肯尼亚与避孕和堕胎相关的污名：量表的制定与验证。
Stigma related to contraceptive use and abortion in Kenya: scale development and validation.
机构信息
Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.
College of Health Sciences, School of Nursing Sciences, University of Nairobi, Nairobi, Kenya.
出版信息
Reprod Health. 2019 Sep 6;16(1):136. doi: 10.1186/s12978-019-0799-1.
BACKGROUND
Stigma related to abortion and contraceptive use is a serious public health threat for young people, and validated scales to measure this stigma are scarce. The purposes of the study were to validate a newly constructed scale to measure the stigma of contraceptive use and to adapt a scale to measure the stigma of abortion.
METHODS
A study nested in a cluster-randomised trial. In 2017, data was collected from 633 secondary school youths, in a semi-urban setting in western Kenya. A qualitative pre-phase (face-validity) were initially utilised to draft and validate a seven-item scale to capture contraceptive use stigma (CUS) and to adapt the Stigmatizing Attitudes, Beliefs and Actions (SABA) scale (18 items), which captures aspects of abortion stigma. Statistical tests used included test-retest reliability analysis, Pearson's correlation coefficients, Wilcoxon signed-rank test, Factor Analysis, Principal Component Analysis, interclass correlation and Cronbach's alpha.
RESULTS
For the CUS scale, paired t-test and Wilcoxon signed-rank test showed no significant score changed between time points (p = 0.64; 0.67). CUS had similar patterns between time points, with two relevant components: promiscuity and lack of autonomy. Cronbach's alpha indicated acceptable internal consistency between time points (0.71;0.7). The confirmatory factor loadings for each item in the modified three subscales of SABA had a similar pattern to the original SABA scale, in particularly regarding negative stereotyping and, excluding and discriminating factors. The Cronbach's alpha was adequate, although lower for the modified SABA (0.74) as compared to the original SABA (0.9). The SABA scale was renamed into Adolescents Stigmatizing Attitudes, Beliefs and Action (ASABA) scale.
CONCLUSIONS
The CUS scale is considered valid and reliable for measuring contraceptive use stigma, and the ASABA scale was rated as reliable for capturing abortion stigma based on negative stereotyping and excluding and discriminating factors. The CUS, up to date the first ever proposed CUS scale, and the ASABA scale can be used to measure effects of stigma reduction interventions with the aim of preventing unintended pregnancies, motherhood and unsafe abortion among adolescents in Kenya and similar low-resource settings.
背景
与堕胎和避孕使用相关的耻辱感是年轻人面临的严重公共卫生威胁，而验证过的衡量这种耻辱感的量表却很少。本研究的目的是验证一个新构建的用于衡量避孕使用耻辱感的量表，并改编一个用于衡量堕胎耻辱感的量表。
方法
这项嵌套在一项整群随机试验中的研究于 2017 年在肯尼亚西部的一个半城市环境中收集了 633 名中学生的数据。最初利用定性预阶段（表面有效性）起草和验证了一个包含七个项目的量表来衡量避孕使用耻辱感（CUS），并改编了包含堕胎耻辱感方面的 18 个项目的 Stigmatizing Attitudes, Beliefs and Actions（SABA）量表。使用的统计检验包括重测信度分析、皮尔逊相关系数、Wilcoxon 符号秩检验、因子分析、主成分分析、组内相关和克朗巴赫α系数。
结果
CUS 量表的配对 t 检验和 Wilcoxon 符号秩检验显示两次时间点之间的分数没有显著变化（p=0.64；0.67）。CUS 在时间点之间具有相似的模式，有两个相关的组成部分：淫乱和缺乏自主性。两次时间点的克朗巴赫α系数表明内部一致性可接受（0.71；0.7）。经过修改的 SABA 的三个子量表中的每个项目的确认性因子负荷与原始 SABA 量表具有相似的模式，特别是在负面刻板印象、排除和歧视因素方面。克朗巴赫α系数在经过修改的 SABA（0.74）中虽然比原始 SABA（0.9）低，但仍足够高。SABA 量表被重新命名为青少年歧视态度、信仰和行为（ASABA）量表。
结论
CUS 量表被认为是衡量避孕使用耻辱感的有效和可靠的工具，而 ASABA 量表基于负面刻板印象、排除和歧视因素被认为是衡量堕胎耻辱感的可靠工具。CUS 量表（迄今为止第一个提出的 CUS 量表）和 ASABA 量表可以用于衡量减少耻辱感干预措施的效果，以防止肯尼亚和类似资源匮乏环境中的青少年意外怀孕、生育和不安全堕胎。
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