Validity of the Modified Lay Public Stigma in the Family Stigma in Alzheimer's Disease Scale (Modified FS-ADS) for General Public in Vietnam.

Although it is widely assumed that persons with Alzheimer disease (AD) and their family caregivers are victims of stigmatization, family stigma in the area of AD has received surprisingly limited attention. Reliable, valid, and user-friendly scales are a first step in expanding this body of knowledge. The aim of this study was to develop and examine the validity of the Family Stigma in Alzheimer's disease Scale. Interviews were conducted with 185 children of persons with AD. A pool of 100 items was identified from the literature and an earlier qualitative study including 3 dimensions (caregivers' stigma, lay persons' stigma, and structural stigma). Exploratory factor analyses, theoretical relevance, and internal reliability analyses allowed us to reduce the pull to 62 items. Regarding construct validity, statistically significant associations were found between family stigma and caregivers' burden and behavioral problems, in most of the scales. Although further testing is warranted, these findings indicate that the Family Stigma in Alzheimer's disease Scale is a reliable and valid instrument for assessing stigma in the context of AD.

This study examined public stigma associated with Alzheimer's disease (AD) among Korean Americans and identified factors affecting their public stigma. Data used in the study were collected using a cross-sectional survey with 268 Korean Americans. Guided by attribution theory, different domains of public stigma were assessed: pity, antipathy, and social distance. Hierarchical regression analyses were conducted to examine the effects of sociodemographic characteristics, exposure to AD, social networking, and AD knowledge on each stigma domain. The influence of emotional attributions (pity and antipathy) on behavioral attributions (social distance) in the stigma process suggested in attribution theory was also examined. Results show that pity is most prevalent followed by social distance and antipathy. Being more proficient in English, knowing fewer relatives/friends with AD, and knowing less about AD risk factors are associated with having more pity stigma. Being less socially engaged and knowing less about AD risk factors are related to having more antipathy stigma. Being younger and more proficient in English and having stronger antipathy stigma are associated with having more social distance stigma. Findings reveal multifaceted nature of public stigma associated with AD in Korean Americans and suggest that we need to work on both positive and negative sides of public stigma for stigma change. Findings of different factors associated with each public stigma domain can be considered when trying to foster and/or reduce certain stigmatic beliefs and behaviors associated with AD.

Apathy in Dementia: An Examination of the Psychometric Properties of the Apathy Evaluation Scale

Providing care to persons with Alzheimer's disease poses challenges for spouses and adult children, including experiencing stigmatic beliefs towards themselves-i.e., family stigma. Drawing on the frameworks of ethnicity and stigma and ethnicity and dementia, the current study explored stigmatic experiences among Israeli Arab family caregivers of a person with Alzheimer's disease. Three focus groups with 20 caregivers (adult children and spouses) of persons with Alzheimer's disease were conducted. Data were analyzed using theory-led thematic analysis. Caregivers reported experiencing family stigma in two dimensions: public and affiliate stigma, in both the existence of an attribution process in which cognitive stereotypes elicit negative and positive emotions which in turn provoke behavioral attributions, was evident. Family stigma was found to be a discernible feature of everyday reality among Israeli Arab caregivers of persons with Alzheimer's disease and stress the importance of developing management strategies that are tailored to the socio-cultural characteristics of the caregivers.

The present study was undertaken in order to evaluate the validity and reliability of the Family Stigma in Alzheimer's Disease Scale (FS-ADS) in the Greek population. The Greek version of the FS-ADS as well as the Maslach Burnout Inventory (MBI) was administered to 171 healthcare professional caring for people with dementia. Exploratory factor analysis was performed to examine the factor structure of the FS-ADS. Test-retest reliability was measured by administration of the FS-ADS in 20 individuals. Principal component analysis revealed 5, 8 and 3 factors (subscales) for each dimension of the original questionnaire, respectively, similar to other previously reported results in the literature. The overall Cronbach's α was .899, yielding a high internal consistency. Test-retest reliability was very high (r = 0.903, p < .001). Statistically significant relationships were found between most of the FS-ADS dimensions and Maslach subscales. The findings favor the use of FS-ADS in nurses and professional caregivers in general, for measuring stigma in dementia in Greece.

This study aims to evaluate the psychometric properties of the Korean version of the public stigma of Alzheimer’s diseases scale (KPS-ADS). Stigma toward Alzheimer’s disease (AD) prevents the early diagnosis of AD, causing the delayed treatments. To our knowledge, there is no proper measure to assess AD public stigma among the Korean-speaking population. We used a community survey dataset with 268 Korean Americans. We translated the 19 items of the layperson’s stigma, a dimension of the Family Stigma in AD scale, using Brislin’s method. After randomly dividing the sample into two sub-groups, we conducted exploratory factor analysis (EFA) with one group to explore the factor structure of the KPS-ADS, and then performed confirmatory factor analysis (CFA) with the other group to validate its identified factor structure. Additionally, we performed reliability tests. EFA identified three factors: negative emotions, empathetic response, and social behaviors. Using this three-factor model, we performed CFA with the highest loading items loaded on each factor, but it showed a poor model fit. After removing three items, the revised model showed an excellent model fit (χ2 = 185.788, df = 97, p = 0.000, CFI = 0.955, TLI = 0.944, RMSEA = 0.081[90% CI: 0.063–0.099, p ≤ 0.05 = 0.003]). All loadings were significant. The KPS-ADS demonstrated excellent internal consistency reliability (α=.87), with each domain demonstrating excellent internal consistency. Our study presents a psychometrically sound, multifaceted KPS-ADS that contribute to better understanding the nature and magnitude of AD public stigma and reducing it in this population.

Introduction: The preset study aimed to develop and standardize the psychometric criteria of attitude toward adoption questionnaire and its relation to prosocial behavior and character strengths. Methods: The method of this study was descriptive survey. The research population included all citizens living in Behshahr (N = 156195). The sample size of the study was 500 subjects of whom 50 subjects were selected through pre-investigation study by available sampling method and 450 subjects were selected by multistage cluster sampling in the final study. The research tools included the attitude toward adoption questionnaire, Prosocial Tendencies Measure Revised (PTM-R) by Carlo et al (2003), and character strengths questionnaire by Seligman and Patterson (2004). The research analysis method was exploratory factor analysis and Pearson correlation coefficient. Results: The results of exploratory factor analysis by main components with varimax rotation indicated two components of attitude toward adoption being named respectively cognitive as the aspects of attitude toward adoption and behavioral-emotional aspects of attitude toward adoption. These two components explained 43.25% of the variance of the total sample. Cronbach's alpha coefficient was used to measure the reliability of the questionnaire. Cronbach's alpha coefficient was 0.709 for the whole questionnaire, 0.71 for the first component, and 0.713 for the second one. In addition, there was a significant positive relationship between desired social tendencies and the cognitive aspect of attitude toward adoption as well as the behavioral -emotional aspects of attitude toward adoption (P ≤ 0.01). Conclusion: As a conclusion, the attitude toward adoption questionnaire has a desirable and appropriate validity and can be used as a useful tool for measuring the attitude toward adoption. Declaration of Interest: None

ObjectiveTo identify internal structure validity evidence of a dysphagia screening questionnaire for caregivers of older adults with Alzheimer's disease dementia and/or vascular dementia. MethodsThe 24-question Dysphagia Screening in Older Adults with Dementia – Caregiver Questionnaire (RaDID-QC) was administered by interviewing 170 caregivers of older people with dementia, selected by convenience at the Outpatient Reference Center for Older People. Exploratory Factor Analysis (EFA) was used to assess the internal structure validity of the questionnaire, and Cronbach's alpha was used to analyze reliability. Questions with factor loadings lower than 0.45 in magnitude were removed from the final questionnaire. Multivariate multiple linear regression was used to assess the percentage of variance explained by the remaining questions. ResultsKayser-Meyer-Olkin (KMO) and Bartlett's tests suggested that the questionnaire was adequate for EFA. Principal Component Analysis (PCA) suggested that 12 components captured at least 75 % of the total variance. The corresponding 12-factor EFA model showed a statistically significant fit, and 15 out of the 24 questions had factor loadings greater than 0.45. Cronbach's alpha was 0.74 for the 15 questions, which explained 71 % of the total variance in the complete dataset. The questionnaire has adequate internal structure validity and good reliability. Based on EFA, RaDID-QC decreased from 24 to 15 questions. Other internal validity and reliability parameters will be obtained by administering the questionnaire to larger target populations. ConclusionThe RaDID-QC applied to caregivers of older adults with dementia due to Alzheimer's disease and/or vascular dementia produced valid and reliable responses to screen dysphagia signs and symptoms.

Objectives Many studies have attempted to identify the factors that are associated with caregiver burden among family caregivers of people with Alzheimer’s disease (AD), because of its plethora of negative consequences. One unique factor that has been investigated recently is family stigma. However, the path leading from family stigma to caregiver burden has not been thoroughly studied. Hence, this study had two main objectives. The first was to examine whether family stigma was a predictor of caregiver burden among Israeli Arab family caregivers of a person with AD. The second was to examine the interplay of family stigma and caregiver burden with coping strategies and social support. Methods Structured face-to-face interviews were conducted with 175 Israeli Arab family caregivers (adult children and spouses) of elderly people with AD (87.4% female; 71.4% adult children; mean age = 54.28). Results Overall, the participants reported moderate levels of caregiver burden and family stigma. Additionally, as expected, family stigma made a unique – although modest – contribution to the explanation of caregiver burden. Whereas neither problem-focused coping nor emotion-focused coping played a significant role in mediating the relation between family stigma and caregiving burden, social support did mediate the relation between these variables. Conclusions Our findings reveal how social support is important as a specific way to reduce the impact of family stigma on caregiver burden.

<h2>ABSTRACT</h2><h3>Objective</h3> This study examined how features of the observer and observed contribute to stigma in Alzheimer's disease (AD). To do this, we conducted a vignette experiment examining how participant and patient gender identities modify AD stigma. <h3>Participants</h3> A sample of 1,817 U.S. adult men and women invited at random. <h3>Methods</h3> Participants read a vignette about a hypothetical patient that was either a man or woman. The patient's clinical characteristics varied by symptom stage (from Clinical Dementia Rating stage 0, no impairment, to 2, moderate dementia), biomarker result (positive vs. negative), and disease-modifying treatment (available vs. unavailable). Multiple regression analyses assessed whether participant gender, patient gender, or their interaction influenced ratings on the Modified <i>Family Stigma in Alzheimer's Disease Scale</i>. <h3>Findings</h3> In comparisons of mild stage symptoms and no clinical symptoms, women made stronger attributions of symptom severity than men (aOR = 1.60, 95%CI 1.06–2.40) and expressed stronger support (aOR = 1.62, 95%CI 1.09–2.40) than men. In comparisons of a positive vs. negative biomarker test result, women had a larger increase than men in worries about structural discrimination (aOR = 1.39, 95%CI 1.01–1.92) and pity (aOR = 1.52, 95%CI 1.10–2.10). The female patient in the vignette evoked fewer negative aesthetic attributions compared to the male patient (aOR=0.79, 95%CI 0.66–0.95). <h3>Conclusions</h3> In most instances, participant gender effects modified AD stigma while patient effects did not. Men may be judged more harshly as patients, while women may experience a worse internalized stigma. The findings advance understanding of AD stigma mechanisms.

To the Editor: With the increase in life expectancy, the number of adults aged 60 and older will increase to 2 billion by 2050, 80% of whom will be living in developing countries.1 Falling is one of the main health problems of older adults, with approximately one-third of individuals aged 65 and older experiencing falls.2 Falls and fear of falls are related to one another, with each being a risk factor for the other.3 Fear of falls may result in avoidance of daily activities and reduction in the older adult's quality of life.4, 5 The Falls Efficacy Scale—International (FES-I) is an instrument that Prevention of Falls Network Europe (ProFaNE) designed to investigate fear of falls in older adults.6 The present study was conducted to assess the reliability and validity of a Persian version of the FES-I in Iranian older adults. Individuals aged 60 and older from a retirement center in Tabriz (Iran) who were able to speak, comprehend, read, and write Persian and were living independently in the community participated (n = 200). The study was performed between October 2012 and March 2013 after approval of the ethics committee of Tabriz University of Medical Sciences. The FES-I is a self-report questionnaire with 16 items assessed on a four-item Likert scale (not at all concerned to very concerned).6 Cronbach alpha (internal consistency) and Spearman-Brown correlation coefficients (test–retest) were used to investigate reliability; values greater than 0.7 indicated good reliability, and values less than 0.5 indicated unacceptable reliability.7 To determine the validity of the construct, exploratory and confirmatory factor analysis were considered. Correlation matrix, principal axis factoring, varimax rotation, and the Kaiser-Meyer-Olkin measure of sampling adequacy (KMO) were used for exploratory factor analysis.1 To evaluate the structure of the factors of exploratory factor analysis, goodness of fit of confirmatory factor analysis was conducted based on chi-square degrees of freedom (χ2/df) less than 5, goodness-of fit index (GFI), adjusted goodness-of-fit index (AGFI) greater than 0.9, root mean square residual (RMSR) less than 0.1, root mean square error of approximation (RMSEA) less than 0.08, comparative fit index (CFI) greater than 0.9, normed fit index (NFI) greater than 0.9, non-normed fit index (NNFI) greater than 0.9, incremental fit index (IFI) greater than 0.9, relative fit index (RFI).7 Data analysis was performed using SPSS version 11.5 (SPSS Inc., Chicago, IL). In all analyses, P < .05 was considered statistically significant. Cronbach alpha was 0.90 to 0.95 and Spearman-Brown correlation coefficients were 0.82 to 0.84 for the factors and total instrument. The adequacy of the factor analysis model was confirmed (KMO = 0.936 and for Bartlett test, χ2 of Bartlett test was 2,505.781, df 120, P < .05). In exploratory factor analysis with varimax rotation, two factors were extracted. Items 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, and 16 from the questionnaire were loaded in the first factor, and items 11, 13, 14, and 15 were loaded in the second factor. Two extracted factors determined 67.55% of total variance changes.1 In confirmatory factor analysis, based on the comparison of the data of goodness of fit for two- and one-factor analysis and theoretical basic (χ2/df < 5, RMSR < 0.1, NFI > 0.9, NNFI > 0.9, CFI > 0.9, IFI > 0.91) and the closeness of GFI and AGFI to 0.9, there was no considerable difference in these values for three models. All relationships between the items and factors were significant (P < .05). Thus, based on this model, the structure of exploratory factor analysis for this questionnaire was confirmed in two factors (Table 1). Test–retest and internal consistency reliability in accordance with previous literature were confirmed.6, 8-10 In the investigation of factor analysis in the present study and other studies, two factors were extracted, but loaded items on each factor in the studies were different.6, 10 Based on the results of this study, the Persian version of the FES-I has good validity and reliability in community-dwelling older people. This instrument can be used as an easy, low-cost method of measuring fear of falling in Iranian older adults. This article is the result of a thesis approved by the ethics committee of Tabriz University of medical sciences no. 9161. Our gratitude goes to all the older adults participating in this study, ProFANE, and the collaboration of Persian and English translators who helped us in translating the instrument. Finally, we are grateful to the staff of the Tabriz retirement center in allowing us to conduct the research there. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: All authors contributed to this paper. Sponsor's Role: None.

ObjectivesThis study aims to explore dementia knowledge and public stigma toward people with dementia (PWD) upheld by Vietnamese adults in their regular metropolitan sociocultural contexts, and their individual and contextual associated factors.MethodsA total of 720 adult participants, aged from 18 to 59, 43.47% of them resided in Northern Vietnam (Hanoi), and 56.53% in Southern Vietnam (Ho Chi Minh city) completed a face-to-face interview with research assistants using a printed survey. They were asked to openly report their language use of local terms and illness labels to address two typical dementia symptom scenarios. Their open-responses were noted verbatim for being coded and grouped into categories of folk and biomedical terms. They also completed other standard measures of dementia knowledge and public stigma toward PWD.ResultsParticipants reported a moderate level of standard dementia knowledge, while combining the folk and biomedical belief models with preference given to the folk beliefs in approaching dementia. Multivariate regression analyses show that education was significantly associated with dementia knowledge, both as a standard scale and open, subjective measures, and dementia stigma. Other individual factors, including anxiety about aging, age, income, exposure to dementia, as well as the contextual factor of region showed their role in predicting dementia knowledge and stigma.DiscussionResults call for future studies with more contextual factors, such as regional sub-cultures, cultural beliefs, and health policy, and imply the need for culturally tailored dementia educational program for groups of publics with diverse backgrounds, as well as advocacy campaigns of positive aging to ease destructive anxiety about aging and increase the willingness to learn about dementia.

Diseño y validación de un instrumento sobre calidad de la planificación anticipada de decisiones para profesionales

Cognitive stimulation therapy (CST) has been shown to have significant benefits in enhancing cognitive functioning and improving the quality of life of people with mild to moderate dementia. The present study examines the efficacy of the Italian version of the therapy (CST-IT). Older adults with mild to moderate dementia (n = 39) were randomly assigned to two programs: one group participated in the CST-IT, consisting of 14 sessions (twice a week for 7 weeks) and the active control group took part in alternative general activities. The outcome measures were cognitive functioning (measured by the Mini-Mental State Examination-MMSE-, the Alzheimer's Disease Assessment scale-cognitive subscale, the backward digit span test, and a narrative language test); quality of life (Quality of life--Alzheimer's Disease scale); mood (Cornell scale for depression in dementia and the social and emotional loneliness scale); functional activities in daily living (Disability Assessment for Dementia); and behavior (neuropsychiatric inventory). After the intervention, only the CST-IT group maintained its MMSE score, while the control group displayed deterioration. The CST-IT group also performed better in some of the cognitive measures (Alzheimer's Disease Assessment Scale-Cognitive subscale and narrative language), mood measures (Cornell scale, social and emotional loneliness scale with a decrease in reported loneliness), and the Quality of life--Alzheimer's Disease scale. No other treatment effect was observed. The findings confirm the efficacy, at least in the short term, of the CST in sustaining cognitive functions and perceived quality of life in older adults with dementia in the Italian care setting as well.

Research shows that people with intellectual disability (ID) face public stigma. However, a recently published narrative review suggests that this phenomenon has not been explored in a Latin American country. This study fills the gap in our understanding of public stigma towards people with intellectual disability in Chile. 395 adults from the general population (18 to 78 years) participated in the survey. Using the Intellectual Disability Literacy Scale, adapted for Chile, we explored the participants' literacy about ID, their causal beliefs, and desire of social distance. Only 1.3% of the sample identified intellectual disability in the instrument's vignette. The most common causal attribution for the condition was environmental, followed by biomedical factors. Participants showed a high desire of social distance, with higher scores associated with more educated participants. Our findings show that low literacy about intellectual disability and a high desire for social distance are significant factors contributing to public stigma in Chile. These are tangible targets for change that can lead to increased social inclusion and participation of people with intellectual disability in Chile. Any such approaches are likely to be transferable to other Latin American countries and could help reduce public stigma for this population.