Stigma towards people with tuberculosis: a cross-cultural adaptation and validation of a scale in Indonesia

Ahmad Fuady*, Bustanul Arifin, Ferdiana Yunita, Saidah Rauf, Agus Fitriangga, Agus Sugiharto, Finny Fitry Yani, Helmi Suryani Nasution, IWayan Gede Artawan Eka Putra, Muchtaruddin Mansyur, Tom Wingfield

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)


Introduction: Tuberculosis (TB) remains a highly stigmatised disease that can cause or exacerbate mental health disorders. Despite increased awareness of the importance of reducing TB stigma, validated tools to measure TB stigma remain scarce. This study aimed to culturally adapt and validate the Van Rie TB Stigma Scale in Indonesia, a country with the second largest TB incidence worldwide.

Methods: We validated the scale in three phases: translation, cultural adaptation, and psychometric evaluation. We invited diverse experts to an interdisciplinary panel for the cross-cultural adaptation, then performed a psychometric evaluation of the scale: exploratory and confirmatory factor analyses, reliability analysis, and correlation analysis with Patient Health Questionnaire 9 [PHQ-9].

Results: We culturally adapted the original scale's language and content during the translation and cultural adaptation phases. After psychometric evaluation with 401 participants in seven provinces of Indonesia, we removed two items. The new scale had two forms: (A) patient and (B) community perspective forms. Both forms had good internal consistency, with respective Cronbach's alpha values of 0.738 and 0.807. We identified three loading factors in Form A (disclosure, isolation, and guilty) and two loading factors in Form B (isolation and distancing). The scale showed correlation with PHQ-9 (Form A, rs = 0.347, p < 0.001; Form B, rs = 0).

Conclusions: The culturally adapted Indonesian version of Van Rie's TB Stigma Scale is comprehensive, reliable, internally consistent, and valid. The scale is now ready for applied scale-up in research and practice to measure TB-stigma and evaluate the impact of TB-stigma reduction interventions in Indonesia.

Original languageEnglish
Article number112
Number of pages11
JournalBMC psychology
Issue number1
Publication statusPublished - 13 Apr 2023

Bibliographical note

Funding Information:
This study had funding from PUTI Q1 Grant, Universitas Indonesia (Grant No. NKB-1103) and the Royal Society of Tropical Medicine and Hygiene, United Kingdom (Grant No. 19590206). TW is supported by grants from the Wellcome Trust, UK (209075/Z/17/Z), the Medical Research Council, Department for International Development, and Wellcome Trust (Joint Global Health Trials, MR/V004832/1), and the Medical Research Foundation (Dorothy Temple Cross International Collaboration Research Grant, MRF-131–0006-RG-KHOS-C0942).

Funding Information:
We acknowledge the supports from Fajri Gafar and Trisasi Lestari in translating the original scale to Indonesian; and Risatianti Kolopaking, Feranindhya Agiananda, Diah Handayani, Angelin Yuvensia, and Indonesian National TB Program officers in providing suggestion and insightful comments during expert panel meeting. We thank all enumerators (Annisa Melianriza, Rima Moehira [West Sumatera]; Fauzan Imari, Aprilya Elchamonika, Rania Nabila Balkis [Jambi]; Salsabila Auni Putri, Rossa Maulida Falatehan [Jakarta]; Prihan Fakhri [West Kalimantan]; IDGA Narendra Suputra, Ni Kadek Putri Ayu Aprilia Swandewi, Ni Wayan Hilda Yani, I Made Tejamurti Anggara, Ida Ayu Made Gia Cahyani [Bali]; Mardiana, Jumriana, Husnul Khotimah, Dian Nur Alisah [South Sulawesi]; and Saada Lestaluhu, Mahvut T, Sakina A. Tehuayo, Sitti Johri Nasela, Samsia Rumuar, Rafela Suarlembit, Rahma Abdurahman Suatkab [Maluku]), province-, district-, and Puskesmas-level TB officers in seven provinces. We also thank Annelies Van Rie and Aaron Kipp for allowing us to validate their original scale to Indonesian setting.

Publisher Copyright:
© 2023, The Author(s).


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