Validating the Persian Version of the Self-stigma of Seeking Help (SSOSH) Scale

Abstract

Background: Stigma presents significant barriers to mental health treatment, influencing treatment decisions and recovery outcomes. Standardized rating scales play a crucial role in assessing Self-stigma, which is essential for intervention efforts aimed at improving mental health outcomes globally. Objectives: This study aims to investigate the internal consistency, face validity, content validity, and factor structure of the Persian version of the Self-stigma of Seeking Help (SSOSH) scale in a group of people with mental health disorders referred to the outpatient clinics of Roozbeh Psychiatry Hospital and several private clinics in Tehran, Iran. Methods: First, a bilingual psychiatrist translated the scale into Persian. Content and face validity were then evaluated by six psychiatrists. A pilot test was conducted with ten patients to assess comprehensibility. A back translation into English was performed by a non-professional, and the result was compared to the original version by a bilingual psychiatrist. The final Persian version of the questionnaire was administered to 347 patients with various mental health disorders, recruited from Roozbeh Hospital, a referral psychiatry hospital, and several private clinics in Tehran. Demographic characteristics were collected via questionnaires, and the type of disorder was determined based on the specialist's evaluation. This process was conducted from October 2023 to May 2024. The Content Validity Index (CVI) and Content Validity Ratio (CVR) were calculated, and internal consistency was analyzed using Cronbach’s alpha and McDonald's Omega tests. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were performed to explore and understand the data structure. Results: The Persian version demonstrated reasonable comprehensibility and translation equivalence, ensuring both semantic and content equivalence. The SSOSH achieved a CVI > 0.8 and CVR > 0.96. All items obtained an acceptable score (greater than 1.5) for face validity. The internal consistency of the total score was good (α = 0.733, ω = 0.818). The EFA revealed that the Persian version had three factors accounting for 57% of the total variance, and the CFA suggested this model fits the data reasonably well, though there is room for improvement. Conclusions: The Persian SSOSH scale exhibits good internal consistency and acceptable face and content validity for use in Persian-speaking patients with mental health disorders. While the three-factor structure identified by the EFA requires further investigation, the application of this tool among other Iranians warrants additional evaluation.