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Cross-Cultural Validation of a Measure of Felt Stigma in People with Intellectual Disabilities

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Title: Cross-Cultural Validation of a Measure of Felt Stigma in People with Intellectual Disabilities
Language: English
Authors: Kock, Elizabeth, Molteno, Chris, Mfiki, Ntathu, Kidd, Martin, Ali, Afia, King, Michael, Strydom, Andre
Source: Journal of Applied Research in Intellectual Disabilities. Jan 2012 25(1):11-19.
Availability: Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail: cs-journals@wiley.com; Web site: http://www.wiley.com/WileyCDA/
Peer Reviewed: Y
Page Count: 9
Publication Date: 2012
Document Type: Journal Articles
Reports - Research
Descriptors: Health Services, Mental Retardation, Focus Groups, Multilingualism, Validity, Factor Structure, Factor Analysis, Foreign Countries, Developing Nations, Adults, Mental Disorders, Disabilities, Reliability, Indo European Languages, English, Multicultural Education
Geographic Terms: South Africa, United Kingdom
DOI: 10.1111/j.1468-3148.2011.00644.x
ISSN: 1360-2322
Abstract: Background: One trade-off for increased independence of adults with intellectual disabilities in developing countries is that they may find themselves more exposed to the negative perceptions held by the general population regarding the mentally ill and disabled. The aim of this study was to adapt and translate a tool to measure felt stigma in people with intellectual disabilities designed in the United Kingdom (UK) to make it culturally viable, and to determine its reliability and validity in the multi-ethnic and multilingual context of South Africa (SA) and to compare the item responses and factor structures of the tool between the UK and SA. Methods: We translated the tool into local languages and refined it by conducting focus groups and pilot studies with professionals and adults with intellectual disabilities, after which test-retest reliability, factor analysis and internal consistency were calculated. Results: Participants were from three different population groups: Afrikaans (n = 71; 37%), English (n = 67; 35%) and Xhosa (n = 53; 28%), who had mild (n = 106; 56%) or moderate intellectual disabilities (n = 85; 44%). 98 (51%) were re-interviewed. The resulting international version of the perceived stigma measure consisted of 10 questions with good test-retest reliability (kappa ranging from 0.41 to 0.59) and a similar factor structure to the UK version, despite including a different set of questions. Conclusions: There is evidence for the validity of felt stigma ratings reported by adults with intellectual disabilities, despite different cultural and health service contexts.
Abstractor: As Provided
Entry Date: 2012
Accession Number: EJ949078
Database: ERIC
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  Value: <anid>AN0067730857;e0301jan.12;2019Jun04.08:07;v2.2.500</anid> <title id="AN0067730857-1">Cross-Cultural Validation of a Measure of Felt Stigma in People with Intellectual Disabilities. </title> <p>Background  One trade‐off for increased independence of adults with intellectual disabilities in developing countries is that they may find themselves more exposed to the negative perceptions held by the general population regarding the mentally ill and disabled. The aim of this study was to adapt and translate a tool to measure felt stigma in people with intellectual disabilities designed in the United Kingdom (UK) to make it culturally viable, and to determine its reliability and validity in the multi‐ethnic and multilingual context of South Africa (SA) and to compare the item responses and factor structures of the tool between the UK and SA. Methods  We translated the tool into local languages and refined it by conducting focus groups and pilot studies with professionals and adults with intellectual disabilities, after which test–retest reliability, factor analysis and internal consistency were calculated. Results  Participants were from three different population groups: Afrikaans (n = 71; 37%), English (n = 67; 35%) and Xhosa (n = 53; 28%), who had mild (n = 106; 56%) or moderate intellectual disabilities (n = 85; 44%). 98 (51%) were re‐interviewed. The resulting international version of the perceived stigma measure consisted of 10 questions with good test–retest reliability (κ ranging from 0.41 to 0.59) and a similar factor structure to the UK version, despite including a different set of questions. Conclusions  There is evidence for the validity of felt stigma ratings reported by adults with intellectual disabilities, despite different cultural and health service contexts.</p> <p>Keywords: ethnicity; intellectual disabilities; mental retardation; South Africa; stigma; culture</p> <p>South Africa (SA) is currently de‐institutionalizing the care of adults with intellectual disabilities by closing large institutional centres. Living within the general community as opposed to residing in an institution is an important contributing factor in facilitating the physical integration of people with intellectual disabilities into the community ([<reflink idref="bib3" id="ref1">3</reflink>]). However, one trade‐off for such increased independence is that people with intellectual disabilities may find themselves more exposed to the negative perceptions held by the general population regarding people with disabilities or mental health needs.</p> <p>According to [<reflink idref="bib10" id="ref2">10</reflink>], stigma occurs when an individual with an attribute, which is deeply discredited by his/her society, is rejected as a result of the attribute. [<reflink idref="bib15" id="ref3">15</reflink>] propose that stigma develops because of an imbalance of power, fuelled by social, economic and political differences. Initially, the person is labelled as being different. Prevailing cultural beliefs link the labelled person to undesirable characteristics and to negative stereotypes; labelled individuals are then placed into distinct categories ('us' and 'them') through the process of separating, resulting in loss of status and discrimination. All of these factors apply to people with intellectual disabilities ([<reflink idref="bib16" id="ref4">16</reflink>]). The institutionalization of people with intellectual disabilities was one of the mechanisms by which people with intellectual disabilities were separated from the outside world. They experienced loss of identity and dignity and led a substandard existence.</p> <p>Clearly defined criteria exist for classifying intellectual disabilities, which are rooted in relatively stable cross‐cultural constructs ([<reflink idref="bib17" id="ref5">17</reflink>]). However, the intellectual disabilities 'label' is often associated with negative connotations that may give rise to such a person being excluded from society and other forms of discrimination ([<reflink idref="bib22" id="ref6">22</reflink>]).</p> <p>Stigma may also be understood as a blend of psychological and social responses, which result from variable interactions between the nature of the stigma, its context and individual differences amongst stigmatizers and the stigmatized ([<reflink idref="bib2" id="ref7">2</reflink>]). Therefore, efforts to understand stigma in different cultural settings require studies of the stigmatizers and the stigmatized in order to understand factors at the individual level, as well as macro‐social factors ([<reflink idref="bib2" id="ref8">2</reflink>]). Few studies have considered the experience of stigma by people with intellectual disability. One recent study has shown that stigmatized groups with intellectual disabilities are aware of being stigmatized and know that they are viewed negatively by society ([<reflink idref="bib13" id="ref9">13</reflink>]). [<reflink idref="bib5" id="ref10">5</reflink>] have shown that these negative experiences are internalized (i.e. become part of the person's own beliefs about the 'self') and affect how adults with intellectual disabilities view and evaluate themselves in relation to others. How stigmatization or discrimination is perceived by people with intellectual disabilities may therefore be hypothesized to be an important determinant of psychological outcomes such as mental well‐being or even mental illness ([<reflink idref="bib5" id="ref11">5</reflink>]). In addition to the effect of internalized negative representations of their status, discrimination and exclusion could contribute to the excess of mental health problems in people with intellectual disabilities through social isolation and by reducing employment and self‐development opportunities ([<reflink idref="bib4" id="ref12">4</reflink>]).</p> <p>In order to measure stigma experienced by adults with intellectual disabilities, we conceptualized 'felt' stigma as the individual's own report of their experiences of being stigmatized and of discrimination. An individual's perception of his or her own experiences would naturally be the result of a complex interaction between his or her experience of overt acts of discrimination or devaluation by others (both from outside and within their social networks), internalized negative representations and their individual psychological vulnerabilities and strengths.</p> <p>Using this framework, we developed a tool to measure felt or perceived stigma as reported by adults with intellectual disabilities ([<reflink idref="bib1" id="ref13">1</reflink>]). The tool was developed in consultation with professionals, caregivers and adults with intellectual disabilities. The objective was to measure the extent to which stigma is encountered by adults with intellectual disabilities. It was structured in the form of a questionnaire that consisted of simple language and accompanying descriptive pictures. Each question was followed by a blank space in which the participant could answer either 'Yes' or 'No'. The authors carefully considered the 'yes/no' format and deemed it to be the least complicated to understand when working with people with intellectual disabilities. The use of a binary response format is associated with better test–retest reliability. However, there is the risk of acquiescence bias (please refer to [<reflink idref="bib1" id="ref14">1</reflink>] for a complete discussion) and therefore interviewees are asked to elaborate on their answers and to provide examples of their experiences. The picture accompanying the question functioned as an aid for the participant to better understand the question. The questions were specifically formulated so that participants would find it easy to understand. The structure of the questions and their accompanying images was not misleading, making it possible for participants to decide for themselves whether or not they were applicable to them ([<reflink idref="bib1" id="ref15">1</reflink>]).</p> <hd id="AN0067730857-2">Aim</hd> <p>The aim of this study was to validate the tool designed by [<reflink idref="bib1" id="ref16">1</reflink>] in a different cultural and language context. Specifically, we aimed to adapt and translate the tool to make it culturally viable and to determine in the multi‐ethnic and multilingual South African context</p> <p></p> <p>• 1</p> <p></p> <ulist> <item> Its test–retest reliability and</item> <p></p> </ulist> <p>• 2</p> <p></p> <ulist> <item> Face validity by comparing factor structures of the tool in the UK and SA.</item> </ulist> <hd id="AN0067730857-3">Method</hd> <p>Ethical approval was obtained from the Research Ethics Committee, Health Science Faculty and University of Cape Town. The study was conducted in the Western Cape Metropolitan Area, SA between August 2007 and May 2008. It was required that participants had reached the age of eighteen, and that they were able to grant informed consent. Adults with mild to moderate intellectual disabilities were included.</p> <p>The study was executed in two phases.</p> <hd id="AN0067730857-4">Phase 1: Adaptation of the UK instrument to local context</hd> <p>In this phase, the instrument was aligned to a SA context. SA is a multilingual country with 11 official languages, and in the Western Cape Province (of which Cape Town is the capital city), three languages are common, i.e., English, Afrikaans and Xhosa. A team of experts, which included a psychologist, two voluntary agency representatives, a social worker, a paediatrician and a psychiatrist, all working with adults with intellectual disabilities, therefore adapted the instrument to suit native English speakers and translated the instrument into the two additional local languages, i.e., Xhosa and Afrikaans. They assessed the wording and images included in each of 18 items found to have sufficient reliability in the original tool ([<reflink idref="bib1" id="ref17">1</reflink>]). Those images that were obviously British, and therefore not suitable for the SA setting, were removed and replaced with pictures that were deemed to be more relevant to the SA context. An example of the changes was the picture representing transport in the UK, which is symbolized by a red bus. This was changed to a mini bus taxi that is more applicable to the South African context. The instrument was translated into both Afrikaans and Xhosa, ensuring that local idiom was applied, and then translated by independent translators back into English again, to ensure that the substance of the original question remained unaltered.</p> <p>Following the adaptation and translation of the instrument, focus groups with people with intellectual disabilities in each of the three local languages were used to verify the face validity of the tool. Each group consisted of 8–10 participants, who were purposively selected to represent different language and cultural groups. Each focus group was led by two facilitators who ensured that the participants were clear about the purpose of the group. Participants were asked about their understanding of each of the questions and key words. Alternative wording used by the participants was noted and later discussed with the experts to determine whether the questionnaire required changes. Overall, most of the individual items appeared to have face validity and participants from all language and cultural groups were able to understand the meaning of the items.</p> <p>After further amendments were made, six pilot studies (two in each language) were undertaken to assess its applicability. These interviews aimed to assess whether the changes made had reduced the clarity of the questions and the overall functioning of the tool before reliability testing. Through the pilot studies, it was evident that the instrument still achieved its original outcomes, reflecting the applicability of the amendments to the questionnaire. The amended version of the tool retained the form of a questionnaire and consisted of 18 questions. Each picture was relevant to the SA context.</p> <hd id="AN0067730857-5">Phase 2: Field testing and assessment of reliability</hd> <p>We aimed to recruit up to 60 participants in each language group, of whom 50% would be approached for retesting. Potential participants were identified by occupational therapists, supervisors, nurses or social workers attached to various sheltered employment workshops, outpatient clinics, the provincial government or local voluntary organizations. We selected everyone from the Xhosa language group, but randomly selected participants from the Afrikaans and English groups to ensure that we had approximately 60 participants per language group. Background information was gathered from the participant, their caregiver or other informant (e.g. the occupational therapist at the sheltered employment or the psychiatric nurse at the outpatient clinic).</p> <p>Participants were interviewed at their workshops, homes or clinics. Assistance was provided for participants in completing the questionnaire by clarifying questions with more examples or assisting participants who had difficulty in reading. The procedure lasted approximately 30 min. Test–retest reliability was determined by approaching one in two of the participants to complete the questionnaire a second time, after a time lapse of between 2 and 6 weeks. This time frame was selected to balance the possibility of recalling previous answers to the questionnaire against the possibility of participants encountering new stigmatizing experiences.</p> <p>Socio‐demographic and clinical data were also collected on the participant's level of intellectual disabilities, gender, ethnicity, housing status and medical and psychiatric conditions.</p> <p>We used data from the UK study previously described ([<reflink idref="bib1" id="ref18">1</reflink>]) to make a comparison between SA and England.</p> <hd id="AN0067730857-6">Analysis</hd> <p>Statistica was used to carry out the data analysis. Kappa coefficients were calculated for test–retest reliability. Items with a Kappa of lower than 0.4 were dropped, as well as questions with little variation in response (i.e. where the response was ≥80 or ≤20% endorsement). An exploratory factor analysis was conducted on the remaining items, which met the test–retest criteria to identify the underlying factor structure of the final questionnaire. We used tetrachoric inter‐item correlations for the factor analysis as the data for each item were dichotomous.</p> <p>A scree plot of successive eigenvalues was inspected to identify the minimum number of factors that explained most of the variance. As 0.5 is an approximate of the critical value for tetrachoric correlations ([<reflink idref="bib24" id="ref19">24</reflink>]), variables with a factor loading of 0.5 or more were considered to load significantly onto the respective factor. Cronbach's alpha was calculated to measure internal consistency. This was calculated for the final scale and for the two factor subscales.</p> <p>A chi‐square test was used to test whether the countries (UK and SA) differed significantly in responses to each question. Logistic regression analyses were conducted for items that showed significantly different responses between the countries in order to adjust for other variables.</p> <hd id="AN0067730857-7">Results</hd> <p>The South African version of the instrument was completed by 191 participants, comprising three different population groups: Afrikaans (<emph>n</emph> = 70; 37%), English (<emph>n</emph> = 68; 35%) and Xhosa (<emph>n</emph> = 53; 28%), who had mild (<emph>n</emph> = 106; 59%) or moderate intellectual disabilities (<emph>n</emph> = 85; 44%). Of the 191 participants interviewed during Phase 2, we re‐interviewed 98 (51%) participants (Table 1).</p> <p>1  Socio‐demographic of the South African participants (n = 191)*</p> <p> <ephtml> <table><thead valign="bottom"><tr><th valign="bottom">Demographic characteristics</th><th>Participants</th></tr><tr><th>Number</th><th>% of total</th></tr></thead><tbody valign="top"><tr><td>Gender (<italic>n</italic> = 191)</td></tr><tr><td> Male</td><td>85</td><td>45</td></tr><tr><td> Female</td><td>106</td><td>56</td></tr><tr><td>Presence of additional health problems (<italic>n</italic> = 191)</td><td>53</td><td>28</td></tr><tr><td>User of psychiatric services (<italic>n</italic> = 191)</td><td>58</td><td>30</td></tr><tr><td>Ability level (<italic>n</italic> = 191)</td></tr><tr><td> Mild</td><td>106</td><td>56</td></tr><tr><td> Moderate</td><td>85</td><td>44</td></tr><tr><td>Housing (<italic>n</italic> = 191)</td></tr><tr><td> Lives on his/her own</td><td>1</td><td>1</td></tr><tr><td> Lives with family/foster care</td><td>131</td><td>69</td></tr><tr><td> Supported housing</td><td>59</td><td>31</td></tr><tr><td>Mother tongue(<italic>n</italic> = 191)</td></tr><tr><td> Afrikaans</td><td>71</td><td>37</td></tr><tr><td> English</td><td>67</td><td>35</td></tr><tr><td> Xhosa</td><td>53</td><td>28</td></tr><tr><td>Ethnicity (<italic>n</italic> = 191)</td></tr><tr><td>Black</td><td>53</td><td>28</td></tr><tr><td> Xhosa (within group%)</td><td>51</td><td>(100)</td></tr><tr><td>Coloured (Mixed‐race)</td><td>70</td><td>37</td></tr><tr><td> Afrikaans (within group%)</td><td>52</td><td>(74)</td></tr><tr><td> English (within group%)</td><td>18</td><td>(26)</td></tr><tr><td>White</td><td>68</td><td>35</td></tr><tr><td> Afrikaans (within group%)</td><td>19</td><td>(28)</td></tr><tr><td> English (within group%)</td><td>49</td><td>(72)</td></tr></tbody></table> </ephtml> </p> <hd id="AN0067730857-8">Test–retest reliability</hd> <p>Table 2 summarizes the test–retest correlations (Kappas) for each item, as well as the percentage 'yes' responses. After items with a Kappa of lower than 0.4 were excluded, as well as the questions with little variation in response (i.e. where the response had ≥80 or ≤20% endorsement), 10 questions remained in the questionnaire. These were entered in a factor analysis.</p> <p>2  Test–retest correlations and percentage responses in a South African sample (n = 98)</p> <p> <ephtml> <table><thead valign="bottom"><tr><th>Question/Statement/Item</th><th>Kappa</th><th>Percentage 'Yes' 1st responses</th><th>Percentage 'Yes' 2nd responses</th></tr></thead><tbody valign="top"><tr><td>People look down on me</td><td>0.36</td><td>59</td><td>53</td></tr><tr><td>The police have treated me badly</td><td>−0.03</td><td>5</td><td>2</td></tr><tr><td>I think I am the same as other people</td><td>0.47</td><td>60</td><td>57</td></tr><tr><td>The way people talk to me makes me angry</td><td>0.41</td><td>68</td><td>62</td></tr><tr><td>People make me feel embarrassed</td><td>0.50</td><td>55</td><td>48</td></tr><tr><td>Doctors and nurses have treated me badly</td><td>−0.05</td><td>14</td><td>4</td></tr><tr><td>People on the street make fun of me</td><td>0.59</td><td>43</td><td>40</td></tr><tr><td>People on the street have hurt me</td><td>0.55</td><td>20</td><td>16</td></tr><tr><td>People on the street look at me in a funny way</td><td>0.48</td><td>48</td><td>32</td></tr><tr><td>People like to talk to me</td><td>0.28</td><td>88</td><td>90</td></tr><tr><td>No one bothers me when I use buses, trains or taxi's</td><td>0.59</td><td>90</td><td>94</td></tr><tr><td>I feel welcome in shops, restaurants and pubs</td><td>0.20</td><td>87</td><td>89</td></tr><tr><td>People laugh at me because of the way I look</td><td>0.36</td><td>39</td><td>31</td></tr><tr><td>People treat me like a child</td><td>0.49</td><td>52</td><td>52</td></tr><tr><td>I keep away from other people because they are nasty to me</td><td>0.38</td><td>71</td><td>73</td></tr><tr><td>People laugh at me because of the way I talk</td><td>0.46</td><td>39</td><td>28</td></tr><tr><td>I worry about the way people act towards me</td><td>0.42</td><td>41</td><td>40</td></tr><tr><td>People make fun of me for going to the day centre/workshop</td><td>0.55</td><td>38</td><td>44</td></tr></tbody></table> </ephtml> </p> <p>1 Shaded items removed as a result of poor test–retest reliability or little variation in response.</p> <hd id="AN0067730857-9">Exploratory factor analysis and internal consistency</hd> <p>The results of a parallel analysis ([<reflink idref="bib20" id="ref20">20</reflink>]) and scree plot of eigenvalues were consistent with one another, confirming two dominant factors in the 10‐item instrument. An orthogonal and oblique rotation was explored. The two solutions were very similar in their factor loadings. Factor 1 has an eigenvalue of 4.06 and explained 40.6% of the variance. It contains seven items. The Cronbach's alpha for the seven items is 0.64. Cronbach's alpha improves slightly (0.69) if one item is deleted ('I am the same as other people'). The subscale has a mean of 2.88 and a standard deviation of 1.84. Factor 2 has an eigenvalue of 1.53 and explains 15.3% of the variance (the two factors combined explain of 55.9% of the variance). Factor 2 contains four items and the Cronbach's alpha is 0.65. There is no improvement in alpha if any of the items are deleted. This subscale has a mean of 2.03 and a standard deviation of 1.39. One item loaded onto both factors ('I worry about the way people act towards me'). Factor 1 was labelled 'felt discrimination' as the items described people's experiences of discrimination (such as 'people on the street make fun of me', 'people on the street look at me in a funny way') and factor 2 was labelled 'reaction to discrimination', which contains items describing people's emotional response to stigma (such as 'people make me feel embarrassed'). The items constituting the final 10‐item instrument are given in Table 3. The full scale has a Cronbach's alpha of 0.73 (mean of 4.47, standard deviation of 2.57), which is considered to be acceptable. The alpha improves slightly (0.76) if the item 'I am the same as other people' is deleted. However, we have decided to retain this item as the improvement in alpha is small. Table 3 shows the factor loadings and the item to total correlations for the items.</p> <p>3  The final 10 items with their factor loadings, item‐to‐total correlations and Cronbach's alpha if each item is deleted</p> <p> <ephtml> <table><thead valign="bottom"><tr><th>Items</th><th>Factor loadings</th><th>Item–total correlation</th><th>Cronbach's alpha if item is deleted</th></tr></thead><tbody valign="top"><tr><td>Factor 1: 'Felt stigma'</td></tr><tr><td> I think I am the same as other people</td><td>0.67</td><td>−0.01</td><td>0.76<sup>1</sup></td></tr><tr><td> People on the street make fun of me</td><td>0.60</td><td>0.50</td><td>0.69</td></tr><tr><td> People on the street have hurt me</td><td>0.76</td><td>0.29</td><td>0.72</td></tr><tr><td> People on the street look at me in a funny way</td><td>0.59</td><td>0.56</td><td>0.68</td></tr><tr><td> People laugh at me because of the way I talk</td><td>0.51</td><td>0.41</td><td>0.70</td></tr><tr><td> People make fun of me for going to the day centre</td><td>0.67</td><td>0.42</td><td>0.70</td></tr><tr><td>Factor 2: Reaction to felt stigma</td></tr><tr><td> The way people talk to me makes me angry</td><td>0.80</td><td>0.41</td><td>0.70</td></tr><tr><td> People make me feel embarrassed</td><td>0.67</td><td>0.40</td><td>0.71</td></tr><tr><td> People treat me like a child</td><td>0.83</td><td>0.46</td><td>0.69</td></tr><tr><td> I worry about the way people act towards me</td><td>0.64</td><td>0.42</td><td>0.70</td></tr></tbody></table> </ephtml> </p> <p>2 <sups>1</sups>Improvement in alpha if item is deleted.</p> <p>The results of the parallel analysis indicated two dominant factors which, in the SA study, were similar to those in the UK study. Attributing to the discrepancies between reliability in the UK and SA and the percentage responses to each item, the SA version of the tool had a different set of items to the UK version and shares six out of the 10 items with the UK tool. The common items loaded on the same factors in both countries, and the non‐common items included in the final versions of the SA and the UK tool also conformed to the two factor structures (Table 4).</p> <p>4  Comparison between the factor loadings of the UK and SA versions of the scale</p> <p> <ephtml> <table><thead valign="bottom"><tr><th valign="bottom"> </th><th>Factor loadings</th></tr><tr><th>UK</th><th>SA</th></tr></thead><tbody valign="top"><tr><td>Factor 1: Felt stigma</td></tr><tr><td> People talk down on me</td><td>0.59</td><td> </td></tr><tr><td> I think I am the same as other people</td><td> </td><td>0.67</td></tr><tr><td> People on the street make fun of me</td><td><bold>0.81</bold></td><td><bold>0.60</bold></td></tr><tr><td> People on the street have hurt me</td><td> </td><td>0.76</td></tr><tr><td> People on the street look at me in  a funny way</td><td><bold>0.82</bold></td><td><bold>0.59</bold></td></tr><tr><td> People laugh at me because  of the way I look</td><td>0.90</td><td> </td></tr><tr><td> People treat me like a child<sup>1</sup></td><td>0.69</td><td> </td></tr><tr><td> People laugh at me because  of the way I talk</td><td><bold>0.70</bold></td><td><bold>0.51</bold></td></tr><tr><td> I worry about the way people act  towards me<sup>1</sup></td><td>0.53</td><td> </td></tr><tr><td> People make fun of me for going to the  day centre</td><td> </td><td>0.67</td></tr><tr><td>Factor 2: Reaction to felt stigma</td></tr><tr><td> The way people talk to me makes  me angry</td><td><bold>0.79</bold></td><td><bold>0.80</bold></td></tr><tr><td> People make me feel embarrassed</td><td><bold>0.81</bold></td><td><bold>0.67</bold></td></tr><tr><td> People treat me like a child<sup>1</sup></td><td> </td><td>0.83</td></tr><tr><td> I keep away from other people because  they are nasty to me</td><td>0.54</td><td> </td></tr><tr><td> I worry about the way people act  towards me<sup>1</sup></td><td><bold>0.53</bold></td><td><bold>0.64</bold></td></tr></tbody></table> </ephtml> </p> <ulist> <item>3 SA, South Africa.</item> <item>4 <sups>1</sups>Appear across each factor.</item> <item>5 Items in bold are common to both versions.</item> </ulist> <hd id="AN0067730857-10">Discussion</hd> <p>We adapted a tool developed in the UK to measure felt stigma in adults with intellectual disabilities for use in SA by translating the tool into local languages and refined it by conducting focus groups and pilot studies. Then, we determined its reliability and selected reliable items to analyze the factor structure. We showed that the tool retained its factor structure despite selecting slightly different items for the SA version.</p> <p>The study had a number of strengths. Participants had different languages and were from different cultural groups and accommodation settings. All participants could respond to their mother tongue. An effort was made to include individuals who did not make use of formal services. We achieved a good sample size that enabled us to establish test–retest reliability and conduct an exploratory factor analysis. However, given the cultural diversity, the South African test–retest sample might have benefited from being larger. Furthermore, many of the participants were identified through sheltered workshops, where people share many experiences that could have affected responses overall.</p> <hd id="AN0067730857-11">Cross‐cultural validity, reliability and experience of stigma and discrimination</hd> <p>We found that different items needed to be selected in SA owing to varying reliability and response sets. There are a number of reasons for this. First, despite our efforts to validate items, translation could have affected reliability. Second, it is possible that stigma is not as commonly addressed or acknowledged in SA as in the UK, where there have been several national campaigns to reduce it. In England, the White Paper 'Valuing People' ([<reflink idref="bib6" id="ref21">6</reflink>]) that has been followed by 'Valuing People 'Now' ([<reflink idref="bib7" id="ref22">7</reflink>]) promotes the principles of 'rights, independence, control and inclusion' of people with intellectual disabilities, including the use of mainstream services used by the general public. Aligned with this are the Disability Discrimination Act (2005) ([<reflink idref="bib27" id="ref23">27</reflink>]) and the Human Rights Act (1998) ([<reflink idref="bib26" id="ref24">26</reflink>]), which aim to improve equality across disability and other groups. This creates an awareness of the rights of people with intellectual disabilities so that reporting acts of discrimination and stigmatization would be more likely. It is possible that the South African participants may have become more aware or sensitized to the issue of stigma following completion of the first questionnaire and might have therefore reported it differently at the second interview (for example, they may have become more aware of other peoples' reactions towards them). This could have affected test–retest reliability and third, stigma and discrimination may well take different forms in the two countries. Finally, the rate of discrimination and stigma may vary between the countries.</p> <p>There have been considerable changes in South African legislation since 1994, with Chapter 2 of the new Constitution (Act 108 of 1996) describing the Bill of Rights that acknowledged the injustices of the past and established the equality of all citizens, including those with disability ([<reflink idref="bib23" id="ref25">23</reflink>]). It prohibits discrimination and states that all citizens have the right to have their dignity respected and protected. The Integrated National Disability Strategy White Paper of 1997 emphasized a human rights perspective to people with disability, asserted the promotion and protection of their rights as well as focusing on improving their quality of life and fulfilment of their aspirations ([<reflink idref="bib21" id="ref26">21</reflink>]). Following this, the Integrated Provincial Disability Strategy (2002) included the integration of disability issues into the function of local Western Cape government departments and promotion of disabled persons, particularly those who are vulnerable ([<reflink idref="bib8" id="ref27">8</reflink>]). A policy on inclusive education has also been established through the White Paper on Special Needs Education. While the country has some of the most comprehensive legislation to protect and promote the rights of disabled people in the world, policy implementation remains a challenge. [<reflink idref="bib9" id="ref28">9</reflink>] proposed several reasons for this: Policies are not addressed consistently at different levels of government; disabled people have not been encouraged to participate in local implementation; and there is a lack of allocated fiscal resources ([<reflink idref="bib9" id="ref29">9</reflink>]).</p> <p>People with disabilities in SA therefore may not enjoy the prominence they have in developed countries. Furthermore, the reports of adults with intellectual disabilities from different ethnic groups may also be influenced by their experience of racism, given the South African historical context. However, participants in the current study often repeated the general message of equality 'we are the same', which is associated with the post‐apartheid effort to create an inclusive 'rainbow nation' inspired by the collectivism of the African philosophy of <emph>Ubuntu</emph> ([<reflink idref="bib19" id="ref30">19</reflink>]) and expressed by slogans used in the media such as 'Simunye, we are one'.</p> <p>Because the final reliable versions of the tools differed between the countries, we were not able to make quantitative comparisons between the participants' overall experience of felt stigma. Nevertheless, this approach to obtaining self‐reported ratings of felt stigma and discrimination had some validity – participants in different countries, speaking different languages, and from different ethnic groups were all able to respond to the questionnaire. We were able to identify comparable factor structures in factor analyses of the UK and SA data, despite the selection of different items for each version of the tool.</p> <hd id="AN0067730857-12">Factors associated with reports of felt stigma</hd> <p>In developing regions and in instances where no family support or other networks exist, the effect of discrimination or stigmatization on the health of disabled people could be considerable ([<reflink idref="bib11" id="ref31">11</reflink>]). Epilepsy in particular may often give rise to stigma and culture‐bound myths with consequences to the health and care of sufferers ([<reflink idref="bib12" id="ref32">12</reflink>]; [<reflink idref="bib18" id="ref33">18</reflink>]).</p> <p>[<reflink idref="bib4" id="ref34">4</reflink>] noted that social comparisons, when a person with intellectual disabilities compares himself to others, may lead to feelings of depression and hopelessness ([<reflink idref="bib4" id="ref35">4</reflink>]). Another study found that the response to such feelings may differ according to gender – males responded more aggressively than females and those females refrained from expressing aggressiveness and rather opted for passive responses ([<reflink idref="bib14" id="ref36">14</reflink>]).</p> <p>People with intellectual disabilities may have several other stigmatizing features, some of which we have not accounted for. These include sensory disability or mobility problems or an unusual appearance. The frequency of these features may have differed between the UK and SA participants. In addition, stigma attributing to ethnicity or race may have been relevant, particularly in the SA context. Further research is required to determine how these and other factors are associated with felt stigma. This is in keeping with Goffman's conceptualization of stigmatization that holds that stigma comes in different forms. Furthermore, the significance of these variations or their potentially negative attributes is likely to differ between cultural groups according to [<reflink idref="bib15" id="ref37">15</reflink>] model. This may influence both the expression of stigmatization or discrimination and the way it is felt by the stigmatized.</p> <hd id="AN0067730857-13">Implications</hd> <p>The degree to which participants may feel stigmatized could vary day to day and event by event. Therefore, it can be argued that an approach that focuses on internalized stigma (i.e. the stigmatized person's own beliefs, perceptions and emotions regarding the negative stereotype associated with their stigmatizable condition) rather than external effects of perceived discrimination (i.e. behavioural consequences of stigma, which act to the disadvantage of the people who are stigmatized – see [<reflink idref="bib25" id="ref38">25</reflink>]) will be the best way to measure a stigmatized person's 'felt' (perceived) stigma. We took the view that an individual's own perception of stigma will necessarily be the result of a complex mix of discriminatory and stigmatizing experiences, as well as their beliefs and psychological factors. Our conceptualization of 'felt stigma' and the use of a questionnaire consisting of items tapping into both discriminatory experiences and internalized perceptions to measure differences between population groups are similar to the concepts and methods used by researchers to compare other constructs with prominent subjective components, such as quality of life, across different illness and cultural groups ([<reflink idref="bib28" id="ref39">28</reflink>]).</p> <p>We showed that felt stigma can be reported by adults with intellectual disabilities from different countries. Further research is required to determine how different factors contribute to felt stigma in different societies and how this then relates to psychological well‐being, use of services or even health outcomes such as adherence to treatments. Another perspective can be gained by investigating the relationships between felt stigma and overt stigmatization or discrimination. This may ultimately lead to studies on how to change attitudes, reduce discrimination and felt stigma through interventions at community, institutional or personal levels.</p> <hd id="AN0067730857-14">Acknowledgments</hd> <p>We are grateful for the assistance received from individuals and organisations during this study – specifically, the staff and residents of the Includid project in Cape Town, the staff and study participants at the Oasis, Worshops Unlimited, Alta du Toit, Alta Centre and Orion workshops; Cape Mental Health and the government of the Western Cape. We made use of the office facilities at Alexandra Hospital. This study was funded by the 'IASSID Research in Africa Fund', and Dr Strydom received support from the Royal College of Psychiatrists in the form of the Natalie Cobbing travelling fellowship.</p> <hd id="AN0067730857-15">Correspondence</hd> <p>Any correspondence should be directed to Andre Strydom, Department of Mental Health Sciences, UCL School of Medical and Life Sciences, Bloomsbury Campus, Charles Bell House, 67‐73 Riding House Street, London W1W 7EY, UK (e‐mail: a.strydom@ucl.ac.uk).</p> <ref id="AN0067730857-16"> <title> References </title> <blist> <bibl id="bib1" idref="ref13" type="bt">1</bibl> <bibtext> Ali A., Strydom A., Hassiotis A., Williams R. & King M. (2008) A measure of perceived stigma in people with intellectual disability. British Journal of Psychiatry 193, 410 – 415.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref7" type="bt">2</bibl> <bibtext> Campbell C. & Deacon H. (2006) Unravelling the contexts of stigma: from internalisation to resistance to change. Journal of Community & Applied Social Psychology 16, 411 – 417.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref1" type="bt">3</bibl> <bibtext> Cummins R. & Lau A. (2003) Community integration or community exposure? A review and discussion in relation to people with an intellectual disability. Journal of Applied Research in Intellectual Disabilities 16, 145 – 157.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref12" type="bt">4</bibl> <bibtext> Dagnan D. & Sandhu S. (1999) Social comparison, self‐esteem and depression in people with intellectual disability. Journal of Intellectual Disability Research 43, 372 – 379.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref10" type="bt">5</bibl> <bibtext> Dagnan D. & Waring M. (2004) Linking stigma to psychological distress: testing a social‐cognitive model of the experience of people with intellectual disabilities. Clinical Psychology & Psychotherapy 11, 247 – 254.</bibtext> </blist> <blist> <bibl id="bib6" idref="ref21" type="bt">6</bibl> <bibtext> Department of Health, England (2001) Valuing People: A New Strategy for Learning Disability for the 21st Century; A White Paper. Available at: <ulink href="http://valuingpeople.gov.uk/dynamic/valuingpeople4.jsp">http://valuingpeople.gov.uk/dynamic/valuingpeople4.jsp</ulink> (accessed on 11 August 2011)</bibtext> </blist> <blist> <bibl id="bib7" idref="ref22" type="bt">7</bibl> <bibtext> Department of Health, England (2009) Valuing People Now: A New Three‐year Strategy for People with Learning Disabilities. Available at: <ulink href="http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH%5f093377">http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH%5f093377</ulink> (accessed on 11 August 2011)</bibtext> </blist> <blist> <bibl id="bib8" idref="ref27" type="bt">8</bibl> <bibtext> Department of Health, Government of the Western Cape (2002) Integrated Provincial Disability Strategy. Department of Health, Government of the Western Cape, Cape Town.</bibtext> </blist> <blist> <bibl id="bib9" idref="ref28" type="bt">9</bibl> <bibtext> Dube A. K. (2005) The Role and Effectiveness of Disability Legislation in South Africa. Disability Knowledge and Research programme. Available at: <ulink href="http://www.dfid.gov.uk/R4D/PDF/Outputs/Disability/PolicyProject%5flegislation%5fsa.pdf">http://www.dfid.gov.uk/R4D/PDF/Outputs/Disability/PolicyProject%5flegislation%5fsa.pdf</ulink> (accessed on 11 August 2011)</bibtext> </blist> <blist> <bibtext> Goffman E. (1963) Stigma; Notes on the Management of Spoiled Identity. Prentice‐Hall, Englewood Cliffs, NJ, USA.</bibtext> </blist> <blist> <bibtext> Hogg J., Lucchino R., Wang K. & Janicki M. (2000) Healthy Ageing – Adults with Intellectual Disabilities Aging & Social Policy. World Health Organization, Geneva.</bibtext> </blist> <blist> <bibtext> Jacoby A. (2008) Epilepsy and stigma: an update and critical review. Current Neurology and Neuroscience Reports 8, 339 – 344.</bibtext> </blist> <blist> <bibtext> Jahoda A. & Markova I. (2004) Coping with social stigma: people with intellectual disabilities moving from institutions and family home. Journal of Intellectual Disability Research 48, 719 – 729.</bibtext> </blist> <blist> <bibtext> Jahoda A., Pert C., Squire J. & Trower P. (1998) Facing stress and conflict: a comparison of the predicted responses and self‐concepts of aggressive and non‐aggressive people with intellectual disability. Journal of Intellectual Disability Research 42, 360 – 369.</bibtext> </blist> <blist> <bibtext> Link B. & Phelan J. (2001) Conceptualising stigma. Annual Review of Sociology 27, 363 – 387.</bibtext> </blist> <blist> <bibtext> Link B. G., Yang L. H., Phelan J. C. & Collins P. Y. (2004) Measuring mental illness stigma. Schizophrenia Bulletin 30, 511 – 541.</bibtext> </blist> <blist> <bibtext> Littlewood R. (2006) Mental health and intellectual disability: culture and diversity. Journal of Intellectual Disability Research 50, 555 – 560.</bibtext> </blist> <blist> <bibtext> McLaughlin D. P., Pachana N. A. & McFarland K. (2008) Stigma, seizure frequency and quality of life: the impact of epilepsy in late adulthood. Seizure 17, 281 – 287.</bibtext> </blist> <blist> <bibtext> Møller V., Dickow H. & Harris M. (1999) South Africa's "Rainbow People", National Pride and Happiness. Social Indicators Research 47, 245 – 280.</bibtext> </blist> <blist> <bibtext> O'Connor B. P. (2000) SPSS and SAS programs for determining the number of components using parallel analysis and Velicer's MAP test. Behavior Research Methods, Instruments, & Computers 32, 396 – 402.</bibtext> </blist> <blist> <bibtext> Office of the Deputy President, Republic of South Africa (1997) Integrated National Disability Strategy – White Paper. Available at: <ulink href="http://www.info.gov.za/whitepapers/1997/disability.htm">http://www.info.gov.za/whitepapers/1997/disability.htm</ulink> (accessed 11 August 2011)</bibtext> </blist> <blist> <bibtext> Special Olympics & Centre for Social Development and Education (2003) Multinational Study of Attitudes toward Individuals with Intellectual Disabilities. Special Olympics Inc., Washington, DC.</bibtext> </blist> <blist> <bibtext> Statutes of the republic of South Africa (1996) Constitution of the Republic of South Africa no. 108 of 1996. Available at: <ulink href="http://www.info.gov.za/documents/constitution/index.htm">http://www.info.gov.za/documents/constitution/index.htm</ulink> (accessed 11 August 2011).</bibtext> </blist> <blist> <bibtext> Stevens J. (1986) Applied Multivariate Statistics for Social Sciences. Lawrence Erlbaum, Hillsdale, NJ.</bibtext> </blist> <blist> <bibtext> Thornicroft G., Rose D., Kassam A. & Sartorius N. (2007) Stigma: ignorance, prejudice or discrimination? British Journal of Psychiatry 190, 192 – 193.</bibtext> </blist> <blist> <bibtext> United Kingdom Parliament (1998) The Human Rights Act. United Kingdom Parliament, London.</bibtext> </blist> <blist> <bibtext> United Kingdom Parliament (2005) Disability Discrimination Act. United Kingdom Parliament, London.</bibtext> </blist> <blist> <bibtext> Wettergren L., Kettis‐Lindblad A., Sprangers M. & Ring L. (2009) The use, feasibility and psychometric properties of an individualised quality‐of‐life instrument: a systematic review of the SEIQoL‐DW. Quality of Life Research 18, 737 – 746.</bibtext> </blist> </ref> <aug> <p>By Elizabeth Kock; Chris Molteno; Ntathu Mfiki; Martin Kidd; Afia Ali; Michael King and Andre Strydom</p> <p>Reported by Author; Author; Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib10" firstref="ref2"></nolink> <nolink nlid="nl2" bibid="bib15" firstref="ref3"></nolink> <nolink nlid="nl3" bibid="bib16" firstref="ref4"></nolink> <nolink nlid="nl4" bibid="bib17" firstref="ref5"></nolink> <nolink nlid="nl5" bibid="bib22" firstref="ref6"></nolink> <nolink nlid="nl6" bibid="bib13" firstref="ref9"></nolink> <nolink nlid="nl7" bibid="bib24" firstref="ref19"></nolink> <nolink nlid="nl8" bibid="bib20" firstref="ref20"></nolink> <nolink nlid="nl9" bibid="bib27" firstref="ref23"></nolink> <nolink nlid="nl10" bibid="bib26" firstref="ref24"></nolink> <nolink nlid="nl11" bibid="bib23" firstref="ref25"></nolink> <nolink nlid="nl12" bibid="bib21" firstref="ref26"></nolink> <nolink nlid="nl13" bibid="bib19" firstref="ref30"></nolink> <nolink nlid="nl14" bibid="bib11" firstref="ref31"></nolink> <nolink nlid="nl15" bibid="bib12" firstref="ref32"></nolink> <nolink nlid="nl16" bibid="bib18" firstref="ref33"></nolink> <nolink nlid="nl17" bibid="bib14" firstref="ref36"></nolink> <nolink nlid="nl18" bibid="bib25" firstref="ref38"></nolink> <nolink nlid="nl19" bibid="bib28" firstref="ref39"></nolink>
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  Label: Title
  Group: Ti
  Data: Cross-Cultural Validation of a Measure of Felt Stigma in People with Intellectual Disabilities
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  Data: English
– Name: Author
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  Data: <searchLink fieldCode="AR" term="%22Kock%2C+Elizabeth%22">Kock, Elizabeth</searchLink><br /><searchLink fieldCode="AR" term="%22Molteno%2C+Chris%22">Molteno, Chris</searchLink><br /><searchLink fieldCode="AR" term="%22Mfiki%2C+Ntathu%22">Mfiki, Ntathu</searchLink><br /><searchLink fieldCode="AR" term="%22Kidd%2C+Martin%22">Kidd, Martin</searchLink><br /><searchLink fieldCode="AR" term="%22Ali%2C+Afia%22">Ali, Afia</searchLink><br /><searchLink fieldCode="AR" term="%22King%2C+Michael%22">King, Michael</searchLink><br /><searchLink fieldCode="AR" term="%22Strydom%2C+Andre%22">Strydom, Andre</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+Applied+Research+in+Intellectual+Disabilities%22"><i>Journal of Applied Research in Intellectual Disabilities</i></searchLink>. Jan 2012 25(1):11-19.
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  Data: Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail: cs-journals@wiley.com; Web site: http://www.wiley.com/WileyCDA/
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  Data: 9
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  Data: 2012
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  Data: Journal Articles<br />Reports - Research
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  Data: <searchLink fieldCode="DE" term="%22Health+Services%22">Health Services</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Retardation%22">Mental Retardation</searchLink><br /><searchLink fieldCode="DE" term="%22Focus+Groups%22">Focus Groups</searchLink><br /><searchLink fieldCode="DE" term="%22Multilingualism%22">Multilingualism</searchLink><br /><searchLink fieldCode="DE" term="%22Validity%22">Validity</searchLink><br /><searchLink fieldCode="DE" term="%22Factor+Structure%22">Factor Structure</searchLink><br /><searchLink fieldCode="DE" term="%22Factor+Analysis%22">Factor Analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Developing+Nations%22">Developing Nations</searchLink><br /><searchLink fieldCode="DE" term="%22Adults%22">Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Disorders%22">Mental Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Disabilities%22">Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Reliability%22">Reliability</searchLink><br /><searchLink fieldCode="DE" term="%22Indo+European+Languages%22">Indo European Languages</searchLink><br /><searchLink fieldCode="DE" term="%22English%22">English</searchLink><br /><searchLink fieldCode="DE" term="%22Multicultural+Education%22">Multicultural Education</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22South+Africa%22">South Africa</searchLink><br /><searchLink fieldCode="DE" term="%22United+Kingdom%22">United Kingdom</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1111/j.1468-3148.2011.00644.x
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  Label: ISSN
  Group: ISSN
  Data: 1360-2322
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: One trade-off for increased independence of adults with intellectual disabilities in developing countries is that they may find themselves more exposed to the negative perceptions held by the general population regarding the mentally ill and disabled. The aim of this study was to adapt and translate a tool to measure felt stigma in people with intellectual disabilities designed in the United Kingdom (UK) to make it culturally viable, and to determine its reliability and validity in the multi-ethnic and multilingual context of South Africa (SA) and to compare the item responses and factor structures of the tool between the UK and SA. Methods: We translated the tool into local languages and refined it by conducting focus groups and pilot studies with professionals and adults with intellectual disabilities, after which test-retest reliability, factor analysis and internal consistency were calculated. Results: Participants were from three different population groups: Afrikaans (n = 71; 37%), English (n = 67; 35%) and Xhosa (n = 53; 28%), who had mild (n = 106; 56%) or moderate intellectual disabilities (n = 85; 44%). 98 (51%) were re-interviewed. The resulting international version of the perceived stigma measure consisted of 10 questions with good test-retest reliability (kappa ranging from 0.41 to 0.59) and a similar factor structure to the UK version, despite including a different set of questions. Conclusions: There is evidence for the validity of felt stigma ratings reported by adults with intellectual disabilities, despite different cultural and health service contexts.
– Name: AbstractInfo
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  Group: Date
  Data: 2012
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  Label: Accession Number
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  Data: EJ949078
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ949078
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1111/j.1468-3148.2011.00644.x
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 9
        StartPage: 11
    Subjects:
      – SubjectFull: Health Services
        Type: general
      – SubjectFull: Mental Retardation
        Type: general
      – SubjectFull: Focus Groups
        Type: general
      – SubjectFull: Multilingualism
        Type: general
      – SubjectFull: Validity
        Type: general
      – SubjectFull: Factor Structure
        Type: general
      – SubjectFull: Factor Analysis
        Type: general
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Developing Nations
        Type: general
      – SubjectFull: Adults
        Type: general
      – SubjectFull: Mental Disorders
        Type: general
      – SubjectFull: Disabilities
        Type: general
      – SubjectFull: Reliability
        Type: general
      – SubjectFull: Indo European Languages
        Type: general
      – SubjectFull: English
        Type: general
      – SubjectFull: Multicultural Education
        Type: general
      – SubjectFull: South Africa
        Type: general
      – SubjectFull: United Kingdom
        Type: general
    Titles:
      – TitleFull: Cross-Cultural Validation of a Measure of Felt Stigma in People with Intellectual Disabilities
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Kock, Elizabeth
      – PersonEntity:
          Name:
            NameFull: Molteno, Chris
      – PersonEntity:
          Name:
            NameFull: Mfiki, Ntathu
      – PersonEntity:
          Name:
            NameFull: Kidd, Martin
      – PersonEntity:
          Name:
            NameFull: Ali, Afia
      – PersonEntity:
          Name:
            NameFull: King, Michael
      – PersonEntity:
          Name:
            NameFull: Strydom, Andre
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2012
          Identifiers:
            – Type: issn-print
              Value: 1360-2322
          Numbering:
            – Type: volume
              Value: 25
            – Type: issue
              Value: 1
          Titles:
            – TitleFull: Journal of Applied Research in Intellectual Disabilities
              Type: main
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