title: Stigma Among Survivors of Sexual Violence in Congo: Scale Development and Psychometrics.
abstract: Stigma related to sexual violence (SV) is associated with many negative physical and social outcomes. We sought to create a contextually relevant measure of SV-related stigma for women in the Democratic Republic of Congo (DRC) and assess itspsychometrics and validity. Using baseline screening data from two randomized controlled trials of services for female SV survivors in Eastern DRC ( n = 1,184), we conducted exploratory and confirmatory factor analyses to test the measurement model. Cronbach's alphas and Kuder-Richardson 20 (KR-20) statistics were used to evaluate internal consistency. Logistic and linear regressions of the stigma measures with related constructs were used to assess construct validity. Two distinct but related scales were developed based on factor analyses: a four-item scale of discrimination-related stigma (i.e., enacted stigma) and an eight-item scale of combined perceived and internalized stigma (i.e., felt stigma). Both scales showed good internal consistency (KR-20 = .68; α = .86). A higher felt stigma score was associated with significant increases in combined depression and anxiety and trauma symptoms, as well as functional impairment ( p < .001). Having a child as a result of SV was associated with both significantly higher enacted and felt stigma ( p < .001). Neither SV stigma scale was associated with medical care seeking. To address harmful ramifications of stigma among SV survivors, locally relevant quantitative measures are necessary to understand the nature and severity of stigma they experience. Our process of scale creation and evaluation can serve as an example for developing locally relevant SV-related stigma measures.
authors.affiliation: 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Sarah McIvor
authors.initials: SM
authors.lastname: Murray
authors.affiliation: 2 The International Rescue Committee, New York, NY, USA.
authors.forename: Katie L
authors.initials: KL
authors.lastname: Robinette
authors.affiliation: 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Bolton
authors.affiliation: 3 The University of Manchester, UK.
authors.forename: Talita
authors.initials: T
authors.lastname: Cetinoglu
authors.affiliation: 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Laura K
authors.initials: LK
authors.lastname: Murray
authors.affiliation: 2 The International Rescue Committee, New York, NY, USA.
authors.forename: Jeannie
authors.initials: J
authors.lastname: Annan
authors.affiliation: 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Judith K
authors.initials: JK
authors.lastname: Bass
mesh_terms: D000328:Adult; D001294:Attitude to Health; D015023:Democratic Republic of the Congo; D005260:Female; D006801:Humans; D008297:Male; D011594:Psychometrics; D016032:Randomized Controlled Trials as Topic; D012111:Residence Characteristics; D012742:Sex Offenses / Q000523:psychology* / Q000706:statistics & numerical data; D012938:Social Perception; D057545:Social Stigma; D011795:Surveys and Questionnaires / Q000706:statistics & numerical data*; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data
keywords: Democratic Republic of Congo; psychometrics; scale development; sexual violence; stigma