Perceived stigma of caregivers: Psychometric evaluation for Devaluation of Consumer Families Scale

Mental health help-seeking in China

BACKGROUND

In China, mental health disorders are considered the leading causes of disability, yet treatment-seeking behaviors among individuals with mental health problems are deficient.

AIMS

This study sought to examine attitudes and participant characteristics associated with help-seeking among adults residing in China's Shanghai metropolitan area.

METHODS

This study employed a convenience cross-sectional sampling strategy and recruited 500 participants in public places in Shanghai. The survey administered in Mandarin was comprised of two sections: a series of demographic questions and standardized instruments measuring stigma and help-seeking attitudes.

RESULTS

Findings indicate that beliefs about seeking professional help for mental health are influenced by knowing someone with a mental health problem. In addition, men who were older, had a child, and were married endorsed more openness to help-seeking for mental health needs, underscoring the importance of life experience as an essential variable when considering attitudes toward help-seeking.

CONCLUSIONS

Findings support future research identifying the mechanisms by which these life experiences impact individuals' help-seeking attitudes.

Psychometric evaluation of the affiliate stigma scale for caregivers of people with mental illness in Uganda

BACKGROUND

Affiliate stigma is common among caregivers of people with mental illness and impacts negatively on the caregivers' quality of life and their ability to care for the patients. Although there is evidence of affiliate stigma in sub-Saharan Africa, the psychometric properties of commonly used tools are not available in the African context. The aim of this analysis was to evaluate the factor structure of the affiliate stigma scale among caregivers of people with mental illness in southwestern Uganda. Having a validated method to assess affiliate stigma in the Ugandan setting helps to appropriately evaluate affiliate stigma among caregivers of people with mental illnesses, which could inform the development of interventions to support such caregivers.

METHOD

A total of 385 caregivers of people with mental illness attending outpatient psychiatry clinics in selected tertiary hospitals in southwestern Uganda were enrolled in the study. The affiliate stigma and depression were assessed using the affiliate stigma scale and the patient health questionnaire (PHQ-9) respectively. We conducted exploratory and confirmatory factor analysis to determine the factor structure, reliability and validity of the affiliate stigma scale. We also evaluated the convergent validity of the affiliate stigma scale by determining the correlation between affiliate stigma scale scores and the PHQ-9.

RESULT

More than half of participants were male (55.06%) and majority of caregivers were living in rural areas (80.26%). The sample size was adequate, as evidenced by the KMO of 0.91 and the inter-correlation was sufficient to conduct the factor analysis, according to the Bartlett test. Confirmatory factor analysis revealed four factors and all 22 items were retained as all of them had a factor loading > 0.4. The internal consistency of the total scale was excellent (alpha = 0.92). The affiliate stigma score correlated with depression which has been hypothesized to be associated with the stigma of mental illness.

CONCLUSION

The study findings show the affiliate stigma scale as a valid measure of affiliate stigma among the caregivers of patients with mental illness in southwestern Uganda. Therefore, this scale provides an opportunity to mental health care providers to assess affiliate stigma and develop interventions aimed at prevention stigma among caregivers and improve outcomes among people with mental illness.

Suicide risks among caregivers of patients with depressive disorders

OBJECTIVE

To investigate the suicide risk factors among caregivers of individuals with depression who may develop suicidal ideation due to the ongoing challenges of managing the patient's mood fluctuations.

METHODS

This cross-sectional study enrolled dyads of patients with depression and their caregivers from a medical centre. The assessment included a psychiatric diagnostic interview, the Hospital Anxiety and Depression Scale, the List of Threatening Experiences, Benefit Finding Scale, Numerical Pain Rating Scale, Stigma Subscale of the Explanatory Model Interview Catalogue, Big Five Inventory-10, the Family APGAR Index and the Suicide Assessment Scale. Univariate and multivariate regression analysis were used to explore the interrelationship between the mental health of patients and caregivers.

RESULTS

Among the 125 caregivers, 60.0% (n = 75) were females. The most common psychiatric diagnoses were depressive disorders (33 of 125; 26.4%), followed by anxiety disorders (21 of 125; 16.8%) and insomnia disorder (19 of 125; 15.2%). There was a significant association between the stressful life events of depressive patients and the suicide risk of their caregivers. The severity of anxiety and depression in caregivers was significantly associated with the suicide risk among the caregivers.

CONCLUSION

A relationship may exist between the psychological well-being of patients with depression and their caregivers.

Mental health help-seeking in Mexico

Most people in need of mental health services in Mexico do not seek formal support or professional services to address their mental health needs. Understanding help-seeking behaviors is crucial to addressing underutilized mental health services and to leverage health promotion efforts. Data were collected as part of a larger research project on stigma and help-seeking for mental-health-related concerns in Mexico. A convenience sample of 469 adults residing in Mexico City participated in the study using an experimental vignette methodology assessing stigma toward individuals with mental health conditions, along with characteristics and demographic correlates of help-seeking. All survey measures were administered in Spanish. A structural regression was conducted for the outcome 'openness to professional help seeking for mental health problems' as a latent variable. Compared with males, females were more open to professional help seeking (b = 0.09, p = 0.038), as were people who endorsed higher spirituality (b = 0.01, p = 0.006); while people who experienced self-stigma were less open to professional help-seeking for mental health concerns (b = -0.15, p = 0.005). Self-stigma was a major driver of low service utilization. Contrary to previous studies, spirituality was a significant positive predictor of professional help-seeking. A more nuanced understanding of mental health help-seeking in Mexico can be useful for outreach efforts to increase service utilization both in Mexico and among Latinos in the United States (US). Given historical, geographic, and cultural ties with the US, it is important to understand mental health help-seeking in Mexico, which may relate directly to help-seeking behaviors in many US Latinos who have immigrated to the US. Directions for future research and practice implications are discussed, including a roadmap for health promotion activities.

The impact of mental health literacy intervention on in-service teachers' knowledge attitude and self-efficacy

Mental health literacy (MHL) is an essential component in the process of de-stigmatization, promoting mental health, and supporting people struggling with mental illness. Today, as the number of people suffering from mental illnesses is nearly 450 million people worldwide, the importance of having a teacher-training program that incorporates MHL in its curriculum has become paramount. This study is a quasi-experimental pre-post research that uses the MHL program as an intervention. The sample included 36 (n = 36) high school in-service teachers from 11 schools. The participants took an online training program for 6 weeks. The evaluations were used before and after the training to assess their mental health knowledge, attitude, and self-efficacy. The data were analyzed using the paired sample t-test. The findings revealed a significant level of improvement in relation to the teachers' MHL knowledge, attitude, and self-efficacy after the training. The study findings reveal the effectiveness of MHL training in improving in-service teachers' knowledge, attitude, and self-efficacy in relation to mental health. The study's limitations and future study recommendations are discussed.

Affiliate stigma of mental illness in family caregivers of persons with mental illness in Hong Kong

BACKGROUND

Affiliate stigma of family caregivers may severely influence family caregiving, early treatment, and recovery of people with mental illness (PMI), and it may be impacted by the knowledge of mental illness and contact with PMI. However, little is known about the correlation between affiliate stigma of family caregivers of PMI and contact in Hong Kong.

AIMS

This study aimed to investigate affiliate stigma and its influencing factors among family caregivers of PMI in Hong Kong.

METHODS

A total of 106 family caregivers in Hong Kong participated in the study. The measurements included affiliate stigma, contacts (quantity, quality, and level), knowledge, prejudice, and discriminatory behaviors. Multiple regression analyses were employed.

RESULTS

The mean score of affiliate stigma scale (ASS) in family caregivers was 2.17 (SD = 0.65). In regression analyses, the results showed that contact quantity and contact level were significantly associated with higher affiliate stigma and its cognitive domain, while contact quality (e.g. positive contact) were significantly associated with lower affiliate stigma and its all domains among family caregivers. The positive relationship between prejudicial attitudes and affiliate stigma was also found.

CONCLUSIONS

Affiliate stigma is severe among family caregivers of PMI in Hong Kong. The results of this study indicate that contact, especially positive contact, contributes to reducing affiliate stigma among family caregivers of PMI. The results of this study are important for development of health policy on reducing stigma in family caregivers of PMI. The effectiveness of Enhancing Contact Model (ECM) should be examined in future anti-stigma interventions.

Quality of life and associated factors among family caregivers of individuals with psychiatric illness at DRH, South Wollo, Ethiopia, 2020

Mental illness results in an enormous social and economic burden not only on patients, but also on their families and communities. Many caregivers of patients with mental illnesses suffer from an extremely poor quality of life. In Sub-Saharan Africa, approximately 71% caregivers suffer from economic burden of severe mental illness. To our knowledge, no study has been conducted on quality of life of caregivers in Ethiopia. Therefore, this study aimed to assess the quality of life of family caregivers of patients with mental illness at Dessie Referral Hospital. The institution-based cross-sectional study was conducted among 398 caregivers selected using a consecutive sampling technique. The World Health Organization Quality of Life BREF was used to assess the quality of life. Logistic regression was performed and statistical significance was declared at a p-value < 0.05. 189 (47.5%) of family caregivers had poor quality of life. Being divorced, unable to read and write, primary education, being spouse, sibling and children of the patient, poor social support and high perceived stigma were significantly associated with the outcome variable. Because the magnitude of poor quality of life among family caregivers was high, family intervention programs are highly recommended to improve quality of life among caregivers.

Improving the care stress, life quality, and family functions for family-caregiver in long-term care by home modification

This study examined whether interventions through barrier-free home environment improvements could reduce family caregivers' care stress, improve their family functions, and increase their quality of life. This study recruited family caregivers of older people with disabilities from a long-term care management center in central Taiwan. These older people required improvements related to a barrier-free home environment. A pretest was conducted before and a post-test was conducted 2 months after the improvements. The content of the pretest and the post-test questionnaires included: demographic characteristics, Caregiver stress scale, Family functions scale, World Health Organization Quality of Life-BREF (WHOQOL-BREF) Questionnaire. This study recruited 72 family caregivers; the average age was 56.25 ± 12.99 years. The results indicated that interventions through barrier-free home environment improvements could significantly reduce the family caregivers' care stress, improve their family functions (e.g., reducing conflicts), and enhance their quality of life. Additionally, after intervention, the family cohesion of family caregivers caring for those with mild disability improved to a greater extent than did that of those caring for people with other disease severities. This study revealed that interventions involving barrier-free home environment improvements have positive effects on family caregivers.

Effectiveness of enhancing contact model on reducing stigma of mental illness among family caregivers of persons with schizophrenia in rural China: A cluster randomized controlled trial

Background

Contact-based intervention has been documented and proved effective on reducing stigma of mental illness in high-income countries, but it is still unclear about the effectiveness of the contact-based intervention among family caregivers of persons with schizophrenia (FCPWS) in low- and middle-income countries including rural China.

Methods

We conducted a cluster randomized controlled trial in FCPWS in eight rural townships in Xinjin district of Chengdu city in Southwest China. The FCPWS in these townships were randomly allocated to the Enhancing Contact Model (ECM), Psychoeducational Family Intervention (PFI), or Treatment as Usual (TAU) group. FCPWS in three groups were provided specific interventions and follow-ups. By using a mixed-effect model, our goal was to examine the differences in affiliate self-stigma scale (ASSS) scores among three groups with the data collected at baseline (T0), post-intervention (T1), 3-month (T2), and 9-month (T3) follow-up timepoints, respectively. This trial is registered with ChiCTR, number ChiCTR2000039133.

Findings

In April 2019, 253 FCPWS from 8 townships were randomly assigned to receive either ECM (cluster=3, n=90), PFI (cluster=2, n=81), or TAU (cluster=3, n=82). Compared with participants in the TAU group, participants in the ECM group had statistically significantly lower ASSS scores at 9-month follow-up (estimated parameter [EP]= -5.51, 95% CI -10.27 to -0.74, p=0.02). There were no statistically significantly different ASSS scores at 9-month follow up between ECM and PFI groups. Compared with participants in the PFI group, younger (<60 years old), with higher monthly income and other caregiver (e.g., parent, sibling, child) participants in the ECM group had statistically significantly lower ASSS scores in the 3-month follow-up (EP = -5.66, 95% CI -10.13 to -1.19, p<0.01; EP = -7.82, 95% CI -11.87 to -3.78, p<0.001; EP = -6.79, 95% CI -10.69 to -2.90, p<0.001, respectively).

Interpretation

This first trial in rural China shows that ECM intervention, a new anti-stigma intervention model, is a promising method for reducing affiliate stigma among FCPWS. The ECM intervention is more effective and stable than the PFI on reducing affiliate stigma among FCPWS. Further research needs to explore whether a long-term intervention could produce a more positive anti-stigma outcome trajectory.

Funding

General Research Fund, University Grants Committee, Hong Kong SAR (GRF, Grant No. 17605618, 2018-2021, PI: Dr. M.S. Ran).

Prevalence of perceived stigma and associated factors among primary caregivers of children and adolescents with mental illness, Addis Ababa, Ethiopia: Cross-sectional study

Background

Mental illness exposes persons to stigma and this stigma also affects family caregivers of persons with mental illness. The objective of the study was to assess the prevalence of perceived stigma and associated factors among primary caregivers of children and adolescents with mental illness, Addis Ababa, Ethiopia.

Methods

A cross-sectional study design and systematic random sampling technique were used to recruit 408 participants at St. Paul’s Hospital Millennium Medical College and Yekatit-12 Hospital Medical College, Addis Ababa, Ethiopia. We collected the data by face-to-face interview. Devaluation of Consumer Families Scale was used to measure perceived stigma. Patient Health Questionnaire-9 and Oslo-3 social support scale were the instruments used to assess the factors. Coded variables were entered into Epidata V.3.1 and exported to SPSS V.21 for analysis. Binary logistic regression was used for analysis.

Result

A total of 408 participants were interviewed, with a response rate of 96.5%. The magnitude of perceived stigma was 38.5% with 95% CI (33.6-43.1). Majority (68.6%) of the respondents were female. In the multivariate logistic regression, being mother (AOR = 2.8, 95% CI: 1.59, 4.91), absence of other caregiver (AOR = 2.0, 95% CI: 1.15, 3.49), poor social support (AOR = 3.9, 95% CI: 1.59, 6.13), and symptoms of depression (AOR = 2.9, 95% CI: 1.88, 3.65) were factors significantly associated with perceived stigma.

Conclusion

The prevalence of perceived stigma among primary caregivers of children and adolescents with mental illness was high. Being mother, absence of other caregiver, poor social support, and symptoms of depression were factors significantly associated with perceived stigma.

Mediation of the stigma in the influence of negative symptomatology over recovery in psychosis

Background/Objective: The interest in recovery processes in psychotic disorders has boosted the necessity of knowledge about the factors that could influence in such recovery. Negative symptomatology and the stigma have been negatively linked to the recovery process in psychosis. The aim of this investigation is to improve the understanding of how the recovery process is affected by negative symptomatology based on the analysis of the mediating effects of the internalized stigma. Method: The sample was composed of 114 people that had experienced, at some point in their life, at least one clinically relevant psychotic episode. CAPE-42, STORI and ISMI were used for the evaluation. The macro PROCESS for SPSS was used. The indirect effect was calculated using 10.000 samples of bootstrap for the bootstrap confidence intervals (IC) corrected for bias. Results: The results show that the influence of negative symptomatology predicts the stigmatization of the person regarding his disorder. This predicts a negative influence in the recovery process of the psychosis. Conclusions: These results back the importance of adding the reduction of the stigma as a specific strategy to improve the recovery process in psychotic disorders.

Stigma associated with parental depression or cancer: Impact on spouse and offspring's cortisol levels and socioemotional functioning

Stress associated with caring for a mentally ill spouse can adversely affect the health status of caregivers and their children. Adding to the stress of caregiving is the stigma often placed against spouses and children of people with mental illness. Contrary to mental illness, many physical disorders such as cancer may be less stigmatized (expect pulmonary cancer). In this study, we measured externalized and internalized stigma, as well as psychological (depressive symptoms and stressful life events) and physiological (basal salivary cortisol levels) markers of stress in 115 spouses and 154 children of parents suffering from major depressive disorder, cancer, or no illness (control group). The results show that spouses and children from families with parental depression present significantly more externalized stigma than spouses and children from families with parental cancer or no illness, although we find no group differences on internalized stigma. The analysis did not show a significant group difference either for spouses or their children on depressive symptomatology, although spouses from the parental depression group reported greater work/family stress. Finally, we found that although for both spouses children the awakening cortisol response was greater on weekdays than on weekend days, salivary cortisol levels did not differ between groups. Bayes factor calculated on the null result for cortisol levels was greater than 100, providing strong evidence for the null hypothesis H0. Altogether, these results suggest an impact of stigma toward mental health disorder on psychological markers of stress but no impact of stigma on physiological markers of stress. We suggest that these results may be due to the characteristics of the families who participated in the present study.

Quality of life with pregnancy outcomes: Further evaluating item properties for refined Taiwan's FertiQoL

PURPOSE

We assessed the reliability and validity of Taiwan's version of FertiQoL, with a focus on the association between quality of life (QoL) and in-vitro-fertilization (IVF) pregnancy.

METHODS

410 women undergoing IVF treatment were included. QoL measured by Taiwan's version of FertiQoL was assessed before embryo transfer. Item properties were examined using corrected item-total correlation, Rasch mean-square (MnSq), and internal consistency. Known-group validity was assessed using IVF pregnancy (i.e., chemical pregnancy, ongoing pregnancy, live birth) as the outcomes of interest.

RESULTS

Five FertiQoL items, namely Q4, Q5, Q15, Q21, and T5, had low corrected item-total correlation (i.e., -0.146-0.290) in their embedded domains; three other items, namely Q11, Q14, and T2, did not have acceptable MnSq values in the Rasch analysis (i.e., infit MnSq: 1.31-2.28; outfit MnSq: 1.95-4.57). These items were removed and a refined Taiwan's FertiQoL was generated. The internal consistency for the refined Taiwan's FertiQoL was improved (α = 0.928) with the capability of distinguishing women who had successful live birth from those who had failed live birth (i.e., 72.40 ± 12.71vs. 69.21 ± 13.26; p = 0.019).

CONCLUSION

The study results demonstrate that the refined Taiwan's FertiQoL is valid and reliable, suggesting that this FertiQoL should refined to be culturally and language appropriate for Taiwanese population.

Psychometric testing on two weight stigma instruments in Iran: Weight Self-Stigma Questionnaire and Weight Bias Internalized Scale

PURPOSE

This study aimed to comprehensively and thoroughly examine the psychometric properties of two commonly used weight-related self-stigma instruments on Iranian adolescents with overweight or obesity: Weight Self-Stigma Questionnaire [WSSQ] and Weight Bias Internalization Scale [WBIS].

METHODS

After ensuring the linguistic validity of both the WSSQ and WBIS in their Persian versions, 737 Iranian adolescents with overweight or obesity (male = 354; mean age = 15.8 ± 1.3 years; body mass index = 30.0 ± 4.8 kg/m²) completed both questionnaires and other relevant measures regarding their depression, anxiety, stress, dietary self-efficacy, weight efficacy lifestyle, quality of life, body fat, self-esteem, body shape preoccupation, and sleepiness.

RESULTS

In the scale level, the confirmatory factory analysis verified the two-factor structure for the WSSQ and the single-factor structure for the WBIS. The factorial structures were further found to be invariant across gender (male vs. female) and across weight status (overweight vs. obesity). Additionally, both the WSSQ and WBIS had promising properties in internal consistency, test-retest reliability, separation reliability, and separation index. In the item level, all items but WBIS item 1 (infit mean square = 1.68; outfit mean square = 1.60) had satisfactory properties in factor loadings, corrected item-total correlation, test-retest reliability, and infit and outfit mean square. Moreover, all the items did not display substantial differential item functioning (DIF) across gender and across weight status.

CONCLUSION

Both the WSSQ and WBIS were valid instruments to assess the internalization of weight bias for Iranian adolescents with overweight or obesity.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Mediated effects of eating disturbances in the association of perceived weight stigma and emotional distress

PURPOSE

This study aimed to examine the relationships between perceived weight stigma, eating disturbances, and emotional distress across individuals with different self-perceived weight status.

METHODS

University students from Hong Kong (n = 400) and Taiwan (n = 307) participated in this study and completed several questionnaires: Perceived Weight Stigma questionnaire; Three-factor Eating Questionnaire; Hospital Anxiety and Depression Scale. Each participant self-reported their height, weight, and self-perceived weight status.

RESULTS

After controlling for demographics, perceived weight stigma was associated with eating disturbances (β = 0.223, p < 0.001), depression (β = 0.143, p < 0.001), and anxiety (β = 0.193, p < 0.001); and eating disturbances was associated with depression (β = 0.147, p < 0.001) and anxiety (β = 0.300, p < 0.001) in the whole sample. Additionally, eating disturbances mediated the association between perceived weight stigma and emotional distress. Similar findings were shown in the subsamples who perceived themselves as higher weight or normal weight and in the male and female subsamples. However, in the subsamples who perceived themselves as lower weight, only the links between eating disturbances and emotional distress were significant.

CONCLUSION

Perceived weight stigma was associated with eating disturbances and emotional distress in young adults with both higher and normal weight. Eating disturbances were associated with emotional distress regardless of participants' weight status.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Psychological Quality of Life in People with Physical Disability: The Effect of Internalized Stigma, Collective Action and Resilience

PURPOSE

The main objective of this study was to examine the role of social identification, collective action and resilience in reducing the negative consequences of internalized stigma on the psychological quality of life of people with physical disability using path analysis. We propose a model with two paths: the first through social identification and collective action and the second via resilience.

METHOD

A total of 288 Spanish people with physical disability aged between 18 and 82 years (46.4% males; mean [SD] of age = 45.1 [12.3] responded to the questionnaire. Data were collected for three months through an online survey.

RESULTS

The tested model adequately fit the data. We found that the relationship between internalized stigma and the psychological quality of life of people with physical disability was mediated by resilience. However, neither social identification nor collective action mediated the association between internalized stigma and quality of life among our participants.

CONCLUSIONS

The results confirmed the negative association between internalized stigma and quality of life in the population with physical disability. The results show that some interactive processes, such as resilience, may contribute to decreasing the negative effects of internalized stigma. In contrast, no effects of identification with the group or collective action intention were found.

Assessing the factorial structure of the mental illness public stigma in Spain

PURPOSE

Despite the importance of the stigma construct for the rehabilitation of people with severe mental illness, there are still no scales that offer a measurement for public stigma in Spanish with good psychometric properties. The aim of this paper is to refine and improve an existing scale to measure public stigma towards people with severe mental illness among the Spanish population. We also intended to decrease the number of items in order to facilitate its applicability.

METHOD

402 college students (73% women) responded to the attributional questionnaire (AQ27) in two subsamples. Exploratory and confirmatory factorial analysis with high cutoffs were conducted. The convergent validity with the resource allocation questionnaire was also tested.

RESULTS

We have obtained a parsimonious tool, with 14 items and four factors, and some reliable psychometric indexes and convergent validity. The factors obtained were dangerousness-fear, lack of solidarity, coercion and avoidance.

CONCLUSIONS

These results improve the findings from other studies that try to validate the AQ27 in other languages. We discuss the different factors that should be considered in the estimation of public stigma and the necessity to implement programmes to reduce it to enable recovery.IMPLICATIONS FOR REHABILITATIONSince the public stigma of mental illness is an obstacle to recovery and rehabilitation, reliable instruments are needed to assess it.A parsimonious instrument in Spanish with good psychometric characteristics for measuring public stigma is obtained.Using exploratory and confirmatory factor analysis, a questionnaire of 14 items is obtained.Four factors constitute the instrument: "dangerousness-fear", "coercion", "lack of solidarity", and "avoidance".

Psychometric Properties of the Persian Food-Life Questionnaire Short Form among Obese Breast Cancer Survivors

OBJECTIVE

To assist weight control among women with breast cancer, improving their food attitudes may be an effective method. Therefore, the present study validated a short instrument assessing food attitudes (i.e., the Short Form of the Food-Life Questionnaire [FLQ-SF]) among Iranian women with breast cancer who are overweight.

METHODS

Women with breast cancer who were overweight (n = 493; mean ± standard deviation age = 52.3 ± 10.7 years) participated in the study. All of them completed the FLQ-SF, questions designed using the theory of planned behavior (TPB; including subjective norm, perceived behavioral control, and behavioral intention), and food frequency questionnaire (FFQ). Both classical test theory and Rasch models were used to examine the psychometric properties of the FLQ-SF. More specifically, the factorial structure of the FLQ-SF was assessed using confirmatory factor analysis (CFA), the item fit was examined using the Rasch model, and the concurrent validity was evaluated using the correlation between the FLQ-SF, TPB elements, and FFQ.

RESULTS

CFA results confirmed the Persian FLQ-SF has a five-factor structure. Rasch models indicated that all the FLQ-SF items fit in the construct of food attitudes. Significant correlations between FLQ-SF and other instruments (TPB elements and FFQ) supported the concurrent validity of the FLQ-SF.

CONCLUSIONS

The psychometric findings of the present study demonstrated that Persian FLQ-SF is a reliable and valid instrument. Therefore, the Persian FLQ-SF can be applied to assess food attitudes among Iranian women with breast cancer who are overweight.

Stigma in Family Patients Who Have a Psychiatric Disorder: A Systematic Review

Introduction: The stigma in families who are caring for patients who experience mental illness in the modern era is high. Some of the experiences of patients with mental illness reveal that they are still stigmatized. This is not just the patients but also the families that care for them. The aim of this study was to conduct a systematic review relating to the stigma felt by the families of the patients experiencing mental illness.Methods: The database used  to identify the potential articles was Scopus. The articles were limited to a range of 5 years from 2014 through to 2018. The keywords used in the literature review were "Stigma Family" And "Mental illness".Results: Fifteen articles from eight countries were evaluated. The families were confirmed as experiencing stigma: labeling, stereotyping, separation and discrimination. Stigma means that the families face psychological, social and intrapersonal consequences which can reduce the family quality of life and family functioning.Conclusion: There are opportunities for negative outcomes related to the family resilience. One of the results of the study revealed that psycho-education programs using education interventions can be an alternative intervention to reduce stigma.

Level of Stigma among Spanish Nursing Students toward Mental Illness and Associated Factors: A Mixed-Methods Study

Mental health problems have been identified by the World Health Organization as a global development priority. Negative attitudes toward mental health patients have been documented in multiple health professionals. The aim of this study was to determine the level of stigma and associated factors toward people with mental health problems among students doing their degree in nursing. An explanatory sequential mixed-methods approach. A cross-sectional descriptive observational study was carried out on a sample of 359 students doing their degree in nursing. Students had to be enrolled in any of the four years of study of the degree at the time the questionnaire was done. We explored the perception and experience of students doing their degree in nursing regarding the level of stigma, through in-depth interviews (n = 30). The mean overall Mental Health Stigma Scale (MHSS) score was 30.7 points (SD = 4.52); 29.5% (n = 106) scored low for stigma, 49.9% (n = 179) showed moderate stigma, and 20.6% (n = 74) scored high. The multivariate analysis showed that 4th-year students had an OR of 0.41 (CI95%: 0.20–0.84) for high/moderate stigma and that 3rd-year students had an OR of 0.49 for high/moderate stigma compared with 1st-year students. We also observed that students with family members with mental health problems had an OR of 2.05 (CI95%: 1.19–3.56) for high/moderate stigma compared with students who did not have family members with mental health problems. The following categories emerged: fear and lack of knowledge, breaking the silence, and integration into society. The levels of mental health stigma in our sample of nursing students were moderate. Stigma levels were lower in 3rd- and 4th-year students (i.e., after having received training in mental health), and in students with family members with mental health problems.

Validating patient and physician versions of the shared decision making questionnaire in oncology setting

Background: This study investigated the psychometric properties of the 9-Item Shared Decision-Making Questionnaire (SDM-Q-9) and the 9-Item Shared Decision-Making Questionnaire-Physician version (SDM-Q-Doc) using comprehensive and thorough psychometric methods in an oncology setting. Methods: Cancer survivors (n=1783; 928 [52.05%] males) and physicians (n=154; 121[78.58%] males) participated in this study. Each cancer survivor completed the SDM-Q-9. Physicians completed the SDM-Q-Doc for each of their cancer patient. Confirmatory factor analysis (CFA) and Rasch model were used to test the psychometric properties of SDM-Q-9 and SDM-Q-Doc. Results: SDM-Q-9 and SDM-Q-Doc demonstrated unidimensional structure in CFA and Rasch model. In addition, the measurement invariance was supported for both SDM-Q-9 and SDM-QDoc across sex using the multigroup CFA. Rash analysis indicates no differential item functioning(DIF)across sex for all the SDM-Q-9 and SDM-Q-Doc items. SDM-Q-9 and SDM-Q-Doc were moderately correlated (r=0.41; P<0.001). Conclusion: SDM-Q-9 and SDM-Q-Doc are valid instruments to assess shared decision making in the oncology setting.

Determinants of satisfactory patient communication and shared decision making in patients with multiple myeloma

OBJECTIVE

To identify determinants of shared decision making in patients with multiple myeloma (MM) to facilitate the design of a program to maximize the effects of shared decision making.

METHODS

This prospective longitudinal study recruited 276 adult patients (52% male, mean age 62.86 y, SD 15.45). Each patient completed the eHealth Literacy Scale (eHEALS), Multidimensional Trust in Health Care Systems Scale (MTHCSS), Patient Communication Pattern Scale (PCPS), and 9-Item Shared Decision-Making Questionnaire (SDM-Q-9) at baseline and the SDM-Q-9 again 6 months later. One family member of the patient completed the Family Decision-Making Self-Efficacy (FDMSE) at baseline. Structural equation modeling (SEM) was used to investigate the associations between eHealth literacy (eHEALS), trust in the health care system (MTHCSS), self-efficacy in family decision making (FDMSE), patient communication pattern (PCPS), and shared decision making (SDM-Q-9).

RESULTS

SEM showed satisfactory fit (comparative fit index = 0.988) and significant correlations between the following: eHealth literacy and trust in the health care system (β = 0.723, P < 0.001); eHealth literacy and patient communication pattern (β = 0.242, P < 0.001); trust in the health care system and patient communication pattern (β = 0.397, P < 0.001); self-efficacy in family decision making and patient communication pattern (β = 0.264, P < 0.001); eHealth literacy and shared decision making (β = 0.267, P < 0.001); and patient communication pattern and shared decision making (β = 0.349, P < 0.001).

CONCLUSIONS

Patient communication and eHealth literacy were found to be important determinants of shared decision making. These factors should be taken into consideration when developing strategies to enhance the level of shared decision making.

Development and Validation of the Parental Smartphone Use Management Scale (PSUMS): Parents' Perceived Self-Efficacy with Adolescents with Attention Deficit Hyperactivity Disorder

The psychometric properties of the Parental Smartphone Use Management Scale (PSUMS) and its prospective relationships with symptoms of smartphone addiction and attention deficit hyperactivity disorder (ADHD) were studies in a sample of parents of adolescents with ADHD. This is a scale to measure parents’ perceived self-efficacy on managing their children’s smartphone use. Construct validity (exploratory factor analysis and confirmatory factor analysis), criterion-related validity (known-group validity and concurrent validity), and reliability (Cronbach’s alpha) were performed for data analyses. The results showed that the PSUMS had good factorials validity and high reliabilities, with Cronbach’s alphas ranging between 0.93 and 0.95. The 17-item PSUMS accounted for 78.58% of the total variance and contains three theoretically and statistically appropriate subscales: reactive management, proactive management, and monitoring. Strong relationships were found between parental smartphone use management and symptoms of smartphone addiction and ADHD in expected directions. Moreover, parents of children with smartphone addiction yielded lower scores on all three PSUMS subscales than parents of children without smartphone addiction. The PSUMS is considered a valuable and reliable tool in the study of parental management on their adolescent children’s smartphone use, while providing us with important targets for intervention.

Psychometric Evaluation of the Persian eHealth Literacy Scale (eHEALS) Among Elder Iranians With Heart Failure

The purpose of the present study was to examine the psychometric properties of the eHealth Literacy Scale (eHEALS) using classical test theory and modern test theory among elderly Iranian individuals with heart failure (HF). Individuals with objectively verified HF (n = 388, 234 males, mean age = 68.9 ± 3.4) completed the (i) eHEALS, (ii) Hospital Anxiety and Depression Scale, (iii) Short Form 12, (iv) 9-item European Heart Failure Self-Care Behavior Scale, and (v) 5-item Medication Adherence Report Scale. Two types of analyses were carried out to evaluate the factorial structure of the eHEALS: (i) confirmatory factor analysis (CFA) in classical test theory and (ii) Rasch analysis in modern test theory. A regression model was constructed to examine the associations between eHEALS and other instruments. CFA supported the one-factor structure of the eHEALS with significant factor loadings for all items. Rasch analysis also supported the unidimensionality of the eHEALS with item fit statistics ranging between 0.5 and 1.5. The eHEALS was significantly associated with all the external criteria. The eHEALS is suitable for health-care providers to assess eHealth literacy for individuals with HF.

The relationship between children's overweight and quality of life: A comparison of Sizing Me Up, PedsQL and Kid-KINDL

Background/Objective: Overweight and obese children are likely to encounter negative impact on psychological well-being and quality of life (QoL). Hence, for overweight and obese children, measuring QoL could go beyond simply assessing objective medical parameters and cover their physical health, psychological well-being, and social interaction. Generic (Kid-KINDL and Pediatric Quality of Life Inventory [PedsQL]) and weight-related (Sizing Me Up) measures are two major types of QoL measurement instruments; however, little is known about the differences between them. Method: We recruited 569 3rd to 6th graders from eleven schools in Southern Taiwan. In addition to the three QoL questionnaires, the Child Depression Inventory and Rosenberg Self-Esteem Scale were applied. Results: Depression had significantly negative associations with all three QoL questionnaires. Self-esteem was only associated with Kid-KINDL. Body mass index had a significantly stronger relationship with Sizing Me Up than its relationships with PedsQL and Kid-KINDL. In other words, the items related to body size concerns in Size Me Up significantly contributed to impaired overweight/obese children’s QoL. Conclusions: The study further identified the characters and strength of these QoL measures for better suggestions on evaluating physical and psychological issues for overweight/obese children.