Validity and Reliability Study of the Turkish Form of the 4th Version of the Mental Illness: Clinicians' Attitudes (MICA) Scale

Yıl 2024, Cilt: 16 Sayı: Supplement 1, 22 - 39

Emre Mısır , Yasemin Hosgören Alıcı , Zeynep Bozkurt , Hüseyin Batuhan Elhan

https://doi.org/10.18863/pgy.1389804

Öz

Objective: The purpose of this study is to adapt the Mental Illness: Clinician Attitude scale version 4 (MICA-v4) into Turkish, conduct validity and reliability study.
Method: The Turkish version of MICA-v4 was administered to 249 healthcare workers, including medical students, nurses, and physicians, and responses were collected in sealed envelopes. Exploratory and confirmatory factor analyses (EFA and CFA) were employed to assess the structural validity of the scale. Cronbach's alpha coefficients were calculated to demonstrate reliability. The Beliefs Toward Mental Illness scale (BTMI) was used to assess criterion-related validity.
Results: EFA yielded a three-factor solution explaining 53.88% of the total variance. Subscales were named MICA-Care (attitudes towards health/social care and views on mental illnesses), MICA-Stereotypes (stereotypes about mental illnesses), and MICA-Social interaction (social interactions with individuals with mental illnesses). Item factor loadings ranged from 0.469 to 0.852. Model fit indices calculated through CFA were at an acceptable level. The scale demonstrated good internal consistency with a Cronbach's alpha coefficient of 0.774. Significant correlations were observed between MICA scores and BTMI scale scores.
Conclusion: The findings of the study indicate that the Turkish version of MICA-v4 is valid and reliable. It is considered a useful tool for studies addressing stigma towards mental illnesses among healthcare workers in Türkiye.

Anahtar Kelimeler

Mental illnesses, stigma, healthcare workers, validity, reliability

Proje Numarası

KA22/222

Ruhsal Hastalıklara Karşı Klinisyen Tutum Ölçeği 4. Versiyonu Türkçe Formunun Geçerlilik ve Güvenilirlik Çalışması

Öz

Amaç: Bu çalışmanın amacı Ruhsal Hastalıklara Karşı Klinisyen Tutum Ölçeği 4. Uyarlaması’nın (RUKTÖ-v4) Türkçe’ye uyarlanması ve geçerlik ve güvenirlik çalışmasının yapılmasıdır.
Yöntem: RUKTÖ-v4 Türkçe formu tıp fakültesi öğrencileri, hemşireler ve hekimlerden oluşan 249 katılımcıya ulaştırıldı ve yanıtlar kapalı zarf içinde alındı. Ölçeğin yapı geçerliğinin değerlendirilmesi için açımlayıcı ve doğrulayıcı faktör analizleri (AFA ve DFA) uygulandı. Güvenirliğin gösterilmesi için Cronbach alfa iç tutarlılık katsayıları hesaplandı. Ölçüt bağımlı geçerliğin değerlendirilmesi için Ruhsal Hastalığa Yönelik İnançlar Ölçeği (RHYİÖ) kullanıldı.
Bulgular: Yapılan AFA ile toplam varyansın %53,88’ini açıklayan üç faktörlü çözüm elde edildi. Alt ölçekler RUKTÖ-Bakım (sağlık/sosyal bakım alanı ve ruhsal hastalıklar hakkında görüşler), RUKTÖ-Kalıp Yargı (ruhsal hastalıklar hakkında kalıp yargı) ve RUKTÖ-Sosyal mesafe (ruhsal hastalığı olan bireylerle sosyal mesafe) olarak isimlendirildi. Madde faktör yükleri 0,469-0,852 arasında değişiyordu. DFA ile hesaplanan model uyum indeksleri kabul edilir düzeydeydi. Ölçeğin Cronbach alfa iç tutarlılık katsayısı 0,774 bulundu. RHYİÖ ölçek puanları ile korelasyonlar anlamlı düzeydeydi.
Sonuç: Çalışmanın bulguları RUKTÖ-v4 Türkçe formunun geçerli ve güvenilir olduğunu göstermiştir. Sağlık çalışanları ve Tıp Fakültesi öğrencilerinde ruhsal hastalıklara yönelik damgalanma konusunda ülkemizde yapılacak çalışmalar için kullanışlı bir ölçek olduğu düşünüldü.

Anahtar Kelimeler

Ruhsal hastalıklar, damgalama, sağlık çalışanları, geçerlilik, güvenilirlik

Etik Beyan

Çıkar çatışması bulunmamaktadır.

Destekleyen Kurum

Herhangi bir finansman bulunmamaktadır.

Proje Numarası

KA22/222

Kaynakça

• Abdulla A, Webb HC, Mahmmod Y, Dalky HF (2022). Beliefs and attitudes of health care professionals toward mental health services users’ rights: a cross-sectional study from the United Arab Emirates. J Multidiscip Healthc, 15:2177-2188.
• Angermeyer MC, Matschinger H, Corrigan PW (2004) Familiarity with mental illness and social distance from people with schizophrenia and major depression: testing a model using data from a representative population survey. Schizophr Res, 69:175–182.
• Arboleda-Flórez J, Stuart H (2012) From sin to science: fighting the stigmatization of mental illnesses. Can J Psychiatry, 57:457–463.
• Arvaniti A, Samakouri M, Kalamara E, Bochtsou V, Bikos C, Livaditis M (2009) Health service staff’s attitudes towards patients with mental illness. Soc Psychiatry Psychiatr Epidemiol, 44:658–665.
• Aydın O, Uykur AB, Cengisiz C, Balıkçı K, Esen Danaci A (2016) Tıp eğitiminin şizofreniye yönelik tutumlar üzerine etkisi; 5 yıllık izlem çalışması. Turk Psikiyatri Derg, 27:176–184.
• Babicki M, Małecka M, Kowalski K, Bogudzińska B, Piotrowski P (2021) Stigma levels toward psychiatric patients among medical students-a worldwide online survey across 65 countries. Front Psychiatry, 12:798909.
• Babicki M, Kotowicz K, Mastalerz-Migas A (2021). The assessment of attitudes of medical doctors towards psychiatric patients: a cross-sectional online survey in Poland. Int J Environ Res Public Health, 18:6419.
• Barlati S, Morena D, Nibbio G, Cacciani P, Corsini P, Mosca A et al (2022) Internalized stigma among people with schizophrenia: Relationship with socio-demograph1ic clinical and medication-related features. Schizophr Res, 243:364–371.
• Baumgartner H, Homburg C (1996) Applications of structural equation modeling in marketing and consumer research: A review. Int J Res Mark, 13:139-161.
• Beaulieu T, Patten S, Knaak S, Weinerman R, Campbell H, Lauria-Horner B (2017) Impact of skill-based approaches in reducing stigma in primary care physicians: results from a double-blind parallel-cluster randomized controlled trial. Can J Psychiatry, 62:327–335.
• Bilge A (2006) Ruhsal hastalığa yönelik inançlar ölçeği geçerlilik ve güvenirlik çalışması (Doktora tezi). İzmir, Ege Üniversitesi
• Chang S, Ong HL, Seow E, Chua BY, Abdin E, Samari E et al (2017). Stigma towards mental illness among medical and nursing students in Singapore: a cross-sectional study. BMJ Open, 7:e018099.
• Chaplin R (2000) Psychiatrists can cause stigma too. Br J Psychiatry, 177:467.
• Chekuri L, Mittal D, Ounpraseut S (2018). Relationship between stereotypes, prejudice, and social distancing in a sample of health care providers. Prim Care Companion CNS Disord, 20:26877.
• Chew‐Graham CA, Rogers A, Yassin N (2003) ‘I wouldn't want it on my CV or their records': medical students' experiences of help‐seeking for mental health problems. Med Educ, 37:873-880.
• Cilingiroglu N, Paksoy Erbaydar N (2010) Tıp eğitimi geleceğin hekimlerinin ruh sağlığı sorunu olan bireylere yönelik tutumlarını etkilemekte midir? Turk Psikiyatri Derg, 21:114–125.
• Clarke DE, Dusome D, Hughes L (2007) Emergency department from the mental health client’s perspective. Int J Ment Health Nurs, 16:126–131.
• Clement S, Schauman O, Graham T, Maggioni F, Evans-Lacko S, Bezborodovs N et al (2015) What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychol Med, 45:11–27.
• Cohen J, Struening El (1962) Opinions about mental illness in the personnel of two large mental hospitals. J Abnorm Soc Psychol, 64:349–360.
• Corrigan PW, Edwards AB, Green A Diwan SL, Penn DL (2001) Prejudice, social distance, and familiarity with mental illness. Schizophr Bull, 27:219-225.
• Corrigan PW, Watson AC (2002) Understanding the impact of stigma on people with mental illness. World Psychiatry, 1:16–20.
• Corrigan P, Markowitz FE, Watson A, Rowan D, Kubiak MA (2003) An attribution model of public discrimination towards persons with mental illness. J Health Soc Behav, 44:162-179.
• Corrigan PW, Rao D (2012) On the self-stigma of mental ıllness: stages disclosure and strategies for change. Can J Psychiatry, 57:464–469.
• Corrigan, PW, Druss, BG, Perlick, DA (2014) The impact of mental illness stigma on seeking and participating in mental health care. Psychol Sci Public Interest, 15:37-70,
• Cunningham R, Imlach F, Haitana T, Every-Palmer S, Lacey C, Lockett H et al (2023). It’s not in my head: a qualitative analysis of experiences of discrimination in people with mental health and substance use conditions seeking physical healthcare. Front Psychiatry,14:1285431.
• Çam O, Arabacı LB (2014) Bölge psikiyatri hastanelerinde çalışan hemşirelerin ruhsal hastalıklara yönelik inançları ve etkileyen faktörler. Türkiye Klinikleri Hemşirelik Bilimleri Dergisi, 6:13-25.
• Dalky HF, Abu-Hassan HH, Dalky AF, Al-Delaimy W (2020) Assessment of mental health stigma components of mental health knowledge, attitudes and behaviors among Jordanian healthcare providers. Community Ment Health J, 56:524-531
• Daumit GL, Pronovost PJ, Anthony CB, Guallar E, Steinwachs DM, Ford DE (2006) Adverse events during medical and surgical hospitalisations for persons with schizophrenia. Arch Gen Psychiatry, 63:267–272.
• Deres AT, Bürkner PC, Klauke B, Buhlmann U (2020) The role of stigma during the course of inpatient psychotherapeutic treatment in a German sample. Clin Psychol Psychother, 27:239–248.
• Douki S, Marvaki C, Toulia G, Stavropoulou A (2019) Attitudes and perceptions of health professionals towards mental patients attending emergency room. Health Res J, 2:261-76.
• Druss BG, Bradford DW, Rosenheck RA, Radford MJ, Krumholz HM (2000) Mental disorders and use of cardiovascular procedures after myocardial infarction. JAMA, 283:506–511.
• Feldman DB and Crandall CS (2007). Dimensions of mental illness stigma: What about mental illness causes social rejection? J Soc Clin Psychol, 26:137-154.
• Fernando SM, Deane FP, McLeod HJ (2010). Sri Lankan doctors’ and medical undergraduates’ attitudes towards mental illness. Soc Psychiatry Psychiatr Epidemiol, 45:733-739.
• Fleary SA, Joseph PL, Gonçalves C, Somogie J, Angeles J (2022). The relationship between health literacy and mental health attitudes and beliefs. Health Lit Res Pract, 6:e270-e279.
• Gabbidon J, Clement S, van Nieuwenhuizen A, Kassam A, Brohan E, Norman I et al (2013) Mental Illness: Clinicians’ Attitudes (MICA) scale-psychometric properties of a version for healthcare students and professionals. Psychiatry Res, 206:81–87.
• George D, Mallery P (2020) IBM SPSS Statistics 26 Step by Step A Simple Guide and Reference 16th ed. London, Routledge.
• Ghuloum S, Mahfoud ZR, Al-Amin H, Marji T, Kehyayan V (2022) Healthcare professionals' attitudes toward patients with mental ıllness: a cross-sectional study in Qatar. Front Psychiatry, 13:884947.
• Giandinoto JA and Edward KL (2015) The phenomenon of co-morbid physical and mental illness in acute medical care: the lived experience of Australian health professionals. BMC Res Notes, 8:295.
• Givens JL, Tjia J (2002) Depressed medical students’ use of mental health services and barriers to use. Acad Med, 77:918–921.
• Goforth C (2015). Using and interpreting Cronbach’s alpha. https://library.virginia.edu/data/articles/using-and-interpreting-cronbachs-alpha. (Accessed 12.12.2023)
• Gorsuch RL (1997) Exploratory factor analysis: its role in item analysis. J Pers Assess. 68:532–560.
• Grausgruber A, Meise U, Katschnig H, Schöny W, Fleischhacker WW (2007). Patterns of social distance towards people suffering from schizophrenia in Austria: a comparison between the general public, relatives and mental health staff. Acta Psychiatr Scand, 115:310-319.
• Grover S, Aneja J, Hazari N, Chakrabarti S, Avasthi A (2019) Stigma and its correlates among caregivers of patients with bipolar disorder. Indian J Psychol Med, 41:455–461.
• Guadagnoli E, Velicer W (1988) Relation of sample size to the stability of component patterns. Psychol Bull, 103:265–275.
• Hallyburton A (2022). Diagnostic overshadowing: An evolutionary concept analysis on the misattribution of physical symptoms to pre‐existing psychological illnesses. Int J Ment Health Nurs, 31:1360-1372.
• Hamilton S, Pinfold V, Cotney J, Couperthwaite L, Matthews J, Barret K et al (2016) Qualitative analysis of mental health service users’ reported experiences of discrimination. Acta Psychiatr Scand, 134:14–22.
• Haslam D (2015) Plan for the unpredictable. Practitioner, 259:35.
• Hirai M, Clum GA (2000) Development reliability and validity of the Beliefs Toward Mental Illness Scale. J Psychopathol Behav Assess, 22:221–236.
• Hoftman GD (2016) The burden of mental llness beyond clinical symptoms: ımpact of stigma on the onset and course of schizophrenia spectrum disorders. Am J Psychiatry Resid J, 11:5–7.
• Hori H, Richards M, Kawamoto Y, Kunugi H (2011) Attitudes toward schizophrenia in the general population psychiatric staff physicians and psychiatrists: a web-based survey in Japan. Psychiatry Res, 186:183–189.
• Jones S, Howard L, Thornicroft G (2008) “Diagnostic overshadowing”: worse physical health care for people with mental illness. Acta Psychiatr Scand, 118:169–171.
• Jorm AF and Oh E (2009). Desire for social distance from people with mental disorders. Aust N Z J Psychiatry, 43:183-200,
• Kaiser HF (1960) The application of electronic computers to factor analysis. Educ Psychol Meas, 20:141–151.
• Kassam A, Glozier N, Leese M, Henderson C, Thornicroft G (2010) Development and responsiveness of a scale to measure clinicians’ attitudes to people with mental illness (medical student version). Acta Psychiatr Scand, 122:153–161.
• Kigozi-Male NG, Heunis JC, Engelbrecht MC (2023) Primary health care nurses' mental health knowledge and attitudes towards patients and mental health care in a South African metropolitan municipality. BMC Nurs, 22:25.
• Knaak S, Mantler E, Szeto A (2017) Mental illness-related stigma in healthcare. Healthc Manage Forum, 30:111–116.
• Kvaale EP, Gottdiener WH, Haslam N (2013) Biogenetic explanations and stigma: A meta-analytic review of associations among laypeople. Soc Sci Med, 96:95–103.
• Latifian M, Abdi K, Raheb G, Islam SMS, Alikhani R (2023) Stigma in people living with bipolar disorder and their families: a systematic review. Int J Bipolar Disord, 11:9.
• Lau YW, Picco L, Pang S, Jeyagurunathan A, Satghare P, Chong SA et al (2017) Stigma resistance and its association with internalised stigma and psychosocial outcomes among psychiatric outpatients. Psychiatry Res, 257:72–78.
• Lauber C, Nordt C, Braunschweig C, Rössler W (2006). Do mental health professionals stigmatize their patients? Acta Psychiatr Scand, 113:51-59.
• Lawrence DM, Holman CD, Jablensky AV, Hobbs MS (2003) Death rate from ischaemic heart disease in Western Australian psychiatric patients 1980–1998. Br J Psychiatry, 182:31–36.
• Ma H, Hsieh CE (2020) Questionnaires on stigmatizing attitudes among healthcare students in Taiwan: development and validation. BMC Med Educ, 20:59.
• MacDonald J, Morley I (2001) Shame and non‐disclosure: A study of the emotional isolation of people referred for psychotherapy. Br J Med Psychol, 74:1–21.
• Modgill G, Patten SB, Knaak S, Kassam A, Szeto AC (2014) Opening Minds Stigma Scale For Health Care Providers (OMS-HC): examination of psychometric properties and responsiveness. BMC Psychiatry, 14:120.
• Muthén LK, Muthén BO (2002) How to use a Monte Carlo study to decide on sample size and determine power. Struct Equ Modeling, 9:599–620.
• Nehra R, Chakrabarti S, Kulhara P, Sharma R (2005) Caregiver-coping in bipolar disorder and schizophrenia--a re-examination. Soc Psychiatry Psychiatr Epidemiol, 40:329–336.
• Oliveira AM, Machado D, Fonseca JB, Palha F, Silva MP, Sousa N et al (2020) Stigmatizing attitudes toward patients with psychiatric disorders among medical students and professionals. Front Psychiatry, 11:326.
• Öri D, Szocsics P, Molnár T, Bankovska ML, Kazakova O, Mörk S et al (2023) Psychometric properties of the Opening Minds Stigma Scale for Health Care Providers in 32 European countries–A bifactor ESEM representation. Front Public Health, 11:1168929.
• Öri D, Szocsics P, Molnár T, Ralovich FV, Husza´r Z, Bene A et al (2022) Stigma towards mental illness and help-seeking behaviors among adult and child psychiatrists in Hungary: A crosssectional study. PLoS One, 17: e0269802.
• Pallant J (2010) SPSS Survival Manual: A Step by Step Guide to Data Analysis Using SPSS. Maidenhead, McGraw-Hill.
• Porfyri, GN, Athanasiadou M, Siokas V, Giannoglou S, Skarpari S, Kikis M et al (2022) Mental health-related stigma discrimination and prejudices among Greek healthcare professionals. Front Psychiatry, 13:1027304.
• Rao H, Mahadevappa H, Pillay P, Sessay M, Abraham A, Luty J (2009) A study of stigmatized attitudes towards people with mental health problems among health professionals. J Psychiatr Ment Health Nurs, 16:279–284.
• Richard-Lepouriel H, Aubry JM, Favre S (2022) Is coping with stigma by association role-specific for different family members? A qualitative study with bipolar disorder patients’ relatives. Community Ment Health J, 58:179–192.
• Rossi A, Galderisi S, Rocca P, Bertolino A, Rucci P, Gibertoni D et al (2017) Personal resources and depression in schizophrenia: The role of self-esteem resilience and internalized stigma. Psychiatry Res, 256 359–364.
• Sathyanath S, Mendonsa RD, Thattil AM, Chandran VM, Karkal RS (2016). Socially restrictive attitudes towards people with mental illness among the non-psychiatry medical professionals in a university teaching hospital in South India. Int J Soc Psychiatry, 62:221-226.
• Schermelleh-Engel K, Moosbrugger H, Müller H (2003) Evaluating the fit of structural equation models: tests of significance and descriptive goodness-of-fit measures. Methods Psychol Res, 8:23–74.
• Sekaran U, Bougie R (2010) Research Methods for Business: A Skill Building Approach 5th edition. Haddington, Wiley Chichester.
• Siddiqua A, Foster A (2015) Critical synthesis package: Mental Illness Clinicians’ Attitudes Scale (MICA). MedEdPORTAL, 11:10024.
• Smith JD, Mittal D, Chekuri L, Han X, Sullivan G (2017) A comparison of provider attitudes toward serious mental illness across different health care disciplines. Stigma Health, 2:327.
• Sukhera J, Chahine S (2016) Reducing mental illness stigma through unconscious bias-informed education. MedEdPublish, 5:44.
• Sullivan G, Han X, Moore S, Kotrla K (2006) Disparities in hospitalisation for diabetes among persons with and without co-occurring mental disorders. Psychiatr Serv, 57:1126–1131.
• Svensson B, Markström U, Bejerholm U, Björkman T, Brunt D, Eklund M, Hansson L et al (2011) Test-retest reliability of two instruments for measuring public attitudes towards persons with mental illness. BMC Psychiatry,11:11.
• Tabachnick BG, Fidell LS, Ullman JB (2007) Using Multivariate Statistics. Boston, MA, Pearson.
• Taherdoost H, Sahibuddin S, Jalaliyoon N (2014) Exploratory factor analysis; concepts and theory. In Advances in Applied and Pure Mathematics Mathematics and Computers in Science and Engineering Series 27 (Ed J Balicki):375-382. Athens, Greece, WSEAS.
• Tavşancıl E (2002) Tutumların Ölçülmesi ve SPSS İle Veri Analizi. Ankara, Nobel.
• Telles-Correia D, Saraiva S, Gonçalves J (2018) Mental disorder: the need for an accurate definition. Front Psychiatry, 9:64.
• Thornicroft G, Brohan E, Rose D, Sartorius N, Leese M, INDIGO Study Group (2009) Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. Lancet, 373:408–415.
• Thornicroft G, Rose D, Kassam A (2007). Discrimination in health care against people with mental illness. Int Rev Psychiatry, 19:113-122.
• Valentim O, Moutinho L, Laranjeira C, Querido A, Tomás C, Longo J et al (2023). “Looking beyond mental health stigma”: an online focus group study among senior undergraduate nursing students. Int J Environ Res Public Health, 20:4601.
• van der Maas M, Stuart H, Patten SB, Lentinello EK, Bobbili SJ, Mann RE et al (2018). Examining the application of the opening minds survey in the community health centre setting. Can J Psychiatry, 63:30-36.
• Vistorte AOR, Ribeiro W, Ziebold C, Asevedo E, Evans-Lacko S, Varas DJ et al (2023) Adaptation to Brazilian Portuguese and Latin-American Spanish and psychometric properties of the Mental Illness Clinicians’ Attitudes Scale (MICA v4). Trends Psychiatry Psychother, 45:e20210291.
• Vistorte AOR, Ribeiro W, Ziebold C, Asevedo E, Evans-Lacko, S, Keeley JW et al (2018). Clinical decisions and stigmatizing attitudes towards mental health problems in primary care physicians from Latin American countries. PLoS One, 13:e0206440.
• Walker ER, McGee RE, Druss BG (2015) Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry, 72:334–341.
• Wang H, Abbas KM, Abbasifard M, Abbasi-Kangevari M, Abbastabar H, Abd-Allah F et al (2020) Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019. Lancet, 396: 1160-1203.
• Weiss AK, Quinn SM, Danley AL, Wiens KJ, Mehta JJ (2021) Burnout and perceptions of stigma and help-seeking behavior among pediatric fellows. Pediatrics, 148:e2021050393.
• Wijeratne C, Johnco C, Draper B, Earl J (2021) Doctors’ reporting of mental health stigma and barriers to help-seeking. Occup Med, 71:366-374.
• WHO (2002) Mental Health Global Action Programme (mhGAP): Close The Gap, Dare To Care. Geneva, World Health Organization.
• Yanos, PT, VayshenkerB, DeLuca JS, O’Connor LK (2017). Development and validation of a scale assessing mental health clinicians’ experiences of associative stigma. Psychiatr Serv, 68:1053-1060,
• Zeller RA (2005) Measurement error issues and solutions. In Encyclopedia of Social Measurement (Ed K Kempf-Leonard): 665–676. New York, Elsevier.