Development of a 12-item short version of the HIV stigma scale

Maria Reinius, Lena Wettergren, Maria Wiklander, Veronica Svedhem, Anna Mia Ekström, Lars E Eriksson, Maria Reinius, Lena Wettergren, Maria Wiklander, Veronica Svedhem, Anna Mia Ekström, Lars E Eriksson

Abstract

Background: Valid and reliable instruments for the measurement of enacted, anticipated and internalised stigma in people living with HIV are crucial for mapping trends in the prevalence of HIV-related stigma and tracking the effectiveness of stigma-reducing interventions. Although longer instruments exist, e.g., the commonly used 40-item HIV Stigma Scale by Berger et al., a shorter instrument would be preferable to facilitate the inclusion of HIV stigma in more and broader surveys. Therefore, the aim of this work was to develop a substantially shorter, but still valid, version of the HIV Stigma Scale.

Methods: Data from a psychometric evaluation of the Swedish 40-item HIV Stigma Scale were reanalysed to create a short version with 12 items (three from each of the four stigma subscales: personalised stigma, disclosure concerns, concerns with public attitudes and negative self-image). The short version of the HIV stigma scale was then psychometrically tested using data from a national survey investigating stigma and quality of life among people living with HIV in Sweden (n = 880, mean age 47.9 years, 26% female).

Results: The hypothesized factor structure of the proposed short version was replicated in exploratory factor analysis without cross loadings and confirmatory factor analysis supported construct validity with high standardised effects (>0.7) of items on the intended scales. The χ2 test was statistically significant (χ2 = 154.2, df = 48, p < 0.001), but alternate fit measures indicated acceptable fit (comparative fit index: 0.963, Tucker-Lewis index: 0.950 and root mean square error of approximation: 0.071). Corrected item-total correlation coefficients were >0.4 for all items, with a variation indicating that the broadness of the concept of stigma had been captured. All but two aspects of HIV-related stigma that the instrument is intended to cover were captured by the selected items in the short version. The aspects that did not lose any items were judged to have acceptable psychometric properties. The short version of the instrument showed higher floor and ceiling effects than the full-length scale, indicating a loss of sensitivity in the short version. Cronbach's α for the subscales were all >0.7.

Conclusions: Although being less sensitive in measurement, the proposed 12-item short version of the HIV Stigma Scale has comparable psychometric properties to the full-length scale and may be used when a shorter instrument is needed.

Keywords: HIV; Instrument; Nursing; Patient-reported outcome measures; Psychometrics; Short-form; Stigma.

Figures

Fig. 1
Fig. 1
Flowchart over the item reduction process to form a short form version of the HIV Stigma Scale
Fig. 2
Fig. 2
Confirmatory factor analysis of the short version of the HIV Stigma Scale. Results show correlations between subscales (circles) and maximum likelihood estimates for the relation between subscales and items (squares). The sample (n = 440) was randomly selected from all respondents with complete answers in a Swedish population of people living with HIV. Maximum likelihood estimates are standardised

References

    1. Holzemer WL, Human S, Arudo J, Rosa ME, Hamilton MJ, Corless I, et al. Exploring HIV stigma and quality of life for persons living with HIV infection. J Assoc Nurses AIDS Care. 2009;20(3):161–168. doi: 10.1016/j.jana.2009.02.002.
    1. Rao D, Chen WT, Pearson CR, Simoni JM, Fredriksen-Goldsen K, Nelson K, et al. Social support mediates the relationship between HIV stigma and depression/quality of life among people living with HIV in Beijing. China. Int J STD AIDS. 2012;23(7):481–4. doi: 10.1258/ijsa.2009.009428.
    1. Fuster-Ruizdeapodaca MJ, Molero F, Holgado FP, Mayordomo S. Enacted and internalized stigma and quality of life among people with HIV: the role of group identity. Qual Life Res. 2014;23(7):1967–75. doi: 10.1007/s11136-014-0653-4.
    1. Rydström L-L, Wiklander M, Navér L, Ygge B-M, Eriksson LE. HIV-related stigma and health-related quality of life among children living with HIV in Sweden. AIDS Care. 2016;28(5):665–671. doi: 10.1080/09540121.2015.1120267.
    1. Fortenberry JD, McFarlane M, Bleakley A, Bull S, Fishbein M, Grimley DM, et al. Relationships of stigma and shame to gonorrhea and HIV screening. Am J Public Health. 2002;92(3):378–381. doi: 10.2105/AJPH.92.3.378.
    1. Rintamaki LS, Davis TC, Skripkauskas S, Bennett CL, Wolf MS. Social stigma concerns and HIV medication adherence. AIDS Patient Care STDs. 2006;20(5):359–368. doi: 10.1089/apc.2006.20.359.
    1. Sayles JN, Wong MD, Kinsler JJ, Martins D, Cunningham WE. The association of stigma with self-reported access to medical care and antiretroviral therapy adherence in persons living with HIV/AIDS. J Gen Intern Med. 2009;24(10):1101–8. doi: 10.1007/s11606-009-1068-8.
    1. Maughan-Brown B, Nyblade L. Different dimensions of HIV-related stigma may have opposite effects on hiv testing: evidence among young men and women in South Africa. AIDS Behav. 2014;18(5):958–965. doi: 10.1007/s10461-013-0636-4.
    1. Sweeney SM, Vanable PA. The association of HIV-related stigma to HIV medication adherence: a systematic review and synthesis of the literature. AIDS Behav. 2016;20(1):29–50. doi: 10.1007/s10461-015-1164-1.
    1. Earnshaw VA, Chaudoir SR. From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures. AIDS Behav. 2009;13(6):1160–1177. doi: 10.1007/s10461-009-9593-3.
    1. Berger BE, Ferrans CE, Lashley FR. Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale. Res Nurs Health. 2001;24(6):518–529. doi: 10.1002/nur.10011.
    1. Lindberg MH, Wettergren L, Wiklander M, Svedhem-Johansson V, Eriksson LE. Psychometric evaluation of the HIV stigma scale in a Swedish context. PLoS One. 2014;9(12):e114867. doi: 10.1371/journal.pone.0114867.
    1. Jeyaseelan L, Kumar S, Mohanraj R, Rebekah G, Rao D, Manhart LE. Assessing HIV/AIDS stigma in South India: validation and abridgement of the Berger HIV stigma scale. AIDS Behav. 2013;17(1):434–443. doi: 10.1007/s10461-011-0128-3.
    1. Bunn JY, Solomon SE, Miller C, Forehand R. Measurement of stigma in people with HIV: a reexamination of the HIV stigma scale. AIDS Educ Prev. 2007;19(3):198–208. doi: 10.1521/aeap.2007.19.3.198.
    1. Wright K, Naar-King S, Lam P, Templin T, Frey M. Stigma scale revised: reliability and validity of a brief measure of stigma for HIV+ youth. J Adolesc Health. 2007;40(1):96–98. doi: 10.1016/j.jadohealth.2006.08.001.
    1. Rongkavilit C, Wright K, Chen X, Naar-King S, Chuenyam T, Phanuphak P. HIV stigma, disclosure and psychosocial distress among Thai youth living with HIV. Int J STD AIDS. 2010;21(2):126–132. doi: 10.1258/ijsa.2009.008488.
    1. Wiklander M, Rydström L-L, Ygge B-M, Navér L, Wettergren L, Eriksson LE. Psychometric properties of a short version of the HIV stigma scale, adapted for children with HIV infection. Health Qual Life Outcomes. 2013;14:11:195.
    1. Bond TG, Fox CM. Applying the Rasch model : fundamental measurement in the human sciences. 2. Mahwah, NJ: Lawrence Erlbaum Associates Publishers; 2007.
    1. Mair P, Hatzinger R. Extended Rasch modeling: the eRm package for the application of IRT models in R. J Stat Softw. 2007;20(9):1–20. doi: 10.18637/jss.v020.i09.
    1. R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing. /. Accessed 24 Nov 2016.
    1. The Public Health Agency of Sweden. Living with HIV in Sweden. 2015. . Accessed 30 Nov 2016.
    1. Gisslén M, Svedhem V, Lindborg L, Flamholc L, Norrgren H, Wendahl S, et al. Sweden, the first country to achieve the joint United Nations Programme on HIV/AIDS (UNAIDS)/World Health Organization (WHO) 90–90-90 continuum of HIV care targets. HIV Med. 2017;18(4):305–7. doi: 10.1111/hiv.12431.
    1. Rosseel Y. lavaan: an R package for structural equation modeling. J Stat Softw. 2012;48(2):1–36. doi: 10.18637/jss.v048.i02.
    1. Blunch NJ. Introduction to structural equation modeling using IBM SPSS statistics and AMOS. 2. SAGE: Los Angeles, CA; 2013.
    1. Smith GT, McCarthy DM, Anderson KG. On the sins of short-form development. Psychol Assess. 2000;12(1):102–111. doi: 10.1037/1040-3590.12.1.102.
    1. McHorney CA, Tarlov AR. Individual-patient monitoring in clinical practice: are available health status surveys adequate? Qual Life Res. 1995;4(4):293–307. doi: 10.1007/BF01593882.
    1. Tabachnick BG, Fidell LS. Using multivariate statistics. 6. Pearson Education: Boston, MA; 2013.
    1. Vandenberg RJ, Lance CE. A review and synthesis of the measurement invariance literature: suggestions, practices, and recommendations for organizational research. Organ Res Methods. 2000;3(1):4–70. doi: 10.1177/109442810031002.
    1. MacCallum RC, Widaman KF, Zhang S, Hong S. Sample size in factor analysis. Psychol Methods. 1999;4(1):84–99. doi: 10.1037/1082-989X.4.1.84.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe