Ife PsychologIA 2016, 24(2), 290-297

Copyright (c) 2016 Ife Centre for Psychologial Studies/Services, Ile-Ife, Nigeria ISSN: 1117-1421

A Brief Scale for HIV Self Disclosure: Development, Validity and Reliability

B. O. Olley & A. Ishola

Department of Psychology,
Faculty of Social Sciences,
University of Ibadan, Ibadan, Oyo State, Nigeria

Abstract
Utilizing the Weiss and Ramakrishna's model of social process- a cognitive process whereby
individual with a health attribute, react adversely to anticipated isolation, rejection, blame, or
devaluation expressed by people around, we develop and validate a tool to measure self
disclosure among people living with HIV/AIDS (PLWHAs) in Nigeria. Existing scales that
measured self disclosure particularly of HIV/AIDS were reviewed. We conducted a qualitative
study to determine salient concerns related to HIV disclosure in Nigeria. Themes were generated,
and those related to barriers to disclosure were used to construct a12-item HIV self disclosure
scale. A descriptive cross-sectional survey was then conducted among 122 PLWHAs to assess the
reliability and validity of the scale. Construct validity using exploratory factor analysis factored
and Varimax rotated the scale into three dimensions (KMO = .875, df = 78, p<.001) with items
loading ranged from 0.72 to .92. Internal Construct validity shows that self-disclosure scale and
its dimensions (Intimate disclosure to family & friends (r = 0.55), Avenue for disclosure, (r =
0.77), Self-imposed/ advocacy disclosure, (r = 0.33) are highly related. Convergent validity was
established between Self-disclosure scale and depression scale, Intimate disclosure to family &
friends sub-dimension and self esteem while Self-imposed/ advocacy disclosure had divergent
validity with self-esteem. The reliability dimensions or sub scales have meritorious reliability
(Intimate disclosure to family & friends, =.63, Avenue for disclosure, =.35; Self-imposed/
advocacy disclosure, =.53). The brief Self-Disclosure Scale was reliable and valid means of
assessing HIV-serostatus disclosure in Nigeria.

Introduction
Disclosure of HIV serostatus, especially to Although there has been considerable effort
sexual partners and other significant social toward disclosure management among
networks, remains an important issue for PLWHAs, just as stated above, tools to measure
prevention (Center for Disease Control and and evaluate such are lacking. Also, despite
Prevention (CDC) 2002; Olley et al 2016). replete of research about HIV self-disclosure,
Suffice to say that it continues to be an ethical most of the studies are flawed with lack of
issue in the management of the HIV/AIDS consensus about the instrument of measure,
disease worldwide (Bohle, Dilger & GroB, which are relatively determined by social
2014). context. There is a question of whether patients
seeking treatment vary in their ability to
Some efforts have been made to ensure self disclosure to different individuals in their social
disclosure of HIV status and by extension assist network, especially, where differential socio-
in effective treatment. For example, in a facility cultural factors that may serve as barriers are
in Akure, Nigeria, it is mandatory for a family pronounced.
member of the people living with HIV/AIDS
(PLWHAs) to be involved in treatment (Olley, et Measures of self disclosure among PLWHA
al 2016). Similarly, in Kenya, TBY- a patient- have mostly emerged from the Western
nominated treatment buddy, have been found to literature, and have often consisted, a one-item
encourage disclosure of sero status and scale or a-one question scale, for instance, Did
treatment adherence, including keeping clinic you disclose your HIV status (Yes or No) (e.g.
appointments (Kibaara et al 2016). Sussan, Arinze-Onyia, Ifeoma Modebe, and
Emmanuel, 2015; Dimie, Peter, Ikenna,

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Tubonye, Otonyo, & Ogechi, 2015). These one experts in their own right. The discussions in the
or two items scale, often lacks content validity FGD centered on both cognitive and cultural
and are therefore puts its reliable to question. barriers to disclosing HIV to either spouse,
Asides, one or few items scale reduce, the scope parents, children, friends and colleagues. The
of constructs needed to quantify in the study. interviews were recorded, translated and
More importantly, a one-item scale might be transcribed. From thematic analysis of the FGD,
described vague in specific situation. For three basis contents emerged: (1) disease factor;
instance, a one-item question such as Did you (2) treatment factor, (3) interpersonal factor.
disclose your HIV status apart from leaving the Items were generated with these factors resulting
respondents, stalked up thinking in what in 12 items/questions. The themes generated
direction is intended, it is also defensive, as it were then pre-testing.
leaves the respondent to either answer in
affirmative or say no. Furthermore, where, there Face validation of the scale: This was assessed
are multi-item disclosure scale, for example, to determine if the questionnaire contained
(Kalichman, 2001), they are not specific to relevant items for assessing HIV/AIDS self
HIV/AIDS disclosure but involved other disclosure in our context. Two Health/Social
construct, like safer sex self-efficacy Again, Psychologist and four doctoral level students in
despite, strong psychometric properties of the, clinical psychology, familiar with the culture of
Kalichman, safer sex self-efficacy scale, it lacks the setting were asked to evaluate the relevance,
disclosure to extended range (i.e. disclosure at clarity and conciseness of the items included in
workplace, disclosure to friends, family, spouse the questionnaire. There was a consensus
e.t.c.) but only assess disclosure to the primary agreement among the six respondents that the
sexual partners. questions measured HIV/AIDS self disclosure.
Based on this initial assessment, all 12 items
In Nigeria, self disclosure of HIV/AIDS may be were retained.
influenced by diverse personal and social
factors, especially stigma and discrimination Pre-testing: One hundred and twenty two
(Olley et al 2016) that have consistently limited individuals seeking treatment at the State
self disclosure intention. A measure that will Specialist Hospital (SSH) Ijebu-ode and patients
consider, the cultural specificity and the existing who belong to a support group facilitated by a
public attitudes towards, HIV/AIDS is therefore community primary health care in Ibadan (not
imperative. To the best of our knowledge, there those involved in item generation) were
is a dearth of a psychometrically developed tool approached and filled the questionnaire. They
to measure self disclosure of HIV/AIDS in were excluded if unwilling and not in a position
Nigeria. This study therefore developed a scale to give informed consent. Corrected filled
to assess HIV self disclosure through explorative questionnaire were scored and subjected to
research process. internal consistency (how well a set of items
conceptually fit together), through Cronbachs
Methods alpha. Concurrent validity (the degree to which
Item Generation: First, we reviewed the the construct being measured correlates with
literature to examine the existing scales that another measure of the same construct) was
measured HIV/AIDS self disclosure and factors assessed by Pearson correlations.
influencing it. (Ref) Second, we conducted a
qualitative study with a purposive sample of Result
individuals living with HIV/AIDS, who were on
Internal Consistency: the initial item analysis
follow-up management to identify issues related
revealed a poor overall alpha 0.13 negative
to disclosure. Focus group discussions (FGDs)
which indicates that there two or more
and in-depth interviews were conducted by
dimensions inversely related in the scale which
(BOO), the lead author, with ten participants.
suggest that there is need to test the structure or
This approach enhanced content validity
factor of the scale before testing the internal
(Nunnally, 1978) as they were considered

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consistencies. From the factor analysis three correlation analysis revealed that there was
factors were identified and Internal consistency significant positive relationship between overall
of the HIV/AIDS brief self disclosure HIV-Status self disclosure scale and sub
(HIV/AIDS-BSD) scale sub dimensions were dimensions of the scale (Intimate disclosure to
meritorious reliability (disclosure to family & family & friends r = 0.55, p<.001, Avenue for
friends =.73, Avenue for disclosure, =.75; disclosure, r = 0.77, p<.001; Self imposed
Self-imposed /Advocacy disclosure, =.73). advocacy, r = 0.33, p<.05). HIV status disclosure
(Anastasi, 1999). increases in the same direction for all the three
subscales. Overall HIV-Status self disclosure
Test-retest reliability: Test-retest reliability was scale was associated with higher depression (r =
determined by comparing responses to the 0.14, p<.05) while the sub scales (Intimate
HIV/AIDS-BSD among 50 participants (48.6%) disclosure to family & friends= 0.10, p<.05) and
who completed the questionnaire, while at Avenue for disclosure(r = 0.13, p<.01) have
follow-up after a 2-week interval. The strong convergent validity with depression.
correlation coefficient for test-retest reliability Intimate disclosure to family & friends sub
was 0.76 (p < 0.01). This demonstrated dimension have convergence validity with self
acceptable reproducibility. A correlation esteem while Self imposed advocacy have
coefficient range of 0.70.8 is acceptable. divergence with self-esteem (see Table 5).The
norm was set using the average score of the
Construct Validity: An exploratory factor HIV-Status self disclosure (Norm (112) = 11.86)
analysis was applied to explore the underlying high score above the mean suggest that the
dimensions of factors disclosure scale. The respondents who have lower HIV-Status self
initial analysis revealed a three dimension disclosure while lower scores equal or below the
structure with poor factor loadings (see Table 2). mean suggests low HIV-Status self disclosure.
After the deletions of items with poor factors
loadings, the 5-items remaining achieved a Discussion
significant Bartlett test of sphericity (p<. 0.001) The purpose of this study was to develop and
and the Kaiser-Meyer measure of meritorious evaluate a culturally appropriate measure of
sampling adequacy suggest that the data matrix HIV/AIDS self disclosure scale among
could be factorized (KMO = .875, df = 10, PLWHAs in Nigeria. Using a social process
p<.001) (see Table 3). Three factors with model and a conventional systematic approach
eigenvalues >1.0 were identified for the self to tool development (Anastasi, 1999), we
disclosure scale. The three factors accounted for developed a 5-item brief scale that provides a
74% of the total variance in the overall HIV- measure of HIV/AIDS self disclosure with
Status self disclosure scale (See Table 4). proven reliability and validity.
Varimax rotation revealed a three dimensions
factor. The factor loading for the items ranged The Cronbach alpha was employed in evaluating
from 0.72 to .92, which indicated that all the the level of acceptability of the observed values
items loaded well on the factors precipitated. of reliability coefficients. Though, alpha
The factors include intimate disclosure to family coefficient was poor for the overall items, but
& friends, Avenue for disclosure and Self- good reliability was observed for the three
imposed /Advocacy disclosure with meritorious dimensions or sub scales. The correlations
reliabilities ( =.73; 0.75 and 0.72 respectively) range from 0.72 to 0.75, and considered an
(see Table 4b). acceptable level of internal consistency. There
was an excellent retest reliability observed in
Concurrent Validity: Concurrent validity was this study and this supported the utility and
accomplished through the convergent and reliability of the self disclosure among
divergent type. The overall scale and its HIV/AIDS patients. Furthermore, the selection
dimensions were correlated with Rosenberg of culturally appropriate items through
(1965) self-esteem scale, the stigmatization scale qualitative research ensured that the items were
and Beck (1988) depression scale. The person appropriate to this context.

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perspective is often difficult at the start;

Factor-analytic evidence suggests that the scale nevertheless, with successful efforts towards
is multi-dimensional, indicating that it measured improvement, many limitations would be
three construct, namely intimate disclosure to (i) corrected. Albeit, use of this self-administered
family (ii) friends, and (iii) others. This suggests brief scale would be valuable to assess the levels
that self disclosure among HIV/AIDS patients of HIV/AIDS self-disclosure in individual
may be selective and viewed from a multi eye patients seeking treatment in daily clinical
or perspectives. Criterion related analysis was practice in Nigeria. In a chronic disease such as
also conducted to examine the correlation HIV/AIDs, coping and maintaining
between certain indices of sero and demographic psychological well-being is paramount and a
variables of the patients and self disclosure validated tool of self-disclosure would indicate
scores. Results indicated a negative correlation the need for measures to be taken to eliminate a
between self disclosure and decreasing CD4 possible barrier to optimal treatment.
count; similarly the more physical symptoms
reported by the patients were inversely related In HIV/AIDS patients, there is evidence that
with self disclosure reported by the patients. self-disclosure management programs are
Gender was however not correlated with the self effective in improving their self-esteem, reduce
disclosure. However, we observed an association perceived discrimination and facilitating their
between self disclosure and age, which provides treatment adherence, including regular clinic
support for the age sensitivity of the scale. Older attendance (Olley et al 2004, Kibarra et al 2016)
age was associated with more self disclosure, a
finding also reported in other studies. Younger Conclusions
people, less likelihood to disclose could be This study has demonstrated that a brief self
understood from the feelings of stigmatization; disclosure scale for HIV/AIDS can be developed
they may still be battling with issues in through a conventional systematic test
personality and value formation that could make construction process. Though, it is a brief, five
them more susceptible to discriminatory item scale, its potential and useful in clinical
attitudes from people around their network. setting is good. Its brevity is particularly
Given its potentially negative impact, there is a germane, considering the clinical nature of most
need to address self disclosure as part of a Nigerian hospital and clinics, with large turnout
comprehensive care system, especially for of patients seeking treatment on a daily basis.
young PLWHAs. The tool can help healthcare providers to a quick
instance identify high-risk situations, with
There are some limitations to this study. First, prompt disclosure management initiated.
the participating patients with HIV/AIDS were
recruited from specialist hospitals/clinics. References
Community based patients who probably Byers, E. S., & Demmons, S. (1999). Sexual
patronize, alternative treatment did not have the satisfaction and sexual self-disclosure
opportunity to be included. Further study, using within dating relationships. Journal of
such a sample is needed to assess the cross- Sex Research, 36, 180-189.
cultural validity of the brief HIV/AIDS scale Dimie, Peter, Ikenna, Tubonye, Otonyo, &
more precisely. Though, items were elicited Ogechi (2015). Types and predictors
from the patients themselves, there is still a of partner reactions to HIV status
possibility of under-reporting, as exemplify from disclosure among HIV- infected adult
the few items generation. Finally, we were not Nigerians in a tertiary hospital in the
able to assess the concurrent validity of self Niger Delta. African Health Sciences
disclosure within our context as no similar Vol 15 Issue 1, March.
validated scale exists for comparison. The Guo-Ming Chen (1995). Differences in Self-
Kaliclman et al scale, do not necessarily assess Disclosure Patterns among Americans
the same construct as we envisaged in our study. Versus Chinese; A Comparative Study.
Developing a new scale with cultural Journal of Cross-Cultural Psychology

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January 1995 vol. 26 no. 1 84-91. infection. Public Health Nursing, 14(5),
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Table 1: Initial Realiability Analysis (HIV/AIDS SDS)

Cronbach Alpha -0.73
Number of items 12
Corrected Cronbachs
Item-Total Alpha if Item
Nos Items Correlation Deleted
1. Do you think having HIV/AIDS affects whether people like you or not? -.128 .000a
2 I have no problem dating anyone, as long, as I will tell him/her, am -.092 -.003a
infected with HIV virus.
3 Having Do you think people with HIV/AID should tell their sexual -0.217 .016
partners that they are infected with HIV/AIDS?
4 I keep my HIV/AIDS status secret from others .344 -.009a
5 5. Do any of your friends know that you have HIV/AIDS? .402 -.014a
6 Do any of your family members know that you have HIV/AIDS? .580 -.032a
7. When people find out that I have HIV/AIDS, it usually because I tell .440 -.026a
them
8 When people find out you have HIV/AIDS, it usually because they found -.090 -.006a
me taking my drugs and I have to explain.
9. When people find out I have HIV/AIDS, it is because someone else tells .334 -.010a
them
10. I often talk to people around me about being an HIV/AIDS positive .251 -.038a
person
11. I will not be scared of telling a new sexual friend that am HIV positive. -.047 .116
12. I am not afraid to stay in a group, even when they can know about my .040 -.016a
HIV/AIDs status

Table 2: initial Factor Analysis (HIV/AIDS SDS)

KMO and Bartlett's Test
Kaiser-Meyer-Olkin Measure of Sampling Adequacy. .333
Bartlett's Test of Sphericity Approx. Chi-Square 1101.265
Df 66
Sig. .000

o Items
Factor loading
1 Do you think having HIV/AIDS affects whether people like you or not? .325
I have no problem dating anyone, as long, as I will tell him/her, am
2 infected with HIV virus. .243
3 Having Do you think people with HIV/AID should tell their sexual .114
partners that they are infected with HIV/AIDS?
4 I keep my HIV/AIDS status secret from others .446
5 Do any of your friends know that you have HIV/AIDS? .536
6 Do any of your family members know that you have HIV/AIDS? .644
7 When people find out that I have HIV/AIDS, it usually because I tell them .599
8 When people find out you have HIV/AIDS, it usually because they found .306
me taking my drugs and I have to explain.
9 When people find out I have HIV/AIDS, it is because someone else tells .328
them
10 I often talk to people around me about being an HIV/AIDS positive .496
person
11 I will not be scared of telling a new sexual friend that am HIV positive. .230
12 I am not afraid to stay in a group, even when they can know about my .045
HIV/AIDs status

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 B. O. Olley & A. Ishola: A Brief Scale for HIV Self Disclosure..

Table 3: HIV/AIDS SDS: Initial Principal Component Analysis factor Loadings

KMO and Bartlett's Test

Kaiser-Meyer-Olkin Measure of Sampling Adequacy. .878
Bartlett's Test of Sphericity Approx. Chi-Square 168.610
Df 10
Sig. .000

Items Initial Principal Component Analysis

Factor Loadings
Friend aware .629
Family aware .747
Sources of Disclosure .753
Keep secret .853
Talk about HIV/Status .708

Table 4: HIV/AIDS Componential exploratory factor analysis using principal component analysis
(PCA)
Extraction Sums of Squared Rotation Sums of Squared
Initial Eigenvalues Loadings Loadings
% of Cumul % of Cumul
Varian ative Varianc Cumulative % of ative
Component Total ce % Total e % Total Variance %
1 1.618 32.350 32.350 1.618 32.350 32.350 1.465 29.303 29.303
2 1.065 21.297 53.647 1.065 21.297 53.647 1.159 23.171 52.474
3 1.007 20.138 73.785 1.007 20.138 73.785 1.066 21.310 73.785
Extraction Method: Principal Component Analysis.

Table 4b: Varimax Rotated factor loadings (HIV/AIDS SDS)

Component
Avenue for Self imposed
Intimate disclosure to family disclosure advocacy
& friends (=.72 ( =.75) ( =.73)
Friend aware .848
Family aware .847
Sources of Disclosure -.795
Keep secret .716
Talk about HIV/Status .922

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Table 5: Pearson Product Moment correlation showing convergent and discriminant validity for
HIV/AIDS Self-disclosure scale
1 2 3 4 5 6 8
1. Overall HIV-Status self- ** ** **
1 .554 .774 .334 .069 -.027 .144**
disclosure scale
2. Avenue for disclosure 1 .033 -.097* -.073 -.071 .101*
3. Intimate disclosure to family &
1 .026 .250** .013 .133**
friends
4. Self-imposed advocacy 1 -.196** .012 -.030
5. Self esteem 1 .113* -.045
6. Stigmatization 1 -.135**
7. Depression 1
**. Correlation is significant at the 0.01 level (2-tailed).

Table 6: Standardized norm for PLWHA in Southwest Nigeria.

No Normed at
Item N Mean S.D Mean 1
S.D
1 Overall HIV-Status self -disclosure scale 112 9.5241 2.34980 11.86
2 Avenue for disclosure 112 2.5757 1.73874
3 Intimate disclosure to family & friends 112 4.8040 1.31341
4 Self-imposed advocacy 112 2.1480 .86231

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