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. 2023 Jul;30(7):621-629.
doi: 10.1111/jvh.13838. Epub 2023 Apr 21.

Measuring stigma associated with hepatitis B virus infection in Sierra Leone: Validation of an abridged Berger HIV stigma scale

George A Yendewa  1   2   3 , Edmond J Sellu  4 , Rashid A Kpaka  5 , Peter B James  6 , Sahr A Yendewa  7 , Peterlyn E Cummings  7 , Lawrence M Babawo  8 , Samuel P Massaquoi  7 , Manal Ghazawi  9 , Ponsiano Ocama  10 , Sulaiman Lakoh  7   8   11 , Lawrence S Babawo  4   5 , Robert A Salata  1   2
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Measuring stigma associated with hepatitis B virus infection in Sierra Leone: Validation of an abridged Berger HIV stigma scale

George A Yendewa et al. J Viral Hepat. 2023 Jul.

Abstract

Stigma associated with hepatitis B virus (HBV) is common in endemic countries; however; instruments are lacking to accurately measure HBV-related stigma. We therefore aimed to develop and validate a concise instrument for measuring perceived HBV-related stigma in Sierra Leone. We enrolled 220 people living with HBV (PWHB) aged ≥18 years from August to November 2022. The initial Likert-scale instrument entailed 12 items adapted from Berger's HIV Stigma Scale. We included four additional items adapted from the USAID indicators for enacted stigma. The proposed scale's psychometric properties were assessed. After item reduction, the final HBV Stigma Scale consisted of 10 items and had good internal consistency (overall Cronbach's α = 0.74), discriminant, and construct validity. Exploratory factor analysis produced a three-dimensional structure accounting for 59.3% of variance: personalized stigma driven by public attitudes (six items), negative self-image (two items), and disclosure concerns (two items). Overall, 72.8% of respondents reported perceived HBV-related stigma (mean score 29.11 ± 4.14) and a similar proportion (73.6%) reported at least one instance of enacted stigma. In assessing criterion-related validity, perceived HBV-related stigma correlated strongly with enacted stigma (r = 0.556) and inversely with having family/friends with HBV (r = -0.059). The 10-item HBV Stigma Scale demonstrated good internal consistency and validity and is suitable for screening for HBV-related stigma in Sierra Leone. The psychometric properties of the scale can be optimized with item additions/modifications and confirmatory factor analysis. The scale may help in combating stigma as a barrier to achieving HBV global elimination goals.

Keywords: Sierra Leone; hepatitis B virus; mental health; stigma; sub-Saharan Africa.

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Conflict of interest statement

CONFLICTS OF INTEREST

The authors report no relevant financial disclosures or conflicts of interests.

Figures

Figure 1.
Figure 1.
Heatmap of Pearson correlations of the subscales of perceived and enacted HBV stigma
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