Negash Misrak, Tadesse Zerihun, Ambaw Fentie, Beka Michael, Belete Tilahun, Abte Melkamu, Deribe Kebede, Eaton Julian, Byrd Eve, Callahan E Kelly, Addiss David, van Brakel Wim H, Fekadu Abebaw, Macleod David, Burton Matthew, Habtamu Esmael
Department of Psychiatry, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia.
The Carter Center, Addis Ababa, Ethiopia.
PLOS Ment Health. 2024 Nov 27;1(6):e0000191. doi: 10.1371/journal.pmen.0000191.
Stigma is common in people affected with Neglected Tropical Diseases (NTDs). However, no validated tools are available to assess and monitor stigma in trachoma-affected communities. We tested the cross-cultural equivalence of the 5-question stigma indicator-affected persons (5-QSI-AP) scale in persons with trachomatous trichiasis (TT), the blinding stage of trachoma, and the 5-question stigma indicator-community stigma (5-QSI-CS) scale in person without TT, in Amhara region, Ethiopia. Conceptual, item, semantic, and operational equivalence were assessed through exploratory qualitative methods; measurement equivalence was assessed quantitatively through internal consistency, construct validity, and reproducibility. A total of 390 people participated: 181 were persons with TT, 182 persons without TT, 19 mental health, trachoma, social science, and linguistics experts, and eight interviewers. Items included in both scales were adequately relevant and important to explore stigma in the target culture. Concern about others knowing that they have TT, shame, avoidance by others, and problems getting married or in their marriage were among the issues persons with TT faced in this study community. The 5-QSI-AP had a Cronbach's α of 0.57 for internal consistency and showed adequate discriminant validity where persons with central corneal opacity from TT had higher mean stigma scores than their counterparts. The 5-QSI-CS had a Cronbach's α of 0.70 for internal consistency and a correlation of r = 0.23 with the Social Distance Scale (SDS) for convergent validity. The test-retest reliability analysis between the initial and repeat measures produced an intraclass correlation coefficient of 0.60 and 0.53 for the 5-QSI-AP and 5-QSI-CS respectively, and no evidence of systematic bias in mean stigma scores. The 5-QSI scales have satisfactory cultural validity to assess and monitor stigma in this trachoma-affected Amharic-speaking study population. With further cross-cultural validation, these brief and easy to administer scales would offer the possibility to rapidly measure and monitor stigma associated with NTDs.
耻辱感在被忽视热带病（NTDs）患者中很常见。然而，目前尚无经过验证的工具可用于评估和监测沙眼流行社区中的耻辱感。我们在埃塞俄比亚阿姆哈拉地区，对5个问题的耻辱感指标——受影响者（5-QSI-AP）量表在患有沙眼倒睫（TT，沙眼致盲阶段）的人群中进行了跨文化等效性测试，并对5个问题的耻辱感指标——社区耻辱感（5-QSI-CS）量表在未患TT的人群中进行了测试。通过探索性定性方法评估概念、条目、语义和操作等效性；通过内部一致性、结构效度和可重复性定量评估测量等效性。共有390人参与：181名是患有TT的人，182名是未患TT的人，19名心理健康、沙眼、社会科学和语言学专家，以及8名访谈员。两个量表中包含的条目对于探索目标文化中的耻辱感具有足够的相关性和重要性。在本研究社区中，患有TT的人面临的问题包括担心他人知道自己患有TT、羞耻感、被他人回避以及结婚或婚姻中遇到的问题等。5-QSI-AP的内部一致性Cronbach's α为0.57，并且显示出足够的区分效度，即患有TT导致中央角膜混浊的人比其同龄人有更高的平均耻辱感得分。5-QSI-CS的内部一致性Cronbach's α为0.70，与社会距离量表（SDS）的收敛效度相关性为r = 0.23。5-QSI-AP和5-QSI-CS在初次测量和重复测量之间的重测信度分析得出组内相关系数分别为0.60和0.53，并且在平均耻辱感得分方面没有系统偏差的证据。5-QSI量表在评估和监测这个受沙眼影响的阿姆哈拉语研究人群中的耻辱感方面具有令人满意的文化效度。经过进一步的跨文化验证，这些简短且易于实施的量表将有可能快速测量和监测与被忽视热带病相关的耻辱感。
