Psychometric evaluation of a cross-culturally adapted HIV felt stigma scale among people living with HIV in south-central Kenya

Background: Initial diagnosis of HIV is reportedly correlated with stigma which is associated with shame, rejection or blame, towards people living with HIV/AIDS (PLWHA). Limited studies have examined HIV related felt stigma in a Kenyan context. To necessitate valid and reliable measurement of HIV felt stigma in Kenya, it is critical to cross-culturally adapt an instrument. Purpose: An 18-item HIV felt stigma scale was cross-culturally adapted among PLWHA in south-central Kenya. Seven items were added to the original validated 11-item scale, developed in the USA, so as to examine the relationship between the cultural context and PLWHA in enhancing felt stigma. Method: Psychometric properties of the scale were examined using data from a diverse ethnic and socioeconomic group of 377 PLWHA receiving HIV/AIDS related health services at an HIV clinic. Results: Factor analyses revealed a four factor solution based on the Scree plot [public attitudes, ostracize, discrimination, personal life disrupted] with explained variance of 44% which had Eigen values greater than 1.00. The total scale had a Cronbach's alpha coefficient of 0.863 while the four factors had coefficient alphas from 0.676 to 0.799. Conclusion: The HIV felt stigma scale was deemed reliable and valid among a diverse population of PLWHA in a clinical setting. A cross-culturally adapted scale can enhance equivalence of questionnaires between the source and target, increase the likelihood of eliciting candid HIV felt stigma responses and improve implementation of effective interventions in resource-limited settings in Kenya.