Cultural validation of a new instrument to measure leprosy-related stigma: the SARI Stigma Scale

BackgroundThere is a need for comprehensive, valid and reliable instruments to assess leprosy-related stigma. This paper presents the process of the cross-cultural validation of an instrument in Cirebon District, Indonesia initiated by the Stigma Assessment and Reduction of Impact (SARI) project.MethodsThe Berger Scale was initially developed to assess HIV/AIDS-relatedstigma. This study explores the conceptual, item, semantic, operational andmeasurement equivalence of this scale for leprosy. The process included a qualitativestudy, translation and back-translation, training of interviewers, a pilot and the maindata collection. We aimed for a sample of 154 people affected by leprosy with60 repeat interviews. They were selected through convenience sampling.ResultsThe original scale showed acceptable conceptual equivalence, butinsufficient item, semantic and operational equivalences. For instance, there wereirrelevant HIV-related items and the respondents found it difficult to indicate theirlevel of agreement with the given statements. Major adjustments were necessary,leading to a new version of the scale. The measurement properties of the new versionshowed good internal consistency (Cronbach’s alpha 0·88); no floor or ceiling effects;and a good reliability (intra-class correlation coefficient 0·75).