title: Development and Validation of a Scale to Measure Adolescent Sexual and Reproductive Health Stigma: Results From Young Women in Ghana.
abstract: Young women's experiences with sexual and reproductive health (SRH) stigma may contribute to unintended pregnancy. Thus, stigma interventions and rigorous measures to assess their impact are needed. Based on formative work, we generated a pool of 51 items on perceived stigma around different dimensions of adolescent SRH and family planning (sex, contraception, pregnancy, childbearing, abortion). We tested items in a survey study of 1,080 women ages 15 to 24 recruited from schools, health facilities, and universities in Ghana. Confirmatory factor analysis (CFA) identified the most conceptually and statistically relevant scale, and multivariable regression established construct validity via associations between stigma and contraceptive use. CFA provided strong support for our hypothesized Adolescent SRH Stigma Scale (chi-square p value < 0.001; root mean square error of approximation [RMSEA] = 0.07; standardized root mean square residual [SRMR] = 0.06). The final 20-item scale included three subscales: internalized stigma (six items), enacted stigma (seven items), and stigmatizing lay attitudes (seven items). The scale demonstrated good internal consistency (α = 0.74) and strong subscale correlations (α = 0.82 to 0.93). Higher SRH stigma scores were inversely associated with ever having used modern contraception (adjusted odds ratio [AOR] = 0.96, confidence interval [CI] = 0.94 to 0.99, p value = 0.006). A valid, reliable instrument for assessing SRH stigma and its impact on family planning, the Adolescent SRH Stigma Scale can inform and evaluate interventions to reduce/manage stigma and foster resilience among young women in Africa and beyond.
authors.affiliation: a Department of Behavioral Sciences and Health Education, Rollins School of Public Health , Emory University.
authors.forename: Kelli Stidham
authors.initials: KS
authors.lastname: Hall
authors.affiliation: b Department of Population, Family and Reproductive Health, University of Ghana School of Public Health.
authors.forename: Abubakar
authors.initials: A
authors.lastname: Manu
authors.affiliation: c Komfo Anokye Teaching Hospital , Kwame Nkrumah University of Science and Technology.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Morhe
authors.affiliation: d Department of Obstetrics and Gynecology, University of Michigan.
authors.forename: Lisa H
authors.initials: LH
authors.lastname: Harris
authors.affiliation: d Department of Obstetrics and Gynecology, University of Michigan.
authors.forename: Dana
authors.initials: D
authors.lastname: Loll
authors.affiliation: d Department of Obstetrics and Gynecology, University of Michigan.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ela
authors.affiliation: d Department of Obstetrics and Gynecology, University of Michigan.
authors.forename: Giselle
authors.initials: G
authors.lastname: Kolenic
authors.affiliation: d Department of Obstetrics and Gynecology, University of Michigan.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Dozier
authors.affiliation: d Department of Obstetrics and Gynecology, University of Michigan.
authors.forename: Sneha
authors.initials: S
authors.lastname: Challa
authors.affiliation: f Health Services Research Division, Department of Obstetrics and Gynecology , University of Michigan.
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Zochowski
authors.affiliation: c Komfo Anokye Teaching Hospital , Kwame Nkrumah University of Science and Technology.
authors.forename: Andrew
authors.initials: A
authors.lastname: Boakye
authors.affiliation: e University of Ghana School of Public Health.
authors.forename: Richard
authors.initials: R
authors.lastname: Adanu
authors.affiliation: f Health Services Research Division, Department of Obstetrics and Gynecology , University of Michigan.
authors.forename: Vanessa K
authors.initials: VK
authors.lastname: Dalton
mesh_terms: D000293:Adolescent; D000328:Adult; D003268:Contraception Behavior / Q000208:ethnology*; D005260:Female; D005869:Ghana / Q000208:ethnology; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D011594:Psychometrics / Q000295:instrumentation / Q000592:standards; D060728:Reproductive Health / Q000208:ethnology*; D000074384:Sexual Health / Q000208:ethnology*; D057545:Social Stigma; D055815:Young Adult