School of Nursing, Peking University, Beijing, 100191, China.
School of Public Health, Wuhan University, Wuhan, China.
Syst Rev. 2024 Apr 27;13(1):115. doi: 10.1186/s13643-024-02535-y.
BACKGROUND: The development of antiretroviral therapy broadly extends the life expectancy of persons living with HIV (PLHIV). However, stigma and discrimination are still great threat to these individuals and the world's public health care system. Accurate and reproducible measures are prerequisites for robust results. Therefore, it is essential to choose an acceptable measure with satisfactory psychometric properties to assess stigma and discrimination. There has been no systematic review of different stigma and discrimination tools in the field of HIV care. Researchers and clinical practitioners do not have a solid reference for selecting stigma and discrimination measurement tools. METHODS: We systematically searched English and Chinese databases, including PubMed, EMBASE, CINAHL, Web of Science, PsycINFO, ProQuest Dissertations and Theses, The Cochrane Library, CNKI,, and Wanfang, to obtain literature about stigma and discrimination measurement tools that have been developed and applied in the field of HIV. The search period was from 1st January, 1996 to 22nd November 2021. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline (2018 version) was applied to assess the risk of bias for each involved study and summarize the psychometric properties of each tool. The modified version of the Grading of Recommendations Assessment, Development, and, Evaluation (GRADE) method was used to grade the evidence and develop recommendations. RESULTS: We included 45 studies and 19 PROMs for HIV/AIDS-related stigma and discrimination among PLHIV. All studies had sufficient methodological quality in content validity, structural validity, internal consistency, and the hypothesis testing of structural validity. Limited evidence was found for cross-cultural validity, stability, and criterion validity. No relevant evidence was found concerning measurement error and responsiveness. The Internalized AIDS-related Stigma Scale (IARSS), Internalized HIV Stigma Scale (IHSS), and Wright's HIV stigma scale (WHSS) are recommended for use. CONCLUSIONS: This study recommends three PROMs for different stigma and discrimination scenarios, including IARSS for its good quality and convenience, IHSS for its broader range of items, higher sensitivity, and greater precision, and WHSS for its comprehensive and quick screening. Researchers should also consider the relevance and feasibility of the measurements before putting them into practice. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022308579.
背景:抗逆转录病毒疗法的发展极大地延长了艾滋病毒感染者(PLHIV)的预期寿命。然而,耻辱感和歧视仍然是这些人以及全球公共卫生保健系统的巨大威胁。准确且可重现的测量方法是获得可靠结果的前提条件。因此,选择可接受且具有令人满意的心理测量特性的测量方法至关重要,以评估耻辱感和歧视。在艾滋病毒护理领域,还没有对不同耻辱感和歧视工具的系统评价。研究人员和临床医生在选择耻辱感和歧视测量工具方面没有可靠的参考依据。
方法:我们系统地检索了英文和中文数据库,包括 PubMed、EMBASE、CINAHL、Web of Science、PsycINFO、ProQuest Dissertations and Theses、The Cochrane Library、CNKI、万方,以获取已开发并应用于 HIV 领域的耻辱感和歧视测量工具的相关文献。检索时间为 1996 年 1 月 1 日至 2021 年 11 月 22 日。采用基于共识的健康测量工具选择标准(COSMIN)指南(2018 年版)评估每个研究的偏倚风险,并总结每个工具的心理测量特性。采用改良的推荐评估、制定与评估分级(GRADE)方法对证据进行分级并提出建议。
结果:我们纳入了 45 项研究和 19 项针对 PLHIV 的 HIV/AIDS 相关耻辱感和歧视的 PROM。所有研究在内容有效性、结构有效性、内部一致性和结构有效性假设检验方面均具有足够的方法学质量。仅发现关于跨文化有效性、稳定性和效标效度的有限证据。没有关于测量误差和反应性的相关证据。建议使用艾滋病相关耻辱感量表(IARSS)、艾滋病毒内化耻辱感量表(IHSS)和赖特艾滋病毒耻辱感量表(WHSS)。
结论:本研究推荐了三种 PROM 用于不同的耻辱感和歧视场景,包括 IARSS,因其质量好且方便;IHSS,因其项目范围更广、灵敏度更高、精确度更高;WHSS,因其全面且快速筛查。研究人员在实施之前还应考虑测量的相关性和可行性。
系统评价注册:PROSPERO CRD42022308579。
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