Psychometric performance of tools to measure internalized drug use stigma among people who use drugs and people on medication-assisted treatment in Dar es Salaam, Tanzania
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引用次数: 0
Abstract
Background
People who use drugs (PWUD) and people who use medication-assisted treatment (MAT) to treat opioid use disorder face severe stigma. Stigma may manifest in delayed health-seeking behaviors, which adversely affects health and increases disease risk. Few validated measures assess internalized drug use stigma or MAT disclosure concerns in sub-Saharan Africa. This study examines the performance of internalized drug use stigma scales and characterizes the prevalence of these stigmas among PWUD and people who use MAT in Dar es Salaam, Tanzania.
Methods
We conducted a cross-sectional survey among 250 PWUD and 251 MAT clinic clients. Internalized drug use and MAT disclosure concerns were measured using scales adapted to the Tanzanian context. We conducted exploratory factor analysis to identify latent constructs and evaluate reliability of the scales. We then used confirmatory factor analysis to assess construct validity and reliability.
Results
The six-item internalized drug use stigma scale (IDUSS) was unidimensional, reflected acceptable goodness-of-fit, and acceptable reliability (Cronbach’s α = 0.79). The eight-item internalized drug use stigma scale for people using MAT (IDUSS-MAT) was bidimensional. Allowing error terms of related items to covary improved goodness-of-fit. The IDUSS-MAT demonstrated acceptable reliability (Cronbach’s α = 0.79). Among PWUD and MAT clinic clients, higher levels of stigma were associated with increased depression and reduced social support and quality of life.
Conclusions
Both the IDUSS and IDUSS-MAT demonstrated good construct validity and acceptable reliability. These validated scales provide the foundation for collecting data to inform the development of stigma reduction interventions in Tanzania and among similar Sub-Saharan populations of PWUD and the tools needed to assess those interventions.
背景:吸毒者(PWUD)和使用药物辅助治疗(MAT)来治疗阿片类药物使用障碍的人面临着严重的耻辱感。污名化可能表现为寻求健康行为的延迟,从而对健康产生不利影响并增加患病风险。在撒哈拉以南非洲地区,很少有经过验证的测量方法来评估内化的药物使用羞辱或 MAT 披露问题。本研究检验了内化的吸毒耻辱感量表的性能,并描述了这些耻辱感在坦桑尼亚达累斯萨拉姆的吸毒者和使用 MAT 的人中的流行程度:我们对 250 名感染艾滋病毒者和艾滋病患者以及 251 名 MAT 诊所客户进行了横断面调查。我们使用适合坦桑尼亚国情的量表测量了内化药物使用和 MAT 披露问题。我们进行了探索性因子分析,以确定潜在的结构并评估量表的可靠性。然后,我们使用确认性因子分析来评估构建的有效性和可靠性:结果:六项目内化吸毒耻辱感量表(IDUSS)是单维的,反映了可接受的拟合优度和可接受的信度(Cronbach's α = 0.79)。针对 MAT 使用者的八项目吸毒污名内化量表(IDUSS-MAT)为二维量表。允许相关项目的误差项共变可以提高拟合优度。IDUSS-MAT 的信度可以接受(Cronbach's α = 0.79)。在PWUD和MAT患者中,污名化程度越高,抑郁程度越高,社会支持和生活质量越低:IDUSS和IDUSS-MAT均表现出良好的结构效度和可接受的信度。这些经过验证的量表为收集数据奠定了基础,为在坦桑尼亚和类似的撒哈拉以南非洲人群中制定减少污名化干预措施以及评估这些干预措施所需的工具提供了依据。
期刊介绍:
Drug and Alcohol Dependence is an international journal devoted to publishing original research, scholarly reviews, commentaries, and policy analyses in the area of drug, alcohol and tobacco use and dependence. Articles range from studies of the chemistry of substances of abuse, their actions at molecular and cellular sites, in vitro and in vivo investigations of their biochemical, pharmacological and behavioural actions, laboratory-based and clinical research in humans, substance abuse treatment and prevention research, and studies employing methods from epidemiology, sociology, and economics.