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Adaptation and Validation of the Shame Questionnaire Among Ugandan Youth Living with HIV


The purpose of this study was to adapt and validate a measure of HIV-related shame, the Shame Questionnaire (SQ), among Ugandan youth living with HIV. Culturally relevant, reliable and valid measurement is critical in the accurate assessment of HIV-related shame (a painful internalized emotion encompassing feelings that the self is damaged and defective) on psychosocial functioning, as well as the determination of the efficacy of interventions among youth living with HIV in sub-Saharan Africa. We utilized qualitative (i.e., cognitive interviews; N = 31) and quantitative (i.e., classical test theory and item response theory; N = 150) methods to establish, content, criterion and construct validity of the SQ. Cognitive interviews resulted in the revision in the wording of 2 out of 8 SQ items. Participants who endorsed having shame had statistically significant higher SQ scores than participants who did not endorse having shame (p < 0.001), suggesting criterion validity. We found a statistically significant positive relationship between SQ scores and average trauma symptom scores among participants (p < 0.001), also suggesting criterion validity. Finally, we found construct validity with discrimination parameters of the graded response IRT model all in the high range with a wide range of difficulty parameters across the 8 items of the SQ. Overall our results suggest that the SQ is a contextually relevant, valid and reliable assessment tool among Ugandan youth living with HIV. Findings provide support for the utilization of qualitative and quantitative methods in the adaptation of measures for cross-cultural use in order to maintain validity and contextual relevance.

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This study was funded by the National Institute of Health, NIH: 1R01HD074949–01 to Dr. Fred Ssewamala. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations



LM designed and executed the study, conducted data analyses and drafted the manuscript. MM collaborated with the data analyses and the manuscript. SMM collaborated with data analyses and contributed to writing the manuscript. JK collaborated with the analyses and assisted with editing the manuscript. MNM collaborated with the execution of the study, data analyses and editing of the manuscript. FN collaborated with the execution of the study, data analyses and editing of the manuscript. CF collaborated with data analyses and edited the manuscript. FMS collaborated with the design and execution of the study and edited the manuscript.

Corresponding author

Correspondence to Lynn Murphy Michalopoulos.

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Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

The authors declare they have no conflict of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study. Informed consent was also obtained by guardians of participants under the age of 16.

Electronic supplementary material

Data related to this study are available and are attached as supplementary materials.


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Michalopoulos, L.M., Meinhart, M., Barton, S.M. et al. Adaptation and Validation of the Shame Questionnaire Among Ugandan Youth Living with HIV. Child Ind Res 12, 1023–1042 (2019).

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  • HIV-related shame
  • Youth
  • Sub-Saharan Africa
  • Cognitive interviews
  • Item response theory