Adaptation and validation of the Van Rie tuberculosis stigma scale in healthcare workers in Indonesia

Stigma related to tuberculosis (TB) is not limited to society and the workplace but also extends to healthcare settings. Stigma can result in delayed diagnoses, poor medication adherence, and a reduced quality of life. Currently, there is no instrument available to assess TB stigma among healthcare workers. This study aimed to adapt and validate a tuberculosis stigma scale specifically for health workers in Indonesia.

This study used Exploratory Sequential Mixed Methods. Instrument development was carried out in three stages: translation, cross-cultural adaptation, and psychometric evaluation. The instrument adapted and validated in this study was the standardized Van Rie questionnaire. A total of 305 respondents from three areas such as Banyumas Regency, Yogyakarta City, and Malang City participated in this study. To assess the tool's internal consistency and reliability, a psychometric evaluation was conducted using exploratory and confirmatory factor analyses (EFA and CFA).

Isolation and exclusion from medical facilities are the two categories of questions that have been identified. The results of the CFA demonstrated that the calculated chi-square value for our model was chi-square/DF = 186.713/43 = 4.3 (>3). The model was reasonably fit based on the following findings: the determining root mean square error of approximation (RMSEA) = 0.105 (>0.08), normed fit index (NFI) = 0.837 (<0.90), tucker-lewis index (TLI) = 0.832 (<0.95), and standardized root mean square residual (SRMR) = 0.080 (<0.10). The instrument was reliable with a Cronbach's alpha of 0.829.

This validated, consistent, and reliable adapted tool is ready to use in larger-scale evaluation of TB-related stigma among health workers in healthcare settings to develop strategies to eliminate TB-related stigma.