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测量工具评估针对性少数和性别少数群体的多方面污名:心理测量特性的系统综述。

Measurement Instruments Assessing Multi-Faceted Stigma Regarding Sexual and Gender Minorities: A Systematic Review of Psychometric Properties.

机构信息

Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA.

College of Arts and Sciences, University of South Carolina, Columbia, USA.

出版信息

AIDS Behav. 2024 Jun;28(6):2054-2077. doi: 10.1007/s10461-024-04305-2. Epub 2024 Mar 5.

Abstract

Stigma against sexual and gender minorities (SGM) populations has serious negative health effects for SGM populations. Despite the growing need for accurate stigma measurement in SGM, there are insufficient valid measurement instruments. Moreover, the lack of consistency in construct usage makes comparisons across studies particularly challenging. A critical review and comparative evaluation of the psychometric properties of the various stigma measures for SGM is necessary to advance our understanding regarding stigma measurement against/among SGMs. Based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive search was conducted in 4 bibliographic databases (MEDLINE, PsycINFO, CINAHL, and Web of Science) for empirical articles published from 2010 to 2022 that evaluated the psychometrics properties of measurement instruments assessing stigma against SGMs. The screening, extraction, and scoring of the psychometric properties and methodological quality of selected instruments were performed by following the established standards and COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) checklist, respectively. Of the 2031 studies identified, 19 studies were included that reported psychometric properties of 17 measurement instruments. All instruments, except two, were developed for SGMs (n = 15/17). Most instruments included men who have sex with men (MSM) or gay men (n = 11/15), whereas less than half of the instruments assessed stigma among SGM women (n = 6/15). Internal consistency (Cronbach's alpha) and content validity was reported for all instruments (n = 17); construct and structural validity was also reported for majority of the instruments (n = 15 and 10, respectively). However, test-retest reliability and criterion validity was reported for very few instruments (n = 5 each). Based on the COSMIN checklist, we identified the most psychometrically and methodologically robust instruments for each of the five stigma types: combined stigma, enacted stigma, internalized stigma, intersectional stigma, and perceived stigma. For each stigma type, except anticipated stigma, at least one instrument demonstrated strong promise for use in empirical research; however, the selection of instrument depends on the target population and context of the study. Findings indicated a growing use of instruments assessing multiple stigma types. Future studies need to develop intersectional stigma instruments that account for the multiple and intersecting social identities of SGMs. Additionally, most existing instruments would benefit from further psychometric testing, especially on test-retest reliability, criterion validity, adaptability to different LGBTQIA + populations and cultures.

摘要

针对性少数群体(SGM)的污名化对 SGM 群体的健康有严重的负面影响。尽管 SGM 群体对准确测量污名的需求不断增长,但可用的有效测量工具仍然不足。此外,由于结构使用上的不一致,使得跨研究进行比较尤其具有挑战性。因此,对 SGM 相关污名的各种污名化测量工具的心理测量特性进行批判性回顾和比较评估,对于推进我们对 SGM 污名化测量的理解是必要的。

根据 PRISMA(系统评价和荟萃分析的首选报告项目)指南,在 4 个文献数据库(MEDLINE、PsycINFO、CINAHL 和 Web of Science)中进行了全面检索,以获取 2010 年至 2022 年期间发表的评估针对 SGM 测量工具的心理测量特性的实证文章。

根据既定标准和 COSMIN(健康测量仪器选择的共识标准)检查表,分别对选定工具的心理测量特性和方法学质量进行了筛选、提取和评分。在确定的 2031 项研究中,有 19 项研究报告了 17 项测量工具的心理测量特性。

所有工具(n=17)均针对 SGM 人群开发,其中除两项外,其余均为男男性接触者(MSM)或男同性恋者(n=11/15)。然而,不到一半的工具评估了 SGM 女性(n=6/15)中的污名。所有工具(n=17)均报告了内部一致性(Cronbach's alpha)和内容效度;大多数工具(n=15 和 10)还报告了结构和结构效度。然而,很少有工具(n=5 个)报告了重测信度和效标效度。

根据 COSMIN 检查表,我们为五种污名类型中的每一种确定了最具心理测量学和方法学稳健性的工具:综合污名、实施污名、内化污名、交叉污名和感知污名。除预期污名外,对于每种污名类型,至少有一种工具在实证研究中表现出了很强的应用前景;然而,工具的选择取决于目标人群和研究的背景。

研究结果表明,评估多种污名类型的工具的使用不断增加。未来的研究需要开发考虑到 SGM 群体的多种和交叉社会身份的交叉污名化工具。此外,大多数现有的工具都需要进一步的心理测量测试,特别是在重测信度、效标效度、对不同 LGBTQIA+人群和文化的适应性方面。

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