Escala de creencias hacia las vacunas y hacia la vacuna contra el SARS-CoV-2: Evidencia de sus propiedades psicométricas / Psychometric properties of two surveys about beliefs towards vaccines in general and SARS-CoV-2 vaccine

BACKGROUND: Negative beliefs about vaccines can threaten herd immunity and pandemic control. Although beliefs about vaccines influence vaccination intention, there are no valid instruments that evaluate this in the Latin American population. AIM: To evaluate the psychometric properties of two scales that measure negative beliefs towards vaccines in general and against SARS-CoV-2 and provide evidence of their association with vaccination intention (convergent validity) in a Chilean sample. MATERIAL AND METHODS: Two studies were carried out. The first included 263 people who answered the beliefs towards vaccines in general scale (CV-G) and the beliefs towards the SARS-CoV-2 vaccine scale (CV-COVID). Exploratory factor analyses were conducted. In the second study, 601 people answered the same scales. Confirmatory factor analyses and structural equation modeling were performed to provide evidence of validity. RESULTS: Both scales had an unifactorial structure and excellent reliability and showed associations with the intention of vaccination against SARS-CoV-2, providing evidence of convergent validity. CONCLUSIONS: The scales evaluated here are reliable and valid measures that showed associations with vaccination intention in the Chilean population.

Escala de creencias hacia las vacunas y hacia la vacuna contra el SARS-CoV-2: Evidencia de sus propiedades psicométricas / Psychometric properties of two surveys about beliefs towards vaccines in general and SARS-CoV-2 vaccine

BACKGROUND: Negative beliefs about vaccines can threaten herd immunity and pandemic control. Although beliefs about vaccines influence vaccination intention, there are no valid instruments that evaluate this in the Latin American population. Aim: To evaluate the psychometric properties of two scales that measure negative beliefs towards vaccines in general and against SARS-CoV-2 and provide evidence of their association with vaccination intention (convergent validity) in a Chilean sample. MATERIAL AND METHODS: Two studies were carried out. The first included 263 people who answered the beliefs towards vaccines in general scale (CV-G) and the beliefs towards the SARS-CoV-2 vaccine scale (CV-COVID). Exploratory factor analyses were conducted. In the second study, 601 people answered the same scales. Confirmatory factor analyses and structural equation modeling were performed to provide evidence of validity. RESULTS: Both scales had an unifactorial structure and excellent reliability and showed associations with the intention of vaccination against SARS-CoV-2, providing evidence of convergent validity. Conclusions: The scales evaluated here are reliable and valid measures that showed associations with vaccination intention in the Chilean population.

Validación de la Escala de Reacciones ante Experiencias de Trato Desigual en Salud / Validating the Scale of Reactions to Experiences of Unequal Treatment in Health / Validação da Escala de Reações ante Experiências de Trato Desigual em Saúde

Resumen Introducción: este artículo tiene por objetivo estimar las propiedades psicométricas de la Escala de Reacciones ante Experiencias de Trato Desigual en Salud de Baeza-Rivera (2015) y establecer si existen diferencias estadísticamente significativas entre quienes se atienden en el sistema privado y público y la pertenencia o no a la etnia mapuche. Materiales y métodos: participaron 337 personas cuyo promedio de edad fue de 31 años, en su mayoría mujeres. El 57 % reportó ser usuario del sistema público de salud y el 32 % declaró su pertenencia a la etnia mapuche. Se realizó un análisis factorial exploratorio, análisis de confiabilidad y Anova factorial. Resultados: los hallazgos dan cuenta de un instrumento con adecuadas propiedades psicométricas, que puede usarse en población con características similares a la muestra empleada. Además, se observa que existen diferencias estadísticamente significativas en función del sistema de salud en que se atiende la persona y la pertenencia a la etnia mapuche. Conclusiones: el instrumento tiene adecuadas propiedades psicométricas que presenta dos factores relacionados, que sirve para ser utilizado en contextos de salud, lo que permite comprender los procesos de salud-enfermedad.

Abstract Introduction: This study aimed to estimate the psychometric properties of the Scale of Reactions to Experiences of Unequal Treatment in Health, from Baeza-Rivera (2015), and to determine any statistically significant differences between those using the private and public healthcare systems and those belonging to the Mapuche ethnic group. Materials and Methods: The Scale of Reactions to Experiences of Unequal Treatment in Health was used in 337 participants (mostly women) with a mean age of 31 years. Of these, 57% reportedly used the public healthcare system and 32% belonged to the Mapuche ethnic group. Subsequently, exploratory factor analysis and reliability analysis using Cronbach's alpha and factorial analysis of variance were conducted. Results: The findings demonstrated that this scale has ideal psychometric properties, such as reliability and factorial validity, and it can be used in a population with characteristics similar to those of the sample population used in this study. Additionally, statistically significant differences were observed between those using the healthcare systems and those belonging to the Mapuche ethnic group. Conclusions: This scale shows adequate psychometric properties, such as the two related factors reliability and factorial validity, and can be used in health-related contexts, thus allowing for an understanding of health-disease processes.

Resumo Introdução: este artigo tem por objetivo estimar as propriedades psicométricas da Escala de Reações ante Experiências de Trato Desigual em Saúde, de Baeza-Rivera (2015), e estabelecer se existem diferenças estatisticamente significativas entre quem se atendem no sistema privado e público e a pertença ou não à etnia mapuche. Materiais e métodos: participaram 337 pessoas cuja média de idade foi de 31 anos, em sua maioria mulheres, 57% reportou ser usuário do sistema público de saúde e 32% declarou pertencer à etnia mapuche. Se realizou análise fatorial exploratório, análise de confiabilidade e a Anova fatorial. Resultados: se conta com um instrumento com adequadas propriedades psicométricas, que pode ser utilizado em população com características similares à amostra utilizada. Adicionalmente, se observa que existem diferenças estatisticamente significativas em função do sistema de saúde em que se atende a pessoa e a pertença ou não a etnia mapuche. Conclusões: o instrumento tem adequadas propriedades psicométricas, apresenta dois fatores relacionados, e serve para ser utilizado em contextos de saúde, permitindo compreender os processos de saúde-doença.

Development and validation of a scale for measuring cultural beliefs about psychotherapy patients in southern Chile

Abstract Purpose: Negative cultural beliefs about psychotherapy patients represent one of the barriers in the psychological help-seeking and treatment adherence. In Chile today, there is little research about specific beliefs towards this group, and therefore measuring them represents a challenge. The aim of the present study was to develop and validate an instrument to measure cultural beliefs about psychotherapy patients. Methods: A mixed method design conducted in four stages was implemented. First, 32 semi-structured interviews were carried out to identify beliefs about psychotherapy patients in southern Chile. Then, a scale of beliefs about psychotherapy patients (SBPP) was developed and piloted in an adult sample (n = 109). Subsequently, the factorial structure of the new scale was explored in patients of primary health centres in La Araucanía Region of Chile (n = 201). Finally, the validity of the construct was assessed in adults who were not undergoing psychotherapy (n = 361). Results: The results showed the existence of negative cultural beliefs about psychotherapy patients which were included in the construction of the SBPP. The scale had a bifactorial structure (αtransitory situations = 0.81 and αstable characteristics = 0.79), consisting of 15 items with a Likert-type response format, and showed good indicators of validity and reliability on the samples in which were applied. Conclusions: The present study shows the importance of using mixed methods for the examination of socially shared beliefs by the cultural group under study, in order to construct instruments that are psychometrically robust and culturally pertinent.

Creencias culturales sobre los médicos y percepción de discriminación: El impacto en la continuidad de la atención / Health care effects of cultural beliefs about physicians and perceived discrimination

Background: Healthcare inequities may hamper physical and mental health. Aim: To examine perceived discrimination in healthcare services in relation to socio-structural and cultural antecedents as well as their effect on psychological processes and health. Material and Methods: Questionnaires on beliefs about physicians, perceived discrimination, emotions and affective states and avoidance consequences in health were answered by 337 child caregivers (85% women) attending preventive health care appointments at primary health care centers. Results: Negative beliefs about healthcare professionals are directly associated with avoidance behaviors in health and perceived discrimination. The latter perception has no direct effects on avoidance behaviors, but it has an indirect effect through negative emotions associated with discrimination. Conclusions: There is an association between cultural, psychological and structural factors in health care. These results contribute to understand the phenomenon of discrimination and its negative consequences.

Universalities and Idiosyncrasies in Self-Concept: East-West and North-South / Universalidades e Idiosincracia del Autoconcepto: Este-Oeste y Norte-Sur

Abstract Self-concept has been crucial to the description of human beings since ancient times. Different authors have offered definitions and approaches to the study of the self. Many instruments have been developed to measure this multifaceted construct. However, there is great difficulty in using definitions and instruments developed in one ecosystem to describe the peoples from different cultures. In order to include the universals and idiosyn-crasies of the self, a model that takes culture into account is needed. The purpose of this article is to compare the cognitive, emotional, and motivational aspects of the self-concept in different countries representing the east-west and north-south axis, such as Mexico, Peru, Japan, China, United States and Chile, from a psycho-socio-cultural point of view. The paradigm for this purpose included descriptions and comparisons based on Hofstede´s cultural syndromes, as well as an overview of some instruments that have been used to measure the construct. The discussion focuses on the importance of considering culture to understand the meanings of this construct, placing emphasis on the methodological tools derived from the theoretical orientation and the attentions that must be had when making cross-cultural comparisons, be it Between countries and even within the same country. This means that we must not forget the aspects shared by cultures in the relationship with oneself (etic), but we must forget about the particular aspects (emic) or idiosyncratic aspects, which are what are finally given by the particularities to self-concept.

Resumen El auto-concepto es un constructo crucial en el estudio de los seres humanos desde la antigüedad. Diferentes autores han propuesto definiciones y acercamientos al estudio del self, así como muchos instrumentos para medir este constructo en sus diversas aproximaciones (social, académico, entre otros). Sin embargo, existe una gran problemática, la cual se asocia a el uso que tienen los instrumentos sin considerar la realidad cultural para la cual se utiliza, es decir, al describir a las personas de una cultura cuando las hemos evaluado con instrumentos desarrollado en una cultura diferente. Por lo tanto, es necesario desarrollar la discusión respecto de cuestiones universales como específicas de cada cultura en relación al autoconcepto. El propósito del presente artículo es realizar esta discusión en relación a comparar los aspectos cognitivos, emocionales y motivaciones del auto-concepto en diferentes países del este-oeste y norte sur desde una perspectiva psico-socio-cultural, los países considerados son: México, Perú, Japón, China, Estados Unidos y Chile. Para ello se incluyen descripciones y comparaciones basadas en los síndromes culturales planteados por Hofstade así como una revisión de los instrumentos que se han utilizado para medir este constructo. La discusión se centra en la importancia de considerar la cultura en el estudio del auto-concepto, haciendo énfasis en las herramientas metodológicas que se derivan de las orientaciones teóricas propuestas y de las atenciones que se deben tener a la hora de realizar comparaciones transculturales, ya sea entre países e incluso dentro de un mismo país. Esto quiere decir, que no se debe olvidar los aspectos compartidos por las culturales en relación al self (etic), pero sin caer en el olvido de los aspectos particulares (emic) o idiosincrático, que son los que finalmente le dan las particularidades al autoconcepto.

Identificación y medición de creencias culturales sobre los médicos: construcción y validación de un instrumento / Development of an instrument to assess cultural beliefs about physicians

Background: Beliefs about professionals' healthcare may influence healthcare behaviors. Such beliefs are in part the result of the interactions that professionals have with their patients. Recent studies highlight the importance of beliefs about physicians, their effect on health-care behaviors, and the requirement of culturally appropriate tools to measure such beliefs. Aim: To develop and validate a culturally appropriate instrument to measure beliefs about physicians. Material and Methods: Based on a "bottom-up" methodology, a culturally pertinent scale of beliefs about physicians was developed and then validated by expert judges. The resulting scale, with 26 items, was applied to 337 participants aged 31 ± 7 years (85% women). Results: Two factors, grouping 24 items, emerged from the exploratory factor analysis. The first was called negative beliefs about doctors (Cronbach's α = 0.96) and the second was called positive beliefs about doctors (Cronbach's α = 0.95). Both factors explain 70 % of the scale variance. Conclusions: The devised instrument has adequate psychometric properties and is also culturally relevant. It allows the assessment of cultural beliefs about physicians.

Atribución de malos tratos en servicios de salud a discriminación y sus consecuencias en pacientes diabéticos mapuche / Healthcare mistreatment attributed to discrimination among mapuche patients and discontinuation of diabetes care

Background: The negative impact of perceived discrimination on health outcomes is well established. However, less attention has been directed towards understanding the effect of perceived discrimination on health behaviors relevant for the treatment of diabetes in ethnic minorities. Aim: To examine the effects of healthcare mistreatment attributed to discrimination on the continuity of Type 2 Diabetes (DM2) care among mapuche patients in a southern region of Chile. Material and Methods: A non-probabilistic sample of 85 mapuche DM2 patients were recruited from public and private health systems. Eligibility criteria included having experienced at least one incident of interpersonal healthcare mistreatment. All participants answered an instrument designed to measure healthcare mistreatment and continuity of diabetes care. Results: Healthcare mistreatment attributed to ethnic discrimination was associated with the discontinuation of diabetes care. Conclusions: Healthcare mistreatment attributed to discrimination negatively impacted the continuity of diabetes care, a fact which may provide a better understanding of health disparities in ethnic minorities.

Propiedades psicométricas de la escala de estrés para diabéticos en una muestra de Pacientes diabéticos tipo II chilenos / Psychometric properties of the diabetes distress scale (DDS) in a sample of Chilean diabetic patients

La identificación de niveles de estrés en pacientes diabéticos tiene implicancias clínicas y prácticas. En Chile no hay escalas válidas y confiables que midan estrés en pacientes diabéticos. Con el objetivo de estimar las propiedades psicométricas de la Escala de estrés para diabéticos de Polonsky et al. (2005) en una muestra de pacientes diabéticos chilenos, se realizó análisis de confiabilidad, análisis factorial exploratorio y correlaciones con la escala de síntomas depresivos (CES-D) y con el marcador fisiológico hemoglobina glicosilada (HbA1c), en una muestra de 76 pacientes diabéticos tipo 2 de la ciudad de Temuco, Chile. Tras los análisis, se estimó una consistencia interna de 0.74, una estructura de 4 subfactores y evidencia de validez convergente con la escala CES-D y HbA1c. La escala de estrés para diabéticos posee propiedades psicométricas adecuadas, permite la identificación de 4 subfactores y es de fácil aplicación en el campo clínico e investigativo.

The measurement of stress levels in type 2 diabetic patients has clinical and practical meaning. In Chile, there is a lack of reliable and valid scales that allow for the right assessment of stress level among diabetic patients. The study purpose was to determine the psychometric properties of the Diabetes Distress Scale (DDS) in a sample of Type 2 Chilean diabetic patients. Several analyses including reliability analysis, exploratory factor analysis, and correlations with the depressive symptoms scale (CES-D), and the HbA1c biomarker were conducted with a Type 2 diabetic sample (n= 76) from Temuco City, Chile. The results provided a reliability of 0.74, a four-factor structure, and evidence for convergent validity with both the CES-D scale and the HbA1c marker. The DDS has acceptable psychometrics properties. It allows for the assessment of 4 factors, and has as advantage to be easy to apply in both clinical and research settings.

Propiedades psicométricas de una escala para medir apoyo social percibido en pacientes chilenos con diabetes tipo 2 / Psychometric properties of a scale designed to measure perceived social support in Chilean patients with Type 2 Diabetes

Este estudio tuvo por objetivo estimar las propiedades psicométricas de laEscala de Apoyo Social Percibido (Multidimensional Scale of Perceived Social Support [MSPSS]) de Zimet, Dahlem, Zimet y Farley, en una muestrade 76 pacientes diabéticos tipo 2, pertenecientes a la ciudad de Temuco,Chile. La escala total presenta una consistencia interna de .0849. Se condujoun análisis factorial exploratorio con rotación Varimax, obteniéndose los tres factores propuestos por los autores, que en conjunto explican el 66.8% de la varianza. Los resultados alcanzados sugieren que esta escala poseeadecuadas propiedades psicométricas para su utilización en población depacientes con Diabetes Mellitus tipo 2.

The present study tested the psychometric properties of the Zimet et al.’Multidimensional Scale of Perceived Social Support (MSPSS), in patientswith Type 2 Diabetes Mellitus (DM) (n = 76) from Temuco City, Chile. The total scale shown appropriate levels of internal consistency (0,849). Anexploratory factorial analysis, with Varimax rotation, was performed overthe MSPSS measures. In agreement with the original Scale, three factorswere obtained explaining 66,8% of the variance. These results suggest thatMSPSS is a psychometrically sound instrument that can be applied to patients with Type 2 Diabetes.