Escala de empoderamento: adaptação transcultural e análise de correlação com a escala de estigma em pessoas acometidas pela hanseníase no contexto brasileiro

Abstract

Leprosy remains an infectious process of high magnitude, comprising the group of neglected tropical diseases (NTDs). The incapacitating nature and psychosocial effects make the affected people express care throughout their lives. The absence of a validated instrument for measuring empowerment in Brazil and the limitation of studies on the topic continue to be significant aspects. The study aims to analyze the cross-cultural adaptation (CCA) of the Empowerment Scale (ES) by Rogers et al. (1997), in people affected by leprosy in Brazil and correlation with the stigma scale (Explanatory Model Interview Catalog-Affected People Stigma Scale - EMIC-AP). It is a methodological study developed in Vitória da Conquista- BA, Fortaleza-CE, Floriano-PI and Cacoal-RO. The scale's CCA followed the references of Herdman Fox-Rushby and Badia (1998), respecting the universalist model during the stages of conceptual equivalence, items, semantics, operational, measurement and functional. 20 people were included in the pre-test and 203 people in the psychometric analysis. The EE was translated and back-translated, resulting in a synthesis version. The pre-test was applied to people undergoing leprosy treatment in a university dermatology clinic, in Fortaleza-CE, 2017. The scale expressed internal consistency with a Cronbach's alpha coefficient of 0.69, being statistically satisfactory among the items. The validation step of the study was performed with a sample of 203 participants, 108 (53.2%) from Fortaleza, 60 (29.6%) from Vitória da Conquista, 22 (10.8%) from Cacoal and 13 (6, 4%) from Floriano. Composed of 109 men (53.6%), the age of the population ranged from 18 to 83 years (general average of 49.2 years). They expressed an average of 6.6 years of study and an average individua income of R $ 1,029.70. The scale showed a positive result regarding the evaluation of the specialists and the target audience, having been systematized and socialized through an application guide. Regarding the factor analysis, there was no statistically significant association with sex (p = 0.117), race (p = 0.304), age (p = 0.307), education (p = 0.433). There was a statistically significant association for work (p = 0.059), income (p = 0.036) and place of residence (p = 0.001). Satisfactory internal consistency occurred with Cronbach's alpha 0.781, KMO = 0.789 and significance in Bartlett's sphericity (p <0.001). The general analysis considered the adequacy of the sample and the factorability of the instrument for context in Brazilian Portuguese. The internal consistency of the subscales (factors) was satisfactory, with a self-esteem and self-efficacy factor, community activism and autonomy. The correlation between the scales of empowerment and stigma was characterized by a statistically significant correlation, with Pearson's coefficient (r = -0.137, p = 0.052). When controlling the variables, statistical significance was observed with the gender variable Pearson's correlation (r = - 0.215, p = 0.037), as well as with race / color, indicating a statistical significance with black / brown (r = -0.179 , p = 0.026). The ES represents a strategic instrument that allows the integration of the category of empowerment as an additional element in SUS (Brazil’s Public Health System). The correlation analysis between the empowerment and stigma scale was statistically significant in the population affected by leprosy, showing significance with race / color and sex. The measurement of empowerment, through ES, is characterized by a collaboration for the state of art in order to control and overcome the impacts of NTDs. This Cross-cultural Adaptation endorses the use of the “Brazil version” of the empowerment scale.