Cultural validation of a new instrument to measure leprosy-related stigma: the SARI Stigma Scale

Dadun, Ruth M. H. Peters, Wim H. Van Brakel, Mimi Lusli, Rita Damayanti, A. Irwanto, J.G.F. Bunders- Aelen

Research output: Contribution to JournalArticleAcademicpeer-review


Background: There is a need for comprehensive, valid and reliable instruments to
assess leprosy-related stigma. This paper presents the process of the cross-cultural
validation of an instrument in Cirebon District, Indonesia initiated by the Stigma
Assessment and Reduction of Impact (SARI) project.
Methods: The Berger Scale was initially developed to assess HIV/AIDS-related
stigma. This study explores the conceptual, item, semantic, operational and
measurement equivalence of this scale for leprosy. The process included a qualitative
study, translation and back-translation, training of interviewers, a pilot and the main
data collection. We aimed for a sample of 154 people affected by leprosy with
60 repeat interviews. They were selected through convenience sampling.
Results: The original scale showed acceptable conceptual equivalence, but
insufficient item, semantic and operational equivalences. For instance, there were
irrelevant HIV-related items and the respondents found it difficult to indicate their
level of agreement with the given statements. Major adjustments were necessary,
leading to a new version of the scale. The measurement properties of the new version
showed good internal consistency (Cronbach’s alpha 0·88); no floor or ceiling effects;
and a good reliability (intra-class correlation coefficient 0·75). Conclusion: Due to the many adjustments we decided to rename the instrument to
SARI Stigma Scale. The scale is comprehensive, reliable and culturally valid to
assess four aspects of stigma among persons affected by leprosy in a setting like
Cirebon District. Further research will determine whether this instrument is valid in
other settings, cultures and with other neglected tropical diseases.
Original languageEnglish
Pages (from-to)23-42
Number of pages20
JournalLeprosy Review
Issue number1
Publication statusPublished - Mar 2017


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