Psychometric assessment of the EMIC Stigma Scale for Brazilians affected by leprosy.

Fabiane Frota da Rocha Morgado,Lilian Pinheiro Rodrigues do Nascimento,José Augusto da Costa Nery,Anna Maria Sales,Ximena Illarramendi,Erika Maria Kopp Xavier da Silveira,Euzenir Nunes Sarno,Lucy Busija

doi:10.1371/journal.pone.0239186

Fabiane Frota da Rocha Morgado, Lilian Pinheiro Rodrigues do Nascimento + Show 6 more

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https://doi.org/10.1371/journal.pone.0239186

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Abstract

BackgroundThe Stigma Scale of the Explanatory Model Interview Catalogue (EMIC-SS) is a useful option to investigate leprosy-related stigma, but its psychometric qualities are unknown in Brazil. This study investigated the factor structure, the convergent and known-groups validity, and the reliability of the EMIC-SS for Brazilians affected by leprosy.MethodologyThe Brazilian Portuguese version of the EMIC-SS was validated in 180 persons affected by leprosy at a Reference Center in Rio de Janeiro. Confirmatory factorial analysis (CFA) and Cronbach alpha were used to assess the EMIC-SS internal consistency. The Construct validity was tested using Spearman Correlation, Kruskal-Wallis, and Mann-Whitney tests comparing with the Participation Scale, Rosenberg Self-esteem Scale, Beck Depression Inventory, and a Sociodemographic Questionnaire. Test-retest reliability was evaluated with intra-class correlation (ICC).Main findingsCFA confirmed the one- and two-dimensional models of the scale after retaining 12 of the 15 EMIC-SS items. The 12—item EMIC-SS was consistent (α = 0.78) and reproducible (ICC = 0.751, 95% Confidence Interval = 0.657–0.822, p < 0.0001). A significant correlation was observed between the EMIC-SS and the other scales confirming convergent validity. The EMIC-SS and its factors were able to differentiate several hypothesized groups (age, change of occupation, monthly family income, communicating others about the disease, and perception of difficulty to follow treatment) confirming the scale known-groups validity, both in its one and two-dimensional models.Conclusions/SignificanceOur study found support for the construct validity and reliability of the EMIC-SS as a measure of stigma experienced by people affected by leprosy in Brazil. However, future studies are necessary in other samples and populations with stigmatizing conditions to determine the optimal factor structure and to strengthen the indications of the validated scale.

Highlights

The past decade has been important for developing the new science of stigma, a fundamental social cause of health inequalities
Mean Body Mass Index (BMI) was 26.89 ± 4.82 Kg/m2, and 21% of the participants were classified as obese (BMI 30)
This study evaluates the factor structure, validity, and reliability of Explanatory Model Interview Catalog (EMIC)-SS applied to persons affected by leprosy in Brazil, making available an important tool for researchers to allow the production of information about the prevalence of social stigma in the country

Summary

Introduction

The past decade has been important for developing the new science of stigma, a fundamental social cause of health inequalities. The paradigm of stigma has changed and today it is viewed as a cultural disease It affects processes such as resource availability, social relationships, psychological, and behavioural responses, all of which mediate adverse population health outcomes [1]. The exclusion, rejection, and guilt or devaluation sensation resulting from the experience, perception, or anticipation of an adverse social judgment [2], might affect the health outcome of the stigmatized person. This judgment is based on a longlife characteristic of the identity conferred to a specific health problem, a condition, or social aspects [3]. This study investigated the factor structure, the convergent and known-groups validity, and the reliability of the EMIC-SS for Brazilians affected by leprosy

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