Contextual Adaptation, Translation, and Validation of the Affiliate Stigma Scale among Primary Caregivers of Children with Physical Disabilities in Nepal: An Observational Study.

Introduction: The experience of affiliate stigma can cause psychosocial problems among caregivers of children with physical disabilities, seriously affecting children's care and rehabilitation. To measure this stigma, we aimed to adapt and validate the widely accepted Affiliate Stigma Scale in the Nepali language. Methods: This study was conducted among 220 primary caregivers of children with physical disabilities, who presented at the Hospital and Rehabilitation Centre for Disabled Children, Nepal, from April to June 2024. The original tool was adapted, translated, followed by experts' reviews, and pretesting. The final Nepali version was then administered among conveniently selected participants through face-to-face interviews. Data analyses comprised different parts, including item analysis, reliability, validity analysis, and Exploratory Factor Analysis, performed using SPSS version 16. Results: Item analyses revealed strong item-total correlations (r=0.31-0.76) for all 21 items except A3 (r=0.23). Critical Ratios indicated high discriminative power (CRs>0.30) for all items. The reliability test showed a strong Cronbach's alpha coefficient (0.90), and odd-even split-half reliability (0.83 and 0.80). The tool exhibits good discriminative validity (p=0.04), and high convergent validity (r=-0.33, p<0.00). Moreover, exploratory factor analysis results supported the three-factor structure of the original scale, though some issues were identified: item A3 not loading onto any of the three factors, some cross-loadings, and items from different domains grouping together. Conclusions: Despite having the problematic structure of the scale, it was still found highly reliable and valid in measuring affiliate stigma among the study population.