Translation, Cross-cultural adaptation and Validation of the Nigerian Pidgin English version of the Rosenberg Self-esteem and Leprosy-adapted Internalized Stigma for Mental Illness Scales among Persons Affected by Leprosy in Southern Nigeria

Background Measuring self-esteem and internalized stigma among persons affected by leprosy is important to monitor stigma-reduction interventions. While the English versions of the Rosenberg self-esteem scale (RSES) and Internalized Stigma of Mental Illness Scale (ISMI) as originally developed have been validated and widely used in many settings, to date, no cross-culturally adapted or validated Nigerian Pidgin English version exists. We describe the translation, cross-cultural validation and adaptation of the Nigerian Pidgin English versions of the RSES and ISMI in Cross River state, southern Nigeria. Methods The Nigerian Pidgin English version of the RSES and ISMI was developed systematically following the World Health Organization’s (WHO) guidelines on the process of translation and adaptation of instruments. The cultural equivalence of the instruments including their conceptual, item, semantic and their operational equivalences were evaluated using qualitative methods through the process of forward and back-translation, expert panel review, pre-testing and cognitive interviewing to generate the final version. A cross-sectional study of 56 participants with leprosy (Hansen’s disease) enrolled from rural and urban communities in 3 local government areas (Boki, Obubra and Calabar-South) in Cross River state, southern Nigeria was undertaken to assess the psychometric equivalence of the tools. After 2-weeks interval, one-third of them (16 participants) had a re-test. Results The conceptual, item, semantic and the operational equivalences of the Nigerian Pidgin English versions of the RSES and ISMI scale showed adequate fit with all items identified as important in the context of the Pidgin speaking population. There was a negative inverse correlation between the mean total scores of the RSES and the ISMI scale (r = -0.57; p <0.001); confirming the construct validity of the two scales. The exploratory factor analysis for the scales indicated good fit as one-dimension scale. The Cronbach’s alpha values representing internal consistency were 0.82 and 0.95 for the RSES and ISMI scale respectively. The test-retest reliability intra-class correlation coefficient for the RSES and the ISMI scale was 0.98 and 0.67, respectively. There were no floor or ceiling effects in the distribution of the responses to the RSES and the ISMI scale. Conclusion The Nigerian Pidgin English version of the RSES and ISMI scales were successfully developed and showed evidence to be reliable and valid instruments for the assessment of self-esteem and internalized stigma respectively among Nigerian Pidgin English speaking population of southern Nigeria. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by Leprosy Research Initiative (LRI) ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee/IRB of University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, Nigeria gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors