The cross-cultural adaptation and psychometric evaluation of the Urdu version of the stigma scale for caring for individuals with sexually transmitted infections (STISS) student version: A translation and validation study among nursing students in Pakistan

Abstract

Objective: Urdu translation, cultural adaptation and psychometric assessment of the Student version of the Stigma Scale – Caring for an individual with sexually transmitted infections (U-STISS) among the Urdu medium of instruction undergraduate nursing students in Pakistan. Methods: A cross-sectional, instrument-validation design was used. The STISS Student Version was translated, back translated and culturally adapted in Urdu. An U-STISS was applied at six nursing institutes (institutions and province illustrative) at third and fourth year undergraduate nursing students in a convenience sample in the province of Punjab, Pakistan. Sample was divided in exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Cronbach's α was used to determine reliability. The convergent validity and discriminant validity are examined by the average variance extracted (AVE) and inter-factor correlations. Results: 350 questionnaires were sent out, of which a response rate of 92.1% of valid responses was received. The original four-factors (Blame, Concealment, Personal Response, and Segregation from Society) were retained along with the support from EFA at 55.3% of total variance. CFA confirmed this structure with good model fit: χ²/df = 1.17, RMSEA = 0.023, CFI = 0.986, TLI = 0.984, GFI = 0.912, and AGFI = 0.891. All four dimensions were found as convergent validity (AVE > 0.50) and discriminant validity (AVE exceeding inter factor correlations). Conclusion: The U-STISS is a legitimate and reliable tool for measuring Urdu speaking nursing students' STI related stigma in Pakistan. May be helpful to teachers in detecting stigmatizing attitudes during their training and to help them create efforts and strategies to make non-judgemental and equitable care. More validation is suggested outside of the target groups, geographic area, and healthcare setting.