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YENDEWA GA, SELLU EJ, KPAKA RA, JAMES PB, YENDEWA SA, CUMMINGS PE, BABAWO LM, MASSAQUOI SP, GHAZAWI M, OCAMA P, LAKOH S, BABAWO LS, SALATA RA. Measuring stigma associated with hepatitis B virus infection in Sierra Leone: Validation of an abridged Berger HIV stigma scale. J Viral Hepat 2023; 30:621-629. [PMID: 37084170 PMCID: PMC10330123 DOI: 10.1111/jvh.13838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/08/2023] [Indexed: 04/22/2023]
Abstract
Stigma associated with hepatitis B virus (HBV) is common in endemic countries; however; instruments are lacking to accurately measure HBV-related stigma. We therefore aimed to develop and validate a concise instrument for measuring perceived HBV-related stigma in Sierra Leone. We enrolled 220 people living with HBV (PWHB) aged ≥18 years from August to November 2022. The initial Likert-scale instrument entailed 12 items adapted from Berger's HIV Stigma Scale. We included four additional items adapted from the USAID indicators for enacted stigma. The proposed scale's psychometric properties were assessed. After item reduction, the final HBV Stigma Scale consisted of 10 items and had good internal consistency (overall Cronbach's α = 0.74), discriminant, and construct validity. Exploratory factor analysis produced a three-dimensional structure accounting for 59.3% of variance: personalized stigma driven by public attitudes (six items), negative self-image (two items), and disclosure concerns (two items). Overall, 72.8% of respondents reported perceived HBV-related stigma (mean score 29.11 ± 4.14) and a similar proportion (73.6%) reported at least one instance of enacted stigma. In assessing criterion-related validity, perceived HBV-related stigma correlated strongly with enacted stigma (r = 0.556) and inversely with having family/friends with HBV (r = -0.059). The 10-item HBV Stigma Scale demonstrated good internal consistency and validity and is suitable for screening for HBV-related stigma in Sierra Leone. The psychometric properties of the scale can be optimized with item additions/modifications and confirmatory factor analysis. The scale may help in combating stigma as a barrier to achieving HBV global elimination goals.
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Affiliation(s)
- George A. YENDEWA
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Edmond J. SELLU
- Department of Nursing, School of Community Health Sciences, Njala University, Bo Campus, Sierra Leone
| | - Rashid A. KPAKA
- Department of Public Health, Faculty of Health Sciences and Disaster Management, Eastern Technical University, Kenema, Sierra Leone
| | - Peter B. JAMES
- Faculty of Health, Southern Cross University, Lismore, Australia
| | | | | | - Lawrence M. BABAWO
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | | | | - Ponsiano OCAMA
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sulaiman LAKOH
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Lawrence S. BABAWO
- Department of Nursing, School of Community Health Sciences, Njala University, Bo Campus, Sierra Leone
- Department of Public Health, Faculty of Health Sciences and Disaster Management, Eastern Technical University, Kenema, Sierra Leone
| | - Robert A. SALATA
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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