Thurber Katherine A, Walker Jennie, Batterham Philip J, Gee Gilbert C, Chapman Jan, Priest Naomi, Cohen Rubijayne, Jones Roxanne, Richardson Alice, Calear Alison L, Williams David R, Lovett Raymond
National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, 54 Mills Road, Acton, ACT, 2601, Australia.
Centre for Mental Health Research, Research School of Population Health, Australian National University, 63 Eggleston Road, Acton, ACT, 2601, Australia.
Int J Equity Health. 2021 Jan 6;20(1):14. doi: 10.1186/s12939-020-01351-9.
It is well established that racism is a fundamental contributor to poor health and inequities. There is consistent evidence of high exposure to discrimination among Aboriginal and Torres Strait Islander (Indigenous Australian) peoples, but impacts have not been fully quantified, in part due to limited measurement tools. We aim to validate instruments developed to measure interpersonal discrimination.
Instruments were discussed at five focus groups and with experts, and field tested in developing Mayi Kuwayu: The National Study of Aboriginal and Torres Strait Islander Wellbeing. Data from 7501 baseline survey participants were analysed. Acceptability was assessed according to extent of missingness, construct validity using exploratory and confirmatory factor analysis, and reliability using Cronbach's alpha. Associations between each instrument and outcomes conceptually understood to be closely (community-level racism) or less closely (family wellbeing) related were quantified to test convergent and discriminant validity.
An 8-item instrument captures experiences of discrimination in everyday life and a 4-item instrument experiences in healthcare, each followed by a global attribution item. Item missingness was 2.2-3.7%. Half (55.4%) of participants reported experiencing any everyday discrimination, with 65.7% attributing the discrimination to Indigeneity; healthcare discrimination figures were 34.1% and 51.1%. Items were consistent with two distinct instruments, differentiating respondents with varying experiences of discrimination. Scales demonstrated very good reliability and convergent and divergent validity.
These brief instruments demonstrate face validity and robust psychometric properties in measuring Aboriginal and Torres Strait Islander adults' experiences of interpersonal discrimination in everyday life and in healthcare. They can be used to quantify population-level experiences of discrimination, and associated wellbeing consequences, and monitor change.
种族主义是导致健康状况不佳和不平等的根本因素，这一点已得到充分证实。有持续证据表明，澳大利亚原住民和托雷斯海峡岛民遭受歧视的情况严重，但由于测量工具有限，其影响尚未得到充分量化。我们旨在验证为测量人际歧视而开发的工具。
在五个焦点小组中与专家讨论了这些工具，并在开展“马伊·库瓦尤：澳大利亚原住民和托雷斯海峡岛民福祉全国研究”时进行了实地测试。对7501名基线调查参与者的数据进行了分析。根据缺失程度评估可接受性，使用探索性和验证性因素分析评估结构效度，使用克朗巴赫α系数评估信度。对每个工具与概念上被认为密切相关（社区层面的种族主义）或不太密切相关（家庭福祉）的结果之间的关联进行量化，以测试聚合效度和区分效度。
一个8项工具捕捉日常生活中的歧视经历，一个4项工具捕捉医疗保健中的经历，每个工具后面都有一个总体归因项目。项目缺失率为2.2%-3.7%。一半（55.4%）的参与者报告经历过任何日常歧视，其中65.7%将歧视归因于原住民身份；医疗保健歧视的数据分别为34.1%和51.1%。这些项目与两个不同的工具一致，区分了具有不同歧视经历的受访者。量表显示出非常好的信度、聚合效度和区分效度。
这些简短的工具在测量澳大利亚原住民和托雷斯海峡岛民成年人在日常生活和医疗保健中人际歧视经历方面具有表面效度和强大的心理测量特性。它们可用于量化人群层面的歧视经历及其相关的福祉后果，并监测变化。
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