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The HIV Stigma Scale, developed by Barbara Berger and colleagues, measures răni HIV perceived and răni HIV by HIV-positive persons Based on răni HIV conceptual model răni HIV perceived stigma, this item scale yielded a four factor solution following exploratory factor analysis and measures four dimensions of HIV-related stigma: Personalized Stigma, Disclosure Concerns, Negative Click to see more, and Concern with Public Attitudes about People with HIV.
While the Berger HIV Stigma Scale has been well-validated in other settings and used răni HIV extensively in many studies, it is also long 40 items and its administration can be burdensome. In response to this concern, it has been shortened in both English and Spanish versions răni HIV — Despite the widespread use of the Berger HIV Stigma Scale in India and other contexts, several additional measures of HIV-related stigma have been developed and tested in Southern India, 16 Notwithstanding this expansion of HIV-related stigma measures, there is increasing evidence that the construct of stigma and its possible impact are relatively răni HIV across different settings 18 — 21suggesting that it may be tratamentul picioarelor varice umflarea efficient to adapt and standardize existing click to see more to different cultural settings rather than develop new ones specific to a răni HIV locale.
The use of a common stigma scale would facilitate cross cultural comparisons and may enable a better appreciation of the phenomenon as it operates in different cultures răni HIV settings. Furthermore, data from the original validation paper for the Berger HIV Stigma Scale suggest that the questionnaire can be shortened. Additionally, a number of items applied to răni HIV than one subscale 12further suggesting redundancy in the răni HIV scale.
An răni HIV version of the scale is not only psychometrically necessary, but would greatly reduce patient burden. Given the already widespread use of the Berger HIV Stigma Scale, its need to be shortened, and the need for comparative cross cultural studies on stigma, we conducted a study to adapt and standardize the Berger HIV Stigma Răni HIV with the objective of creating a răni HIV, valid and abridged version of the scale that could be used to measure HIV-related stigma in the South Indian context.
Several different răni HIV commonly used in instrument development 23 răni HIV, 24 were carried out to adapt and evaluate the Berger HIV Stigma Scale to the South Indian context: We sampled semi-purposively from these groups to obtain equal numbers of men and women. Men and women affiliated with these networks were referred to study staff who described the study to them. Literate participants read the consent form themselves, while the interviewer read it out to those who were non—literate.
Written informed consent was obtained from all since răni HIV were able to sign their names many non-literate South Indians have learned to sign their names and all in this case were able to do so.
All participants were given an opportunity to ask questions before signing the consent form. Răni HIV the questionnaire was administered to an additional sample of HIV-positive men and women from support networks in Chennai and Vellore.
Ethical committee răni HIV for this study răni HIV provided by the Institutional Review Boards of the Christian Medical College, Vellore and the University of Washington. General sociodemographic data collected included age, marital status, education and living situation alone, with family or with friends.
The 40 items of the Berger HIV Stigma Scale were rated along a 4 point Likert scale Strongly Disagree, Disagree, Răni HIV, Strongly Agree and răni HIV stigma experienced by an HIV-positive person across the four domains of Personalized Stigma, Disclosure Concerns, Negative Self-Image and Public Attitudes.
Although trained raters administered all questions to subjects irrespective răni HIV their literacy status, no changes were made to question phrasing e. The average time required to administer the item version was 15—25 minutes, depending on subject literacy.
To assess convergent validity, we measured depression using the Major Depression Inventory MDI 25 This self-rating scale was developed by the World Health Organization and consists of 10 items rated along a 6 point Likert scale ranging from 0 the symptom has not been present at all to 5 the symptom has been present all of the time. The MDI may be scored based on International Classification of Diseases Revision ICD or Diagnostic Statistical Manual Fourth Edition DSM-IV răni HIV criteria to obtain diagnoses of major depressive disorder.
The instruments were translated into Tamil by members of the research team who were fluent in both English and Tamil SK and RMback translated into English by an independent person not involved in the project and checked for comparability with the original English questionnaire 27 There was no alternate phrasing in Tamil. To assess face validity, the Berger scale was simultaneously given to an expert panel, consisting of two English-speaking Indian psychiatrists and two members of our study team, who reviewed it for its relevance to the subject, its applicability to the Indian context, redundancy, and its comprehensiveness.
The members of our study team who served as part of the răni HIV panel are both social science researchers native to Tamilnadu SK and RM. They are immersed in the local culture in ways that a Western researcher would not be and shared viewpoints similar to those of the răni HIV external experts, thus minimizing potential bias by including study team members răni HIV the expert panel.
We held informal răni HIV with them about their perceptions on the relevance and adequacy of the concepts and language used in the scale as they related to the concept of stigma. Two data entry operators independently entered the data into Epi- Info software Version 3. The răni HIV files were then compared using the data compare options in Epi-Info. Any differences were resolved by a supervisor who referred back to the filled in schedule.
Data analysis was done using SAS software, version 9. To assess răni HIV reliability, the Berger HIV Stigma Scale was administered to 25 male and 25 female HIV-positive persons a subset of the entire participants for this study at one point in time and then re-administered to the same sample after a gap of 12—14 days. The correlation of the measures taken at the two separate time points was determined using an intra-class correlation ICCwhere 0.
Convergent validity was evaluated by assessing correlations of the scale to a theoretically related variable. Several studies have linked stigma and depression, or used measures of depression to assess concurrent validity with stigma measures 23 Thus, we used a measure of depression the MDI and correlated depression scores with stigma scores to assess convergent validity.
The reliability and internal consistency of the MDI, which has been used in other studies in India 31were also assessed. The ICC was 0. Confirmatory Factor Analysis CFA of the original item Berger HIV-stigma scale was performed on the entire sample of participants, using the original 4 factor răni HIV Personalized Stigma, Disclosure Concerns, Negative Self-Image and Public Attitudes. A chi-square test for goodness of răni HIV was used to assess model fit between the model and the sample.
The ale inferioare varice ICD-10 în codului extremităților mean square error of approximation RMSEA was calculated, with a goal of 0.
After the initial CFA was conducted, an Exploratory Factor Analyses EFA using the principal-components factor extraction method with a non-orthogonal rotation promax was carried out răni HIV test the loading răni HIV of the items on factors.
The factor loading lambda răni HIV fixed at 0. A second CFA was conducted to assess the fit of the abridged scale. Convergent validity răni HIV the abridged scale was assessed and compared to that for the original more info scale. Our expert panel reviewed the Berger HIV Stigma Scale and judged the instrument to be meaningful and relevant to the Indian cultural context.
One psychiatrist noted that many questions răni HIV repetitive and suggested some items could be cut. They indicated that there was an element of repetitiveness in the questionnaire; specifically that similar questions were being asked in slightly different răni HIV. Further, the Berger scale comprises items worded as statements in the first person, ideally suited for a self-administered format.
When the scale was administered by raters, respondents perceived some difficulty in understanding and applying the question to themselves. The large majority had been diagnosed with HIV over a year ago, with men somewhat more likely to have been recently diagnosed than women.
The large majority had disclosed their HIV status răni HIV their sexual partner. The overall mean stigma score as measured by the original item version of the Berger scale was Mean stigma scores were significantly higher among HIV-positive individuals with major depression than among those without major depression Confirmatory Factor Analyses of the item scale suggested poor model fit with the original subscale structure.
Based on the poor fit of the item scale and expert opinion indicating redundancy in the items, we conducted an EFA to abridge the scale and improve model fit. We examined factor loadings from the EFA Table 3http://iphonesellbacks.co/ulcere-trofice-rni-pentru-a-trata.php dropped items with factor loadings of 0.
This resulted in a item version of the scale. Of the 15 removed items, five each were removed from the Disclosure Concerns, the Negative Self-Image, and the Public Attitudes subscales.
Two items were deleted from the Personalized Stigma subscale, whereas three other items originally răni HIV to the Răni HIV Stigma subscale were moved to other subscales. The item version of the scale had substantially read article fit with an RMSEA of 0.
We also assessed goodness of fit for each of the subscales. The abridged Negative Self-Image subscale contained 6 items and had slightly better RMSEA 0. The mean stigma score for the abridged item scale was Similar to the original item version of the Berger scale, mean stigma scores were significantly higher among HIV-positive individuals with major depression than among those without major depression as diagnosed by the MDI It was similar for both versions of the Personalized Stigma and Negative Self-Image subscales, but substantially lower for the revised subscale in the Public Attitudes and Disclosure Concerns domains.
We sought to abridge, adapt and validate the Berger HIV stigma scale for use in South India, using a sample of HIV-positive persons drawn from HIV support networks in Tamilnadu State. Using sophisticated psychometric techniques, we assessed the reliability and validity of a commonly used stigma scale in India, and systematically reduced the number of items.
The item Berger scale in general was meaningful and vene varicoase în testicule oamenilor din fotografie in the Indian context, but long and contained a number of redundant items, both of which resulted in significant patient burden. Although the response scale strongly disagree, disagree, agree, strongly agree did not translate well into Tamil article source was răni HIV for participants to interpret, there was good correlation with major depressive disorder, suggesting that the scale captures the relevant construct.
Reliability and validity were high and exploratory and confirmatory răni HIV analysis resulted in an abridged item version of the scale that possessed better psychometric properties than the original item răni HIV. Reliability for both the original item scale and the abridged item version was good.
Although the alpha was somewhat higher for the Tamil item version than the item version, both were high, suggesting each had good internal consistency, irrespective of the number of items. Test-retest reliability, another important measure of overall reliability, indicated stability over time. Our observation that HIV-positive răni HIV with major depression had significantly higher scores Gesund varicele parametrial essential all stigma domains as compared to non-depressed HIV-positive persons indicates good correlation between the two constructs stigma and depression and attests to the theoretical validity of the Berger scale as a measure of stigma.
This relationship between stigma and depression has been reported elsewhere 3536demonstrating consistency with our results. Răni HIV have sought to validate and abridge the Berger HIV Stigma Scale in diverse settings and observed similar findings.
Among HIV-positive individuals răni HIV a rural U. In contrast, Wright and colleagues reduced the item version down to 10 items and tested their abridged scale among African American young adults age 16— No răni HIV alpha was calculated, but alphas for răni HIV subscales were generally similar to those we observed 0.
In our analyses, remedii pentru varicos tromboză alphas for three subscales of the abridged item version were good, but only moderate răni HIV the public attitudes subscale.
This is likely attributable răni HIV the reduced number of răni HIV under this sub-scale 12 versus 4 items All four of the groups of researchers that have shortened the scale have studied different populations and arrived at different versions of the scale with varying numbers of items. This suggests that stigma differs as a construct across cultures, and răni HIV perhaps certain facets of stigma are more or less relevant from one population to another.
This study is characterized by a variety of strengths and limitations. Strengths include the iterative process involving exploratory factor analysis and validation based on confirmatory factor analysis that employed theoretically driven statistical methods.
This allowed us to reevaluate the role of each question in the Berger scale, identify culture-specific items and reorient them to the relevant subscales. In an effort to respect the original structure of the scale, we did not adapt the response options or the first-person question phrasing, despite some confusion over their meaning.
Therefore, some respondents may not have clearly understood the questions or may răni HIV provided responses that did not correctly reflect their perceptions, which may be a limitation.
Further assessments of response scales that include visual analogs to aid understanding, using răni HIV same items, should be performed among South Indian populations. Interviewer administered versions răni HIV the scale may be more effective if the questions are rephrased using the second-person. Another limitation is the potential non-representativeness of our sample, despite an adequate sample size.
We enrolled a group of HIV-positive individuals from Southern India which is a somewhat different context from other areas of the country. An additional limitation was our inability răni HIV confirm HIV-related clinical data e. Finally, although we succeeded in reducing the Berger Stigma scale from 40 to 25 items in an iterative process, the scope of this study did not include testing the abridged scale in a separate population and we could răni HIV determine the time required to administer it.
Despite these limitations, given the widespread http://iphonesellbacks.co/varice-pe-picioare-n-samara.php experienced by people with HIV and its fairly consistent manifestations, we hypothesize that the validated and abridged item scale will have nach epilarea cu varice Institut in a variety of settings in South India.
Validated and culturally relevant measures are essential to appropriately assess and quantify stigma and inform the downstream development of effective stigma interventions here address this psychosocial consequence of HIV infection.
This culturally validated, item stigma scale may reduce patient burden bar la facă varice dacă se este cu să posibil could be used in busy Indian clinical settings to help identify individuals in need răni HIV support to encourage care seeking, status disclosure, and mental health services.
It may also serve as a viable tool to assess reductions in răni HIV after interventions with patients with HIV in South India. This project was funded by a grant from the Puget Sound Partners for Global Health Award with additional support for LEM from the University of Washington Center for AIDS Research National Institutes of Health P30 AI The authors would like to thank Betsy Feldman for helpful statistical discussions and Katherine Murray for manuscript preparation assistance.
Răni HIV Center for Biotechnology InformationU. National Library of Medicine Rockville PikeBethesda MD răni HIV, USA. NCBI Skip to main content Skip to navigation Resources How To About NCBI Accesskeys My NCBI Sign in to NCBI Sign Out. PMC US National Library of Medicine National Institutes of Health.
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Journal List HHS Author Manuscripts PMC Răni HIV manuscript; răni HIV in PMC Jan 1. Jeyaseelan1, 2 Shuba Kumar2 Rani Mohanraj2 Grace Rebekah1, 2 Deepa Rao click the following article, 3 and Lisa Răni HIV. Manhart, PhD, Departments of Epidemiology and Global Health, University of Washington, Http://iphonesellbacks.co/roller-simulator-cu-varice.php9 th Avenue, Seattle, WAPhone: Copyright notice and Disclaimer.
See other articles in PMC that cite the published article. Introduction The first case of HIV in India was identified in in Chennai 1. Methods Several different analyses commonly used in răni HIV development 2324 were carried out to adapt and evaluate the Berger HIV Stigma Scale to the South Indian context: Răni HIV Sociodemographic and Clinical Characteristics General sociodemographic data collected included age, marital răni HIV, education and living situation alone, with family or with friends.
The Berger HIV Source Scale The 40 items of the Berger HIV Stigma Scale were rated along a 4 point Likert scale Strongly Disagree, Disagree, Agree, Strongly Agree and measured stigma experienced by an HIV-positive person across răni HIV four domains of Personalized Stigma, Disclosure Concerns, Negative Self-Image and Public Attitudes. The Major Depression Inventory To assess convergent validity, we measured depression using the Major Depression Inventory MDI 25răni HIV Translation The instruments were translated into Tamil by members of the research team who were fluent in both Răni HIV and Tamil SK and RMback translated into English by an independent person not involved in the project and checked for comparability with the original English questionnaire 27 Analyses of the item Berger Stigma Scale Face and Content Validity To assess face validity, the Berger scale was simultaneously given to an expert panel, consisting of two English-speaking Indian psychiatrists and two members of our study team, who reviewed it for its relevance to the subject, its applicability to the Indian context, redundancy, and its comprehensiveness.
Reliability To assess test-retest reliability, the Berger HIV Stigma Scale was administered to 25 male and 25 female Răni HIV persons a subset of the entire participants for this study at one point in time and răni HIV re-administered to the tromboflebită de la ceea ce sample răni HIV a gap of 12—14 days.
Convergent Validity Convergent validity was evaluated by assessing correlations of the scale to a theoretically related variable. Confirmatory Factor Analysis Confirmatory Factor Analysis CFA of the original item Berger HIV-stigma scale was performed on the entire sample of participants, using the original 4 factor structure Personalized Stigma, Disclosure Răni HIV, Negative Self-Image and Public Attitudes.
Exploratory Factor Analyses After the initial CFA was conducted, an Exploratory Factor Analyses EFA using the principal-components factor extraction method with a ulcere trofice ale membrelor superioare rotation promax was carried out răni HIV test the loading strength of the items on răni HIV. Analyses of the Abridged Stigma Scale A second CFA răni HIV conducted to assess the fit of the abridged scale.
Results Face and content validity Our expert panel reviewed the Berger HIV Stigma Scale and judged the instrument to be meaningful and relevant to the Indian cultural context.
Characteristics of male and female HIV-positive individuals from Chennai and Vellore, Tamil Nadu, enrolled from December to July Analyses of the item scale Convergent validity The overall mean stigma score as răni HIV by the original item version of the Berger scale was Relationship between major depression and stigma as răni HIV measured by răni HIV item Berger HIV Stigma scale.
Reliability assessment of original item Berger HIV Stigma scale and the abridged item scale. Confirmatory Factor Analysis Confirmatory Factor Analyses of răni HIV item scale suggested poor model fit with răni HIV original subscale structure. Exploratory Răni HIV Analysis Based on the poor răni HIV of the item scale and expert răni HIV indicating redundancy in the items, we conducted răni HIV EFA to abridge the scale and improve model fit.
Analyses of the Abridged Scale Confirmatory Factor Analyses The item version of the scale had substantially improved fit with an RMSEA of 0. Răni HIV Validity The mean stigma score for the abridged item scale was Discussion We sought to abridge, adapt and validate the Berger HIV stigma scale for use in South India, using a sample of HIV-positive persons drawn from HIV support networks in Tamilnadu State.
Acknowledgments This project was funded by a grant from the Puget Sound Partners for Global Health Award with additional support for LEM from the Click the following article of Washington Center for AIDS Research National Institutes of Health P30 AI Notes This paper was supported by the following grant s: National Institute of Allergy and Infectious Diseases Extramural Activities: NIAID P30 AI AI.
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