Abstract
Health care providers have been shown to stigmatize mental disorders, which has serious consequences in the care, treatment and recovery of people. The instruments that have been developed to assess stigma in this population are few in number; some do not specifically focus on health workers, are aimed at a reduced range of professionals, and lack robust psychometric analyses. The aim of this study was to develop and evaluate the psychometric properties of an instrument meant to assess the stigmatizing attitudes of health care providers toward people with mental illnesses. An instrumental design with two independent convenience samples of health care providers who worked in primary and secondary health care centers was used. The first sample (n = 272) was used for exploratory factor analysis, and the second sample (n = 419) was used for confirmatory analysis. Each subject received the studied scale, a sociodemographic background survey and the Social Distance Scale (SD), which were all used for the concurrent validity analysis. To evaluate concurrent validity, the Pearson correlation index was used, while internal consistency was evaluated via Cronbach’s alpha and McDonald’s total omega coefficient. The final instrument includes 2 dimensions: stigmatizing beliefs (12 items) and infantilization and relational distance (6 items). Reliability indexes (Cronbach’s alpha and McDonald’s total omega) are between 0.73 and 0.86, respectively. Moreover, concurrent validity present moderated and significant correlations ranging from rp = 0.28 (p < .001) to rp = 0.45 (p < .001). The instrument has a robust factor structure and suitable levels of internal consistency and concurrent validity, which support its use in studying the attitudes of health care providers.
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Data Availability
The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
References
Brooke, P. P., Russell, D. W., & Price, J. L. (1988). Discriminant validation of measures of job satisfaction, job involvement, and organizational commitment. Journal of Applied Psychology, 73(2), 139–145. https://doi.org/10.1037/0021-9010.73.2.139.
Byrne, B. M. (2001). Structural equation modeling with Amos: Basic concepts, applications and programming. (N. Erlbaum Ed.). Mahwah.
Carrara, B. S., Ventura, C. A. A., Bobbili, S. J., Jacobina, O. M. P., Khenti, A., & Mendes, I. A. C. (2019). Stigma in health professionals towards people with mental illness: An integrative review. Archives of Psychiatric Nursing, 33(4), 311–318. https://doi.org/10.1016/j.apnu.2019.01.006.
Charles, J. L. K., & Bentley, K. J. (2018). Measuring mental health provider-based stigma: Development and initial psychometric testing of a self-assessment instrument. Community Mental Health Journal, 54(1), 33–48. https://doi.org/10.1007/s10597-017-0137-4.
Chen, M.-D., & Chang, Y.-C. (2016). Personnel attitudes toward people with mental illness at a psychiatric hospital in Taiwan. International Journal of Social Psychiatry, 62(4), 361–368. (Sage UK: London, England). https://doi.org/10.1177/0020764016634385.
Chiles, C., Stefanovics, E., & Rosenheck, R. (2017). Attitudes of students at a US medical school toward mental illness and its causes. Academic Psychiatry, 41(3), 320–325. https://doi.org/10.1007/s40596-016-0508-0.
Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155–159. https://doi.org/10.1037/0033-2909.112.1.155.
Corrigan, P. W., & Shapiro, J. R. (2010). Measuring the impact of programs that challenge the public stigma of mental illness. Clinical Psychology Review, 30(8), 907–922. https://doi.org/10.1016/j.cpr.2010.06.004.
Corrigan, P. W., Markowitz, F. E., Watson, A. C., Rowan, D., & Kubiak, M. A. (2003). An attribution model of public discrimination towards persons with mental illness. Journal of Health and Social Behavior, 44(2), 162–179.
Del Olmo-Romero, F., González-Blanco, M., Sarró, S., Grácio, J., Martín-Carrasco, M., Martinez-Cabezón, A. C., … The INTER NOS group. (2019). Mental health professionals’ attitudes towards mental illness: Professional and cultural factors in the INTER NOS study. European Archives of Psychiatry and Clinical Neuroscience, 269(3), 325–339. https://doi.org/10.1007/s00406-018-0867-5
DiIorio, C. K. (2006). Measurement in health behavior: Methods for research and evaluation (1.a Ed.). John Wiley & Sons Ltd.
Fokuo, J. K., Goldrick, V., Rossetti, J., Wahlstrom, C., Kocurek, C., Larson, J. E., & Corrigan, P. W. (2017). Decreasing the stigma of mental illness through a student-nurse mentoring program: A qualitative study. Community Mental Health Journal, 53(3), 257–265. https://doi.org/10.1007/s10597-016-0016-4.
Forgione, F. A. (2018). Diagnostic dissent: Experiences of perceived misdiagnosis and stigma in persons diagnosed with schizophrenia. Journal of Humanistic Psychology, 59(1), 69–98. https://doi.org/10.1177/0022167818777151.
Gabbidon, J., Clement, S., van Nieuwenhuizen, A., Kassam, A., Brohan, E., Norman, I., & Thornicroft, G. F. (2013). Mental illness: Clinicians’ attitudes (MICA) scale—Psychometric properties of a version for healthcare students and professionals. Psychiatry Research, 206(1), 81–87. https://doi.org/10.1016/j.psychres.2012.09.028.
Grandón, P., Cova, F., Saldivia, S., & Bustos, C. (2015). Análisis psicométrico y adaptación de la Escala de Distancia Social (DS) en una muestra chilena. Salud Mental, 38(2), 117–122. https://doi.org/10.17711/SM.0185-3325.2015.016.
Hansson, L., Jormfeldt, H., Svedberg, P., & Svensson, B. (2011). Mental health professionals’ attitudes towards people with mental illness: Do they differ from attitudes held by people with mental illness? International Journal of Social Psychiatry, 59(1), 48–54. (Sage UK: London, England). https://doi.org/10.1177/0020764011423176.
Kassam, A., Glozier, N., Leese, M., Henderson, C., & Thornicroft, G. F. (2010). Development and responsiveness of a scale to measure clinicians’ attitudes to people with mental illness (medical student version). Acta Psychiatrica Scandinavica, 122(2), 153–161. https://doi.org/10.1111/j.1600-0447.2010.01562.x.
Kassam, A., Papish, A., Modgill, G., & Patten, S. (2012). The development and psychometric properties of a new scale to measure mental illness related stigma by health care providers: The opening minds scale for Health Care Providers (OMS-HC). BMC Psychiatry, 12(1), 1–12. https://doi.org/10.1186/1471-244X-12-62.
Kennedy, S. C., Abell, N., & Mennicke, A. (2014). Initial validation of the mental health provider stigma inventory. Research on Social Work Practice, 27(3), 335–347. https://doi.org/10.1177/1049731514563577.
Knaak, S., Mantler, E., & Szeto, A. (2017). Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. Healthcare Management Forum, 30(2), 111–116. (Sage CA: Los Angeles, CA). https://doi.org/10.1177/0840470416679413.
Kopera, M., Suszek, H., Bonar, E., Myszka, M., Gmaj, B., Ilgen, M., & Wojnar, M. (2015). Evaluating explicit and implicit stigma of mental illness in mental health professionals and medical students. Community Mental Health Journal, 51(5), 628–634. https://doi.org/10.1007/s10597-014-9796-6.
Link, B. G., & Phelan, J. C. (2001). Conceptualizing Stigma. Annual Review of Sociology, 27(1), 363–385. https://doi.org/10.1146/annurev.soc.27.1.363.
Lloret-Segura, S., Ferreres-Traver, A., Hernández-Baeza, A., & Tomás-Marco, I. (2014). El Análisis Factorial Exploratorio de los Ítems: Una guía práctica, revisada y actualizada. Anales de Psicología, 30(3), 1151–1169. https://doi.org/10.6018/analesps.30.3.199361.
Ministerio de Desarrollo Social del Gobierno de Chile. (2018). Salud. Síntesis de Resultados. CASEN. Recuperado de CASEN website: http://observatorio.ministeriodesarrollosocial.gob.cl/casen-multidimensional/casen/docs/Resultados_Salud_casen_2017.pdf
Ministerio de Salud del Gobierno de Chile. (2017). Plan Nacional de Salud Mental 2017–2025. Recuperado de https://www.minsal.cl/wp-content/uploads/2017/12/PDF-PLAN-NACIONAL-SALUD-MENTAL-2017-A-2025.-7-dic-2017.pdf
Mittal, D., Corrigan, P. W., Sherman, M. D., Chekuri, L., Han, X., Reaves, C., et al. (2014). Healthcare providers’ attitudes toward persons with schizophrenia. Psychiatric Rehabilitation Journal, 37(4), 297–303. https://doi.org/10.1037/prj0000095.
Modgill, G., Patten, S. B., Knaak, S., Kassam, A., & Szeto, A. C. (2014). Opening minds stigma scale for health care providers (OMS-HC): Examination of psychometric properties and responsiveness. BMC Psychiatry, 14(1), 1–10. https://doi.org/10.1186/1471-244X-14-120.
Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory (3.a Ed.). New York: McGraw-Hill.
Nyblade, L., Stockton, M. A., Giger, K., Bond, V., Ekstrand, M. L., Lean, R. M., Mitchell, E. M. H., Nelson, L. R. E., Sapag, J. C., Siraprapasiri, T., Turan, J., & Wouters, E. (2019). Stigma in health facilities: Why it matters and how we can change it. BMC Medicine, 17(1), 1–15. https://doi.org/10.1186/s12916-019-1256-2.
Ozer, U., Varlik, C., Ceri, V., Ince, B., & Delice, M. A. (2017). Change starts with us: Stigmatizing attitudes towards mental illnesses and the use of stigmatizing language among mental health professionals. Dusunen Adam The Journal of Psychiatry and Neurological Sciences, 30(3), 224–232. https://doi.org/10.5350/DAJPN2017300306.
Pavon, G., & Vaes, J. (2017). Bio-genetic vs. psycho-environmental conceptions of schizophrenia and their role in perceiving patients in human terms. Psychosis, 9(3), 245–253. https://doi.org/10.1080/17522439.2017.1311359.
Podsakoff, P. M., MacKenzie, S. B., Lee, J.-Y., & Podsakoff, N. P. (2003). Common method biases in behavioral research: A critical review of the literature and recommended remedies. Journal of Applied Psychology, 88(5), 879–903. https://doi.org/10.1037/0021-9010.88.5.879.
Sapag, J. C., Klabunde, R., Villarroel, L., Velasco, P. R., Álvarez, C., Parra, C., Bobbili, S. J., Mascayano, F., Bustamante, I., Alvarado, R., & Corrigan, P. W. (2019). Validation of the opening minds scale and patterns of stigma in Chilean primary health care. PLoS One, 14(9), e0221825. https://doi.org/10.1371/journal.pone.0221825.
Sastre-Rus, M., García-Lorenzo, A., Lluch-Canut, M.-T., Tomás-Sábado, J., & Zabaleta-Del-Olmo, E. (2019). Instruments to assess mental health-related stigma among health professionals and students in health sciences: A systematic psychometric review. Journal of Advanced Nursing, 75(9), 1838–1853. https://doi.org/10.1111/jan.13960.
Sercu, C., & Bracke, P. (2017). Stigma, social structure, and the biomedical framework: Exploring the stigma experiences of inpatient service users in two Belgian psychiatric hospitals. Qualitative Health Research, 27(8), 1249–1261. (Sage CA: Los Angeles, CA). https://doi.org/10.1177/1049732316648112.
Taylor, S. M., & Dear, M. J. (1981). Scaling community attitudes toward the mentally ill. Schizophrenia Bulletin, 7(2), 225–240. https://doi.org/10.1093/schbul/7.2.225.
Tei-Tominaga, M., Asakura, T., & Asakura, K. (2014). Stigma towards nurses with mental illnesses: A study of nurses and nurse managers in hospitals in Japan. International Journal of Mental Health Nursing, 23(4), 316–325. https://doi.org/10.1111/inm.12052.
Vaccari, P., Ramírez-Vielma, R., Saldivia, S., Cova, F., Vielma-Aguilera, A., Victoriano, V., Ulloa-Vidal, N., & Grandón, P. (2020). Stigma towards people with a diagnosis of severe mental disorder in primary healthcare centers: Perspectives of service users and health teams in Chile. International Journal of Mental Health Systems, 14(1), 6. https://doi.org/10.1186/s13033-020-0340-5.
Varas-Díaz, N., Santos-Figueroa, A., Polanco-Frontera, N., Cajigas-Vargas, I., Díaz, M. R., Candelas, C. I. L., et al. (2012). Desarrollo de una Escala para Medir el Estigma Relacionado a Problemas de Salud Mental en Puerto Rico. Revista Puertorriqueña de Psicología, 23, 107–118.
Vicente, B., Saldivia, S., & Pihán, R. (2016). Prevalencias y brechas hoy: Salud mental mañana. Acta Bioethica, 22(1), 51–61. https://doi.org/10.4067/S1726-569X2016000100006.
Vistorte, A. O., Ribeiro, W., Ziebold, C., Asevedo, E., Evans-Lacko, S., Keeley, J. W., … Mari, J. de J. (2018). Clinical decisions and stigmatizing attitudes towards mental health problems in primary care physicians from Latin American countries. PLoS One, 13(11), e0206440. https://doi.org/10.1371/journal.pone.0206440
Wagner, L. C., Torres-González, F., Geidel, A. R., & King, M. B. (2011). Existential questions in schizophrenia: Perception of patients and caregivers. Revista de Saúde Pública, 45(2), 401–408. https://doi.org/10.1590/S0034-89102011000200019.
Wilkins, B. T., & Abell, N. (2010). Validation of the mental illness stigma scale for mental health professionals. Presentado en Society for Social Work and Research 14th Annual Conference: Social Work Research: A WORLD OF POSSIBILITIES, Houston.
World Health Organization. (2013). Mental health action plan 2013–2020. G. W. H. Organization. Recuperado de https://www.who.int/publications/i/item/9789241506021
Yang, L. H., Valencia, E., Alvarado, R., Link, B. G., Huynh, N., Nguyen, K., … Susser, E. (2013). A theoretical and empirical framework for constructing culture-specific stigma instruments for Chile. Cadernos Saúde Coletiva, 21(1), 71–79.
Yanos, P. T., Vayshenker, B., DeLuca, J. S., & O’Connor, L. K. (2017). Development and validation of a scale assessing mental health clinicians’ experiences of associative stigma. Psychiatric Services, 68(10), 1053–1060. https://doi.org/10.1176/appi.ps.201600553.
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The first author was supported by CONICYT - National Doctorate 2015 Scholarship. Mental Health Doctorate Program.
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AV designed and conducted the study. PG designed the study and developed the manuscript. CB analyzed data and SS developed the manuscript. All authors read and approved the final manuscript.
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Vielma-Aguilera, A., Bustos, C., Saldivia, S. et al. Psychometric properties of the attitudes scale of health care professionals’ toward people with a diagnosis of mental illness (EAPS-TM). Curr Psychol 42, 5851–5863 (2023). https://doi.org/10.1007/s12144-021-01911-4
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DOI: https://doi.org/10.1007/s12144-021-01911-4