| Popis: |
Tuberculosis (TB) ranks among the top 10 causes of death worldwide, and it is the second largest cause of death from a single infectious agent behind the SARS-CoV-2 virus.1 Although successful treatment options are available, TB remains a major cause of global morbidity, mortality and disability. TB can also have social consequences, such as alienation, isolation and stigmatisation. Stigmatisation contributes to reduced TB health outcomes and can impede TB control activities. Despite the effect of stigma on people with TB, well-validated and reliable TB stigma scales are lacking. This thesis adapts, develops, and validates two scales to measure stigma in people with TB and drug-resistant (DR)-TB in Vietnam. It then compares stigma, depression, and quality of life (QoL) in this population. This thesis adapts and validates the Van Rie TB stigma scale for use in Vietnam. The scale was adapted to local linguistic norms by transforming scale items to third person. The scale demonstrated good internal consistency and content validity. The human immunodeficiency virus (HIV)-related items were found to be less relevant to people with TB in Vietnam. This thesis then develops and validates a stigma scale for use in people with DR-TB in Vietnam. Firstly, a qualitative study explored stigma in people with DR-TB. This study informed the generation of a draft set of stigma-related items. Secondly, cognitive interviews were used to evaluate and refine the draft items. Lastly, item reduction and psychometric evaluation of the scale was performed. The final scale contained 14 items and demonstrated satisfactory construct validity and reliability testing. Finally, this thesis compared stigma, depression, and QoL among people with TB and DR-TB in Vietnam. People with DR-TB demonstrated higher stigma and depressive symptoms level in compared to those with TB. People with DR-TB also had a lower QoL. The findings of this thesis demonstrate the importance of scale localisation and the high prevalence of stigma in TB and DR-TB populations. This research demonstrates the significant impacts of societal stigma upon people with DR-TB. Supportive policies which address the underlying drivers of stigma will enable care to be more patient-centred and improve treatment outcomes among this vulnerable population. |
