Adaptação transcultural das escalas de estigma Explanatory Model Interview Catalogue (EMIC) na perspectiva de pessoas acometidas pela hanseníase e da comunidade para o contexto brasileiro

Abstract

The study of different conceptions of health conditions and possible psychosocial consequences is important for research purposes, but especially for professionals who work in health services likewise in the development and execution of public policies. In the context of leprosy, knowing these conceptions is fundamentally important in the face of the associated stigma and its representations, which persist through time and can have negative impacts on individuals, families and communities. The study aimed to adapt cross-culturally the Explanatory Model Interview Catalog (EMIC) Stigma Scale to the perspective of people affected by leprosy (EMIC-AP) and community members (EMIC-CSS) for the brazilian context. It is a methodological study of cross-cultural adaptation of two scales of stigma in different perspectives, based on the universalist model. The study was conducted in Cacoal (RO), Floriano (PI), Fortaleza and Maracanaú (CE) and Vitória da Conquista (BA). After translation and back-translation of the scales, both were evaluated and adapted to the Brazilian context. Subsequently, the psychometric properties of the two instruments were analyzed: content validity, construct validity, reliability and stability. For content validity, four judges evaluated the scales, reaching a satisfactory Content Validity Coefficient (CVC) for EMIC-AP (0.88) and EMIC-CSS (0.89). The EMIC-AP was applied to 203 people affected by leprosy. The exploratory factorial analysis was used to verify the construct validity and was adequate for evaluation of the Brazilian version - Kaiser Meyer-Olkin (KMO = 0.79) and Bartlett's sphericity (p <0.001). It was confirmed the existence of two factors, evidencing its validity of construct and that it would be adequate to maintain all of the items. For this scale, the stigma was significantly associated with age (p = 0.011), marital status (p = 0.002), work context (p = 0.031) and operational disease classification (p = 0.038). In addition, Cronbach's alpha showed good internal consistency (α = 0.79), as did the Spearman-Brown coefficient (0.81), which pointed to the stability of the instrument by the two halves method. The EMIC- CSS was applied to 300 community members (non-affected by the disease), KMO = 0.80 and significant Bartlett's sphericity (p <0.001). It was confirmed the existence of 4 factors, which attest the construct validity of the scale. There was a statistically significant association between stigma and the following variables: race (p = 0.010), age group (p = 0.038), natural state (p = 0.025); municipality of residence (p = 0.004). Cronbach's alpha demonstrated a high internal consistency of the instrument (α = 0.84). The test-retest stability was calculated using the Spearman-Brown (0.80) and Pearson's coefficient (r = 0.65, p = 0.001), demonstrating that

the correlation between the results of the two applications at different times was significant. The scales were adequate for the psychometric properties analyzed. They are valid for the Brazilian context and can be incorporated into the daily life of health services, allowing the development of actions directed to psychosocial aspects, extrapolating the biomedical model that prevails in the country. It should be recognized that these are tools for screening to contribute to a situational diagnosis, therefore they denote the need for studies that deepen, in qualitative perspectives, the causes and impacts of stigma.