Evaluating the validity of depression-related stigma measurement among diabetes and hypertension patients receiving depression care in Malawi: A mixed-methods analysis.
Evaluating the validity of depression-related stigma measurement among diabetes and hypertension patients receiving depression care in Malawi: A mixed-methods analysis.
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评估糖尿病和高血压患者在马拉维接受抑郁症护理的高血压患者中的有效性：混合方法分析。
DOI：
10.1371/journal.pgph.0001374
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发表时间：
2023
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马拉维关于精神疾病耻辱的研究很少。我们的团队之前分析了定量工具的可靠性和统计有效性，该工具使用定量心理测量方法来测量患有抑郁症状的参与者中与抑郁相关的耻辱感。该分析旨在通过比较参与者的定量反应与定性数据来进一步评估污名工具的内容有效性。 SHARP 项目于 2019 年 4 月至 2021 年 12 月在马拉维各地的 10 个非传染性疾病诊所进行了抑郁症筛查和治疗。合格参与者为 18-65 岁，患有 PHQ-9 评分≥5 分的抑郁症状。每个研究时间点的问卷包括一个基于小插曲的定量耻辱工具，具有三个主题领域：披露遗留（即对披露的担忧）、治疗遗留（即因接受抑郁症治疗而对外部耻辱的担忧）和负面影响（即对抑郁症患者的消极态度）。每个领域的子分数都被汇总，分数越高表明耻辱越大。为了更好地理解参与者对定量耻辱问卷的解释，我们以类似于认知访谈的方法，在半结构化定性访谈中向六名参与者提出了一组平行的问题。使用 Stata 16 和 NVivo 软件将定性反应与参与者最近的定量后续访谈联系起来。定量耻辱披露子分数较低的参与者的定性反应表明披露方面的耻辱感较少，而定量耻辱子分数较高的参与者的定性反应表明耻辱程度更大。同样，在负面影响和治疗遗留领域，参与者有平行的定量和定性反应。此外，参与者在定性访谈中认同了小插曲角色，并且参与者根据自己的生活经历谈论了该角色的预计感受和经历。参与者对耻辱工具进行了适当的解释，为衡量这些耻辱领域的定量工具的内容有效性提供了有力的证据。
Mental illness stigma research is sparse in Malawi. Our team previously analyzed the reliability and statistical validity of a quantitative tool to measure depression-related stigma among participants with depressive symptoms using quantitative psychometric methods. This analysis aims to further evaluate the content validity of the stigma tool by comparing participants’ quantitative responses with qualitative data. The SHARP project conducted depression screening and treatment at 10 noncommunicable disease clinics across Malawi from April 2019 through December 2021. Eligible participants were 18–65 years with depressive symptoms indicated by a PHQ-9 score ≥5. Questionnaires at each study timepoint included a vignette-based quantitative stigma instrument with three thematic domains: disclosure carryover (i.e., concerns about disclosure), treatment carryover (i.e., concerns about external stigma because of receiving depression treatment), and negative affect (i.e., negative attitudes about people having depression). Sub-scores were aggregated for each domain, with higher scores indicating greater stigma. To better understand participants’ interpretation of this quantitative stigma questionnaire, we asked a subset of six participants a parallel set of questions in semi-structured qualitative interviews in a method similar to cognitive interviewing. Qualitative responses were linked with participants’ most recent quantitative follow-up interviews using Stata 16 and NVivo software. Participants with lower quantitative stigma disclosure sub-scores had qualitative responses that indicated less stigma around disclosure, while participants with higher quantitative stigma sub-scores had qualitative responses indicating greater stigma. Similarly, in the negative affect and treatment carryover domains, participants had parallel quantitative and qualitative responses. Further, participants identified with the vignette character in their qualitative interviews, and participants spoke about the character’s projected feelings and experiences based on their own lived experiences. The stigma tool was interpreted appropriately by participants, providing strong evidence for the content validity of the quantitative tool to measure these stigma domains.