Reliability And Validity Of The Chinese Version Of The Stigma Scale For Chronic Illness And Application In Stroke Patients

Objectives1.To translate the English version of Stigma Scale for Chronic Illness(SSCI)into Chinese and to test the reliability and validity of the Chinese version of Stigma Scale for Chronic Illness in patients with stroke.2.To investigate the level and influencing factors of stigma in stroke patients.Methods1.From March 2016 to June 2016,a total of 204 patients with stroke were recruited using convenience sampling method.The Chinese version was developed by direction translation,back translation,and was reviewed and culturally adjusted by panel of experts.Stroke patients were investigated using Socio-demographic Questionnaire,Stigma Scale for Chronic Illness,Barthel Index Scale,Self-Rating Depression Scale and SF-12 Item analysis.The content validity,construct validity,internal consistency and rest-retest reliability,were applied to test the reliability and validity.2.From March 2016 to June 2016,189 stroke patients were investigated using Socio-demographic Questionnaire,Stigma Scale for Chronic Illness,Barthel Index,Self-Rating Depression Scale,Medical Moping Questionnaire,and Social Support Rating Scale.Using univariate analyses to compare the sitgma in different groups and using the continuous variables(acitivity of daily living,depression,social support,family and medical coping strategies)to test the bivariate correlation coefficient.A multiple linear regression analysis was performed to explore the potential influencing factors of stigma in patients with stroke.Results1.Psychometric characteristics of Chinese version of SSCIItem analysis showed that the Chinese version of SSCI could discriminate the high score group from the low group(P<0.01).Correlation coefficient between the scores of each item and the total score was 0.472~0.806;correlation coefficient between the scores of the 13 items of the dimension of self-stigma and the score of the dimension was 0.673~0.807;correlation coefficient between the scores of the 11 items of the dimension of enacted stigma and the score of the dimension was 0.519~0.845;The correlation coefficient between self-stigma,enacted stigma and the total score was 0.955,0.900 respectively(P<0.01).Internal consistency was confirmed by Cronbach's ? coefficient of 0.951,and the Cronbach's ? of self-stigma and enacted stigma were both 0.927;the test-retest interclass correlation of total scale was both 0.881,and the test-retest interclass correlation of self-stigma and enacted stigma was 0.927,0.797 respectively.From exploratory factor analysis,3 factors were generated with an accumulated variance contribution of 65.586%.The item content validity index ranged from 0.800-1.000,the scale content validity indices of S-CVI was 0.932.As for the association between the SSCI and depression,activity of daily living,MCS and PCS of SF-12,Pearson's correlation was 0.609,-0.486,-0.524,-0.462(P<0.01).2.Influecing factors of sitgma in stroke patientsThe total score of SSCI was(44.96±16.71),score of self-stigma was(27.70±10.91),score of enacted-stigma was(17.26±7.00).Univariate analysis revealed total stigma was significantly associated with patients' marital status,employment status,type of stroke,stroke event,sequel or not,duration of disease(P<0.05).In the bivariate correlation analysis,total score of stigma were associated with activity of daily living,depression status,objective support,subjective support,utilization of support,avoding yielding coping strategy(P<0.01).Multiple regression analysis showed that stroke patients' depression,avoiding coping,subjective support and activity of daily living were influencing factors of total score of SSCI,which explained 57.5% of the variance.Univariate analysis revealed self stigma was significantly associated with patients' employment status,type of stroke,stroke event,sequel or not,duration of disease(P<0.05).In the bivariate correlation analysis,total score of stigma were associated with activity of daily living,depression status,objective support,subjective support,utilization of support,avoding yielding coping strategy(P<0.01).Multiple regression analysis showed that stroke patients' depression,avoiding coping,subjective support,activity of daily living,sequel or not were influencing factors of self stigma,which explained 57.8% of the variance.Univariate analysis revealed enacted stigma was significantly associated with patients' employment status,stroke event,sequel or not,duration of disease(P<0.05).In the bivariate correlation analysis,total score of stigma were associated with activity of daily living,depression status,objective support,subjective support,avoding yielding coping strategy(P<0.01).Multiple regression analysis showed that stroke patients' depression,avoiding coping,subjective support,activity of daily living were influencing factors of enacted stigma,which explained 41.5% of the variance.Conclusion1.In this study,the Chinese version of SSCI showed good reliability and validity.Chinese version of SSCI was recommended as an assessment tool to evaluate the level of stroke and it provided a theoretical basis for research of stigma in neurological disorder diseases.2.Our study showed the total score of stigma was in the medium level among Chinese stroke patients with stigma,with relatively higher score of self-stigma and lower socre of enacted stigma.Nurses should pay attention to the issue of stigma of stroke patients,especially focus on those with higher degree of depression,lower activity of daily living and patients with sequela,guiding them to adopt positive coping strategies and enhance subjective support.Oriented by influencing factors,proper intervention should be provided to lower the level of stigma,and promote psychosomatic rehabilitation and improve quality of life.