Stigma towards people with tuberculosis: a cross-cultural adaptation and validation of a scale in Indonesia

Introduction Tuberculosis (TB) remains a highly stigmatised disease that can cause or exacerbate mental health disorders. Despite increased awareness of the importance of reducing TB stigma, validated tools to measure TB stigma remain scarce. This study aimed to culturally adapt and validate the Van Rie TB Stigma Scale in Indonesia, a country with the second largest TB incidence worldwide.
Methods We validated the scale in three phases: translation, cultural adaptation, and psychometric evaluation. We invited diverse experts to an interdisciplinary panel for the cross-cultural adaptation, then performed a psychometric evaluation of the scale: exploratory and confrmatory factor analyses, reliability analysis, and correlation analysis with Patient Health Questionnaire 9 [PHQ-9].
Results We culturally adapted the original scale’s language and content during the translation and cultural adapta- tion phases. After psychometric evaluation with 401 participants in seven provinces of Indonesia, we removed two items. The new scale had two forms: (A) patient and (B) community perspective forms. Both forms had good internal consistency, with respective Cronbach’s alpha values of 0.738 and 0.807. We identifed three loading factors in Form A (disclosure, isolation, and guilty) and two loading factors in Form B (isolation and distancing). The scale showed cor- relation with PHQ-9 (Form A, rs=0.347, p<0.001; Form B, rs=0).
Conclusions The culturally adapted Indonesian version of Van Rie’s TB Stigma Scale is comprehensive, reliable, inter- nally consistent, and valid. The scale is now ready for applied scale-up in research and practice to measure TB-stigma and evaluate the impact of TB-stigma reduction interventions in Indonesia.
Keywords Tuberculosis, Stigma, Tool, Scale, Indonesia