Translation, Cross-cultural adaptation and Validation of the Nigerian Pidgin English version of the Rosenberg Self-esteem and Leprosy-adapted Internalized Stigma for Mental Illness Scales among Persons Affected by Leprosy in Southern Nigeria

Abstract

ABSTRACTBackgroundMeasuring self-esteem and internalized stigma among persons affected by leprosy is important to monitor stigma-reduction interventions. While the English versions of the Rosenberg self-esteem scale (RSES) and Internalized Stigma of Mental Illness Scale (ISMI) as originally developed have been validated and widely used in many settings, to date, no cross-culturally adapted or validated Nigerian Pidgin English version exists. We describe the translation, cross-cultural validation and adaptation of the Nigerian Pidgin English versions of the RSES and ISMI in Cross River state, southern Nigeria.MethodsThe Nigerian Pidgin English version of the RSES and ISMI was developed systematically following the World Health Organization’s (WHO) guidelines on the process of translation and adaptation of instruments. The cultural equivalence of the instruments including their conceptual, item, semantic and their operational equivalences were evaluated using qualitative methods through the process of forward and back-translation, expert panel review, pre-testing and cognitive interviewing to generate the final version. A cross-sectional study of 56 participants with leprosy (Hansen’s disease) enrolled from rural and urban communities in 3 local government areas (Boki, Obubra and Calabar-South) in Cross River state, southern Nigeria was undertaken to assess the psychometric equivalence of the tools. After 2-weeks interval, one-third of them (16 participants) had a re-test.ResultsThe conceptual, item, semantic and the operational equivalences of the Nigerian Pidgin English versions of the RSES and ISMI scale showed adequate fit with all items identified as important in the context of the Pidgin speaking population. There was a negative inverse correlation between the mean total scores of the RSES and the ISMI scale (r = -0.57; p <0.001); confirming the construct validity of the two scales. The exploratory factor analysis for the scales indicated good fit as one-dimension scale. The Cronbach’s alpha values representing internal consistency were 0.82 and 0.95 for the RSES and ISMI scale respectively. The test-retest reliability intra-class correlation coefficient for the RSES and the ISMI scale was 0.98 and 0.67, respectively. There were no floor or ceiling effects in the distribution of the responses to the RSES and the ISMI scale.ConclusionThe Nigerian Pidgin English version of the RSES and ISMI scales were successfully developed and showed evidence to be reliable and valid instruments for the assessment of self-esteem and internalized stigma respectively among Nigerian Pidgin English speaking population of southern Nigeria.