Table 2 TB-stigma measurement tools
References | Scale/tool | Questionnaire administration | Ensuring bias reduction and validity | Internal and external validation prior the study | Intervention evaluation on stigma reduction | Type of stigma assessed | Limitations to the tool |
|---|---|---|---|---|---|---|---|
People with TB | |||||||
Macq et al. 2008 [28] | 10 statements with Likert Scale responses from 1 (completely disagree) to 5 (completely agree) | Self-applied | Conducted outside the healthcare facility to decrease likelihood of influence of HCWs on survey responses | Piloted for internal validity Adapted previously validated Boyd Ritsher mental illness stigma scale | Scores taken after 15 days and 2 months | Internalised stigma | Self-applied. Adapted from a validated questionnaire that was not specific to TB |
Wilson et al. 2016 [33] | Questionnaire with six items | Questions were asked by HCWs | Questionnaire was supplied by the Ministry of Health, so questions were not selected under the influence of researcher bias | Information not given | Before and 1 month after watching the educational video | Anticipated and enacted stigma | Pre- and post-video data were not collected uniformly in the early stages of the study. There was no study coordinator which meant that there were inconsistencies in using the tool |
Bond et al. 2017 [26] | Questionnaire with 14 TB-specific items: four questions towards TB-affected household members and 10 towards people with TB | Administered using paper copies by a research assistant and nurse/counsellor | The questionnaire was administered by the same pair of researchers at two time points to ensure consistency | Tool was piloted in six different communities (four in Zambia and four in South Africa) | Before the study and 18 months later | Internalised and enacted stigma | Research assistants were not trained specifically in TB-Stigma which could have affected how questions were asked and interpreted by interviewers |
Population: Healthcare Workers | |||||||
Wu et al. 2009 [34] | Structured 8-item questionnaire with 5-point Likert Scale (1–extremely unimportant to 5—extremely important) | Participants completed the questionnaire immediately before and after training | Information not given | Used the Attribution Questionnaire – Short forms- 9 items (AQ-S8). No information on validation | Before and after intervention | Anticipated stigma | Adapted from a validated questionnaire that was not specific to TB |
Sommerland et al. 2020 [24] | Respondents’ external TB-Stigma (TB-REXT): three items capturing stigmatising attitudes towards colleagues with HIV or TB Other co-workers’ external TB-Stigma (TB-OEXT): five items of perception the general attitudes of other co-workers towards co-workers with HIV or TB | Self-administered questionnaire | The questionnaire was very short and easy to be filled | Questionnaire was previously validated and resulted in good reliability (Wouters et al. 2017). It was again tested for its reliability during the study | Baseline (2016) and follow-up (2018) | Enacted and secondary stigma | Both questionnaires were too short; resulting in lower reliability than previous measures of reliability when the questionnaire was first validated (2017) |
Population: Public | |||||||
Croft and Croft 1999 [27] | Questionnaire with five items and responses limited to “yes”, “no” or “don’t know” | House to house questioning by interviewer. Head of the house usually answered with details added from family members | Questionnaire was deliberately short to ensure it could be completed quickly | Tool had been piloted for internal validity | No | Anticipated stigma | No previous assessments of the tool have been carried out so comparison could not be made |
Balogun et al. 2015 [32] | Questionnaire on personal characteristics, living conditions, TB attitudes and care seeking behaviours, TB attitudes and stigma, TB information and preventive practices | Pre-intervention and repeated 6 months post-intervention | Interviewer-administered questionnaires were used, and the same interviewers collected data post-intervention | Used WHO Knowledge Attitudes and Perceptions (KAP) survey. No information on validation | Scores taken at the beginning and 6 months after the intervention | Anticipated stigma (knowledge and attitudes) of the general community | Adapted from a validated questionnaire that was not specific to TB |
Idris et al. 2020 [25] | Questionnaire adapted from TB Scale Stigma (Van Rie, 2008) | Self-administered | Information not given | Used TB-Stigma Scale (Van Rie, 2008). No information on validation | Before training and 4 weeks after training | Anticipated stigma | The questionnaire could lead to bias and inaccurate responses. No reliability test was applied |