scale can be a valid and reliable instrument for the Brazilian context.