Cross-Cultural Adaptation of Scales Measuring Stigma Related to HPV, HIV, and Cervical Cancer Stigma for Use in a Kenyan Context
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Objective
To develop and validate a culturally adapted stigma scale to measure the levels and effects of human papillomavirus (HPV)- and cervical cancer-related stigma, especially as cervical cancer prevention strategies become globally available.
Methods
Between February 2020 and May 2022 in Kisumu, Kenya, we adapted items from existing validated scales addressing HIV, HPV, and cervical cancer stigma and incorporated additional items based on qualitative data, forming an item pool across three dimensions: stigmatizing attitudes, enacted stigma, and internalized stigma. Cognitive interviews (CIs) were conducted in English and Dhluo to refine items. Psychometric properties were assessed using exploratory and confirmatory factor analysis.
Results
Following CIs, we conducted a pilot survey with 998 participants and subsequently a validation survey with 480 women. Psychometric analysis identified 77 items with satisfactory properties across four health domains. The average factor loading of retained items was 0.64 (SD = 0.08), and all final scale models demonstrated high internal consistency (Cronbach’s alpha > 0.9).
Conclusions
This rigorously validated tool offers a reliable method to evaluate stigma’s impact on screening behaviors and assess stigma-responsive interventions as HPV vaccination and testing expand globally.
Clinical Impact Statement
Our team developed contextually relevant item pools to measure stigma related to HPV and cervical cancer in areas of high HIV prevalence in western Kenya. Through cognitive interviews, pilot survey, and validation survey, we tailored down the final item pool to 77 items with Cronbach’s alpha all greater than 0.9. As HPV vaccination and testing become more available in the target location, it remains imperative for researchers and providers to recognize and avoid furthering stigma. These tools can be used to measure the impact of stigma on health engagement and outcomes and the impact of stigma-reduction interventions in this area.
