Development and Validation of a Scale to Measure Adolescent Sexual and Reproductive Health Stigma: Results From Young Women in Ghana
Development and Validation of a Scale to Measure Adolescent Sexual and Reproductive Health Stigma: Results From Young Women in Ghana
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DOI：
10.1080/00224499.2017.1292493
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发表时间：
2018-01-01
影响因子：
3.6
通讯作者：
Dalton, Vanessa K.
中科院分区：
文献类型：
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作者：
Hall, Kelli Stidham;Manu, Abubakar;Dalton, Vanessa K.
年轻女性在性健康和生殖健康（SRH）方面遭受的耻辱可能会导致意外怀孕。因此，需要采取污名干预措施并采取严格的措施来评估其影响。根据形成性工作，我们针对青少年 SRH 和计划生育（性、避孕、怀孕、生育、堕胎）不同维度的耻辱感生成了 51 个项目。我们对从加纳的学校、医疗机构和大学招募的 1,080 名 15 至 24 岁女性进行的调查研究中的项目进行了测试。验证性因素分析（CFA）确定了概念上和统计上最相关的量表，多变量回归通过耻辱与避孕药具使用之间的关联建立了结构有效性。 CFA 为我们假设的青少年 SRH 耻辱量表提供了强有力的支持（卡方 p 值 < 0.001；近似均方根误差 [RMSEA] = 0.07；标准化均方根残差 [SRMR] = 0.06）。最终的20个项目量表包括三个子量表：内在耻辱（六个项目）、制定的耻辱（七个项目）和耻辱化外行态度（七个项目）。该量表表现出良好的内部一致性（α = 0.74）和很强的子量表相关性（α = 0.82 至 0.93）。较高的 SRH 耻辱感评分与曾经使用过现代避孕措施呈负相关（调整后优势比 [AOR] = 0.96，置信区间 [CI] = 0.94 至 0.99，p 值 = 0.006）。青少年性健康和生殖健康耻辱量表是评估性健康和生殖健康耻辱及其对计划生育影响的有效、可靠的工具，可以为非洲及其他地区的年轻女性提供信息和评估干预措施，以减少/管理耻辱并增强其复原力。
Young women's experiences with sexual and reproductive health (SRH) stigma may contribute to unintended pregnancy. Thus, stigma interventions and rigorous measures to assess their impact are needed. Based on formative work, we generated a pool of 51 items on perceived stigma around different dimensions of adolescent SRH and family planning (sex, contraception, pregnancy, childbearing, abortion). We tested items in a survey study of 1,080 women ages 15 to 24 recruited from schools, health facilities, and universities in Ghana. Confirmatory factor analysis (CFA) identified the most conceptually and statistically relevant scale, and multivariable regression established construct validity via associations between stigma and contraceptive use. CFA provided strong support for our hypothesized Adolescent SRH Stigma Scale (chi-square p value < 0.001; root mean square error of approximation [RMSEA] = 0.07; standardized root mean square residual [SRMR] = 0.06). The final 20-item scale included three subscales: internalized stigma (six items), enacted stigma (seven items), and stigmatizing lay attitudes (seven items). The scale demonstrated good internal consistency (alpha = 0.74) and strong subscale correlations (alpha = 0.82 to 0.93). Higher SRH stigma scores were inversely associated with ever having used modern contraception (adjusted odds ratio [AOR] = 0.96, confidence interval [CI] = 0.94 to 0.99, p value = 0.006). A valid, reliable instrument for assessing SRH stigma and its impact on family planning, the Adolescent SRH Stigma Scale can inform and evaluate interventions to reduce/manage stigma and foster resilience among young women in Africa and beyond.