Validating Day’s Stigma towards Mental Illness Scale using National Mental Health Survey data; Bangladesh context

Mental health stigma, especially in developing countries, particularly in south-Asian regions, hinders treatment and care seeking, leading to abuse and social exclusion. The lack of a culturally sensitive, socially contextual, and statistically valid tool for measuring stigma towards mental illness hinders targeted measures to reduce stigma and increase awareness. As culturally validated measures for evaluating stigma were lacking, Bangladesh's national mental health survey relied on using 28-item Day et al.'s stigma towards mental illness scale. This study assesses the construct validity of the Day's Stigma Scale in Bangladesh using Confirmatory Factor Analysis (CFA), a crucial tool in social and behavioral sciences. The national mental health survey in Bangladesh, conducted from 2018 to 2019, involved 7238 eligible respondents, resulting in an >80% response rate. The study used SPSS and Jamovi to input, screen, and assess data for outliers, normality, and multicollinearity. The Day's Stigma Scale was studied using Exploratory Factor Analysis (EFA) to identify underlying components, yielding a four-factor solution. EFA discovered that 15 items had loadings of less than 0.4 in any of the four categories, and hence they were removed. The model's theoretical validity for the four EFA subscales e.g. Relationship disruption, Anxiety, Hygiene, Hesitancy and Fear, was verified again using confirmatory factor analysis. The construct validity of thirteen-item scale was assessed using AVE and CR, focusing on structural, cultural, convergent, and discriminant validity. Various statistical tests were used to evaluate the models' goodness of fit, including χ2, RMSEA, AIC, BIC, CFI, TLI, and SRMSR. Internal consistency was assessed using Cronbach's alpha, Macdonald's omega, and Guttman's λ2. The study demonstrates the reliability and validity of the thirteen-item version of the Day's stigma towards mental illness scale, which may be used to measure mental health stigma in Bangladesh, as well as for epidemiological studies, intervention design, and mental health service improvement.