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. 2023 Apr 13;11(1):112.
doi: 10.1186/s40359-023-01161-y.

Stigma towards people with tuberculosis: a cross-cultural adaptation and validation of a scale in Indonesia

Ahmad Fuady  1   2   3 , Bustanul Arifin  4   5   6 , Ferdiana Yunita  7 , Saidah Rauf  8 , Agus Fitriangga  9 , Agus Sugiharto  10 , Finny Fitry Yani  11   12 , Helmi Suryani Nasution  13 , IWayan Gede Artawan Eka Putra  14 , Muchtaruddin Mansyur  10   15 , Tom Wingfield  16   17   18
Affiliations

Stigma towards people with tuberculosis: a cross-cultural adaptation and validation of a scale in Indonesia

Ahmad Fuady et al. BMC Psychol. .

Abstract

Introduction: Tuberculosis (TB) remains a highly stigmatised disease that can cause or exacerbate mental health disorders. Despite increased awareness of the importance of reducing TB stigma, validated tools to measure TB stigma remain scarce. This study aimed to culturally adapt and validate the Van Rie TB Stigma Scale in Indonesia, a country with the second largest TB incidence worldwide.

Methods: We validated the scale in three phases: translation, cultural adaptation, and psychometric evaluation. We invited diverse experts to an interdisciplinary panel for the cross-cultural adaptation, then performed a psychometric evaluation of the scale: exploratory and confirmatory factor analyses, reliability analysis, and correlation analysis with Patient Health Questionnaire 9 [PHQ-9].

Results: We culturally adapted the original scale's language and content during the translation and cultural adaptation phases. After psychometric evaluation with 401 participants in seven provinces of Indonesia, we removed two items. The new scale had two forms: (A) patient and (B) community perspective forms. Both forms had good internal consistency, with respective Cronbach's alpha values of 0.738 and 0.807. We identified three loading factors in Form A (disclosure, isolation, and guilty) and two loading factors in Form B (isolation and distancing). The scale showed correlation with PHQ-9 (Form A, rs = 0.347, p < 0.001; Form B, rs = 0).

Conclusions: The culturally adapted Indonesian version of Van Rie's TB Stigma Scale is comprehensive, reliable, internally consistent, and valid. The scale is now ready for applied scale-up in research and practice to measure TB-stigma and evaluate the impact of TB-stigma reduction interventions in Indonesia.

Keywords: Indonesia; Scale; Stigma; Tool; Tuberculosis.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow of cross-cultural adaptation and validation of the scale
Fig. 2
Fig. 2
Participant allocation in each facility
Fig. 3
Fig. 3
Confirmatory factor analysis of (A) Form A: patient perspective and (B) Form B: Community Perspective of the TB stigma scale in people with TB in Indonesia. F: loading factors; V: tool’s item; RMSEA: root mean square error of approximation; TLI: Tucker Lewis index; CFI: comparative fit index; LF: covariance between factors; R: variance indicating magnitude of relationship of items to factor; R2: percentage of variance of each item explained by factor; 1-R2: percentage of variance of each item not explained by factor
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