Date of Award

12-2022

Degree Type

Thesis

Degree Name

MS in Epidemiology & Biostatistics

First Advisor

Syed Iqbal Azam

Second Advisor

Dr Nargis Asad

Third Advisor

Dr Shireen Shehzad Bhamani

Department

Community Health Sciences

Abstract

Background: “Attitudes toward Seeking Mental Health Services (IASMHS)” is a commonly used scale for measuring attitudes toward utilizing professional mental health services, which is an important determinant of service uptake and a potential target of health promotion activities. There is a need to conduct research in this area in Pakistani population, necessitating validation of translated versions of available and widely used research instruments.
Methods: A cross-sectional validation study was carried out on 992 participants from different regions of Pakistan, using an anonymous, self-administered, web-based electronic questionnaire and purposive sampling. IASMHS, along with an adapted “General Help-seeking Questionnaire (GHSQ)” and “Self-stigma of Seeking Help (SSOSH)” scale were translated into Urdu following recommended steps. Scale level Content Validity Index (Average method) was calculated, using relevance ratings by eight healthcare professionals. Internal consistency was tested through Cronbach’s alpha. Validity against constructs of ‘Intention to seek professional mental help’, ‘Self-stigma’, ‘Previous mental help-seeking experience’, ‘Suboptimal mental wellbeing’, and ‘Perceived social support’ were checked through Spearman’s correlation coefficient. Exploratory Factor Analysis (EFA) [Principal FactorAnalysis with Oblique Promax rotation], followed by Confirmatory Factor Analysis (CFA) using Generalized Structural Equation Modelling (family Ordinal, link Logit) of one-, two- and three-factor models were performed to examine factor structure.
Results: Out of 992 respondents, more than half were females (53.33%) and currently married (55.85%). Mean age was 32.68 + 9.96 years, and less than half (48.69%) were residents of Sindh. Most common ethnic groups were Pashto and Urdu-speaking (30.75% and 21.57% respectively). More than half of subjects (53.02%) had completed an education level of graduation or higher. IASMHS-Urdu had an excellent Content Validity (S-CVI/Ave 0.96) and an acceptable Cronbach’s alpha of 0.79. All subscales had positive and highly statistically significant correlation with IASMHS-Urdu score (p value < 0.001), ranging from very strong for ‘Indifference to Stigma’ (ρ 0.85), to weak for ‘Help-seeking Propensity’ (ρ 0.29). Inter[1]subscale correlation between ‘Psychological Openness’ and ‘Indifference to Stigma’ was positive and moderately strong (ρ 0.51). ‘Help-seeking Propensity’ was negatively correlated with ‘Psychological Openness’ (ρ -0.25) but had no correlation with ‘Indifference to Stigma’ (ρ 0.01); though the result was statistically insignificant. Correlation between IASMHS-Urdu and average GHSQ-professional score, PHQ-4 and MSPSS scores ranged from weak to very weak (0.19, 0.25, and 0.09 respectively). IASMHS-Urdu had a moderate negative correlation with SSOSH score (ρ -0.44). Spearman’s coefficient for IASMHS-Urdu and previous mental help-seeking experience was very small and statistically insignificant. Although EFA suggested a two-factor structure, the originally proposed three-factor structure consisting of ‘Psychological Openness’, ‘Help-seeking Propensity’ and ‘Indifference to Stigma’ had lowest AIC and BIC among the three models compared in CFA.
Conclusion: IASMHS-Urdu is internally consistent and valid against the construct of self-stigma of seeking mental health help. It has an excellent content validity for Pakistani cultural context. It consists of three latent factors, as proposed by its developers. It is a suitable tool for assessing attitudes toward seeking professional mental help among Pakistani general population.

First Page

1

Last Page

151

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