Department of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia.
J Multidiscip Healthc. 2012;5:97-113. doi: 10.2147/JMDH.S29789. Epub 2012 Mar 28.
Stigma and discrimination (SAD) against people living with human immunodeficiency virus (HIV) are barriers affecting effective responses to HIV. Understanding the causes and extent of SAD requires the use of a psychometrically reliable and valid scale. The objective of this study was to validate an HIV-related stigma scale among health care providers in a resource-poor setting.
A cross-sectional validation study was conducted in 18 health care institutions in southwest Ethiopia, from March 14, 2011 to April 14, 2011. A total of 255 health care providers responded to questionnaires asking about sociodemographic characteristics, HIV knowledge, perceived institutional support (PIS) and HIV-related SAD. Exploratory factor analysis (EFA) with principal component extraction and varimax with Kaiser normalization rotation were employed to develop scales for SAD. Eigenvalues greater than 1 were used as a criterion of extraction. Items with item-factor loadings less than 0.4 and items loading onto more than one factor were dropped. The convergent validity of the scales was tested by assessing the association with HIV knowledge, PIS, training on topics related to SAD, educational status, HIV case load, presence of an antiretroviral therapy (ART) service in the health care facility, and perceived religiosity.
Seven factors emerged from the four dimensions of SAD during the EFA. The factor loadings of the items ranged from 0.58 to 0.93. Cronbach's alphas of the scales ranged from 0.80 to 0.95. An in-depth knowledge of HIV, perceptions of institutional support, attendance of training on topics related to SAD, degree or higher education levels, high HIV case loads, the availability of ART in the health care facility and claiming oneself as nonreligious were all negatively associated with SAD as measured by the seven newly identified latent factors.
The findings in this study demonstrate that the HIV-related stigma scale is valid and reliable when used in resource-poor settings. Considering the local situation, health care managers and researchers may use this scale to measure and characterize HIV-related SAD among health care providers. Tailoring for local regions may require further development of the tool.
针对艾滋病毒感染者的污名化和歧视（SAD）是影响艾滋病毒应对工作有效性的障碍。要了解 SAD 的原因和程度，就需要使用具有心理测量学可靠性和有效性的量表。本研究的目的是在资源匮乏的环境中对卫生保健提供者的艾滋病毒相关污名量表进行验证。
本横断面验证研究于 2011 年 3 月 14 日至 4 月 14 日在埃塞俄比亚西南部的 18 家卫生保健机构进行。共有 255 名卫生保健提供者对调查问卷做出了回应，问卷内容涉及社会人口学特征、艾滋病毒知识、感知机构支持（PIS）和艾滋病毒相关的 SAD。采用主成分提取的探索性因子分析（EFA）和具有 Kaiser 标准化旋转的最大方差法来开发 SAD 量表。特征值大于 1 被用作提取标准。将项目因子负荷小于 0.4 和项目加载到多个因子的项目删除。通过评估与艾滋病毒知识、PIS、与 SAD 相关主题的培训、教育程度、艾滋病毒病例数、卫生保健机构中是否存在抗逆转录病毒治疗（ART）服务以及感知宗教信仰的关联来检验量表的聚合效度。
在 EFA 期间，从 SAD 的四个维度中出现了七个因素。项目的因子负荷从 0.58 到 0.93 不等。量表的克朗巴赫α值从 0.80 到 0.95 不等。对艾滋病毒的深入了解、对机构支持的看法、参加与 SAD 相关主题的培训、学位或更高学历水平、大量的艾滋病毒病例、卫生保健机构中是否提供 ART 以及自认为非宗教人士，这些因素都与七个新确定的潜在因素所衡量的 SAD 呈负相关。
本研究的结果表明，在资源匮乏的环境中，艾滋病毒相关污名量表是有效和可靠的。考虑到当地情况，卫生保健管理人员和研究人员可以使用该量表来衡量和描述卫生保健提供者的艾滋病毒相关 SAD。针对当地地区，可能需要进一步开发该工具。
