Matshabane Olivia P, Appelbaum Paul S, Faure Marlyn C, Marshall Patricia A, Stein Dan J, de Vries Jantina, Campbell Megan M
Department of Medicine, University of Cape Town, Cape Town, South Africa.
Social and Behavioral Research Branch, National Institutes of Health, Bethesda, MD, USA.
Transcult Psychiatry. 2025 Feb;62(1):33-44. doi: 10.1177/13634615231168461. Epub 2023 Jun 18.
Internalised stigma is highly prevalent among people with mental illness. This is concerning because internalised stigma is often associated with negative consequences affecting individuals' personal, familial, social, and overall wellbeing, employment opportunities and recovery. Currently, there is no psychometrically validated instrument to measure internalised stigma among Xhosa people in their home language. Our study aimed to translate the Internalised Stigma of Mental Illness (ISMI) scale into isiXhosa. Following WHO guidelines, the ISMI scale was translated using a five-stage translation design which included (i) forward-translation, (ii) back-translation, (iii) committee approach, (iv) quantitative piloting, and (v) qualitative piloting using cognitive interviews. The ISMI isiXhosa version (ISMI-X) underwent psychometric testing to establish utility, within-scale validity, convergent, divergent, and content validity (assessed using frequency of endorsements and cognitive interviewing) with = 65 Xhosa people with schizophrenia. The resultant ISMI-X scale demonstrated good psychometric utility, internal consistency for the overall scale (α = .90) and most subscales (α > .70, except the Stigma Resistance subscale where α = .57), convergent validity between the ISMI Discrimination Experiences subscale and the Discrimination and Stigma (DISC) scale's Treated Unfairly subscale (isiXhosa version) ( = .34, = .03) and divergent validity between the ISMI Stigma Resistance and DISC Treated Unfairly subscales ( = .13, = .49). But more importantly the study provides valuable insights into strengths and limitations of the present translation design. Specifically, validation methods such as assessing frequency of endorsements of scale items and using cognitive interviewing to establish conceptual clarity and relevance of items may be useful in small piloting sample sizes.
内化耻辱感在精神疾病患者中极为普遍。这令人担忧，因为内化耻辱感通常与影响个人的个人、家庭、社会和整体幸福感、就业机会及康复的负面后果相关。目前，尚无经过心理测量学验证的工具来用科萨语测量科萨族人群中的内化耻辱感。我们的研究旨在将精神疾病内化耻辱感（ISMI）量表翻译成科萨语。遵循世界卫生组织的指南，ISMI量表采用五阶段翻译设计进行翻译，其中包括：（i）正向翻译，（ii）回译，（iii）委员会方法，（iv）定量预试验，以及（v）使用认知访谈进行定性预试验。ISMI科萨语版本（ISMI-X）接受了心理测量测试，以确立其效用、量表内效度、聚合效度、区分效度和内容效度（使用认可频率和认知访谈进行评估），样本为65名患有精神分裂症的科萨族患者。最终的ISMI-X量表显示出良好的心理测量效用，整体量表（α = 0.90）及大多数子量表（α > 0.70，除耻辱感抵抗子量表α = 0.57外）具有内部一致性，ISMI歧视经历子量表与歧视和耻辱感（DISC）量表的受到不公平对待子量表（科萨语版本）之间具有聚合效度（r = 0.34，p = 0.03），ISMI耻辱感抵抗子量表与DISC受到不公平对待子量表之间具有区分效度（r = 0.13，p = 0.49）。但更重要的是，该研究为当前翻译设计的优势和局限性提供了有价值的见解。具体而言，诸如评估量表项目认可频率以及使用认知访谈来确立项目的概念清晰度和相关性等验证方法，在小样本预试验中可能会很有用。
