Translation, Cultural Adaptation, and Psychometric Validation of the Urdu Perceived Stigmatization Questionnaire Among Acid Attack Survivors in Pakistan
Abstract
No culturally adapted and psychometrically validated Urdu instrument is currently available to assess perceived stigmatization among individuals with visible disfigurements in Pakistan. Therefore, this study aimed to translate, culturally adapt, and evaluate the psychometric properties of the PSQ in Urdu (PSQ-Urdu). Following standard forward–backward translation and cultural adaptation procedures, a cross-sectional study was conducted on a sample of 133 acid attack survivors recruited using purposive sampling from different burn care centers and rehabilitation organizations in Pakistan. Participants completed the PSQ-Urdu and RSES Urdu version. Furthermore, visibility of burn scars was included as a clinical characteristic to examine its association with perceived stigmatization. The PSQ-Urdu version showed excellent internal consistency reliability, i.e., α = .91, ω =.93, with high reliability across its subscales: α = 0.90, ω=.91 for absence of friendly behavior, α =.93, ω=.95 for staring behavior, and α =.90, ω=.96 for hostile behavior. Furthermore, a strong negative correlation (r = -.85**) between perceived stigmatization and self-esteem provides evidence for good construct validity. Additionally, a moderate positive association between PSQ-U and visibility of burn scars provided evidence of validity based on associations with a relevant clinical characteristic. Exploratory factor analysis using principal axis factoring with Promax rotation supported a three-factor structure consistent with the original PSQ (KMO = .94; Bartlett’s test of sphericity, χ² (210) = 4166.24, p < .001), explaining 85.34% of the total variance. The findings provide evidence for the PSQ-Urdu as a reliable and valid instrument to assess perceived stigmatization among the Urdu-speaking population with visible disfigurements.
Keywords
Perceived stigmatization, psychometric validation, Urdu translation, visible disfigurement, acid attack survivors
Author Biography
Zainab Mamoon
Zainb Mamoon has completed an MPhil from the Department of Applied Psychology. She is the first author of this manuscript.
References
- Asif, S., Khan, S., Butt, T. A., Mehmood, A., Zulfiqar, A., & Mubashar, T. (2024). Psychosocial indicators of suicidal ideation among acid attack survivors. International Journal of Human Rights in Healthcare, 17(2), 210–220. https://doi.org/10.1108/IJHRH-06-2022-0056
- Baumeister, R. F., Campbell, J. D., Krueger, J. I., & Vohs, K. D. (2003). Does high self-esteem cause better performance, interpersonal success, happiness, or healthier lifestyles? Psychological science in the public interest, 4(1), 1-44. https://doi.org/10.1111/1529-1006.01431
- Bennis, I., Thys, S., Filali, H., De Brouwere, V., Sahibi, H., & Boelaert, M. (2017). Psychosocial impact of scars due to cutaneous leishmaniasis on high school students in Errachidia province, Morocco. Infectious Diseases of Poverty, 6(1), 46.
- Cattell, R. B. (1966). The scree test for the number of factors. Multivariate Behavioral Research, 1(2), 245–276. https://doi.org/10.1207/s15327906mbr0102_10
- Freitas, N. de O., Forero, C. G., Caltran, M. P., Alonso, J., Dantas, R. A. S., Piccolo, M. S., Farina, J. A., Jr., Lawrence, J. W., & Rossi, L. A. (2018). Validation of the Perceived Stigmatization Questionnaire for Brazilian adult burn patients. PLoS ONE, 13(1), e0190747. https://doi.org/10.1371/journal.pone.0190747
- Gjersing, L., Caplehorn, J. R., & Clausen, T. (2010). Cross-cultural adaptation of research instruments: Language, setting, time and statistical considerations. BMC Medical Research Methodology, 10(1), 13.
- Gnambs, T., Scharl, A., & Schroeders, U. (2018). The structure of the Rosenberg Self-Esteem Scale. Zeitschrift für Psychologie. https://doi.org/10.1027/2151-2604/a000317
- Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Prentice-Hall.
- Goswami, S., & Handa, R. K. (2020). The peril of acid attacks in India and susceptibility of women. Journal of Victimology and Victim Justice, 3(1), 72–92. https://doi.org/10.1177/2516606920927247
- Ismail, S., Guriro, S., & Lakho, M. K. (2020). Acid violence in Pakistan: A study on women victims of acid attacks in Karachi. Global Social Sciences Review, 5(3), 326–332. https://doi.org/10.31703/gssr.2020(V-III).34
- Jain, A., Sharma, P., Afsar, M., Ghosh, R., & Kaur, H. (2025). Surviving an acid attack is half the battle, living life is another half: A qualitative enquiry from India. Human Arenas, 1–23.
- Kim, H. Y. (2013). Statistical notes for clinical researchers: assessing normal distribution (2) using skewness and kurtosis. Restorative dentistry & endodontics, 38(1), 52. https://doi.org/10.5395/rde.2013.38.1.52
- Knekta, E., Runyon, C., & Eddy, S. (2019). One size doesn’t fit all: Using factor analysis to gather validity evidence when using surveys in your research. CBE—Life Sciences Education, 18(1), rm1. https://doi.org/10.1187/cbe.18-04-0064
- Lawrence, J. W., Fauerbach, J. A., Heinberg, L. J., Doctor, M., & Thombs, B. D. (2006). The reliability and validity of the Perceived Stigmatization Questionnaire (PSQ) and the Social Comfort Questionnaire (SCQ) among an adult burn survivor sample. Psychological Assessment, 18(1), 106–111. https://doi.org/10.1037/1040-3590.18.1.106
- Malta, M., Gomes de Jesus, J., LeGrand, S., Seixas, M., Benevides, B., Silva, M. D. D., ... & Whetten, K. (2020). "Our life is pointless…": Exploring discrimination, violence and mental health challenges among sexual and gender minorities from Brazil. Global Public Health, 15(10), 1463–1478. https://doi.org/10.1080/17441692.2020.1767676
- Muldoon, O. T., Haslam, S. A., Haslam, C., Cruwys, T., Kearns, M., & Jetten, J. (2019). The social psychology of responses to trauma: Social identity pathways associated with divergent traumatic responses. European Review of Social Psychology, 30(1), 311–348. https://doi.org/10.1080/10463283.2020.1711628
- Patel, M. (2014). A desire to disfigure: Acid attack in India. International Journal of Criminology and Sociological Theory, 7(2), 1–11.
- Qazi, R., Khan, S., Akhtar, T., & Butt, T. A. (2019). Psychosocial correlates of suicidal ideation in acid attack survivors. Pakistan Journal of Physiology, 15(4), 31-34.
- Rizwan, M., Malik, S., Malik, N. J., & Siddiqui, R. S. (2017). Urdu Rosenberg self-esteem scale: An analysis of reliability and validity in Pakistan. Sociology International Journal, 1(2), 56–61. https://doi.org/10.15406/sij.2017.01.00010
- Rosenberg, M. (1965). Society and the adolescent self-image. Princeton University Press.
- Rumsey, N., & Harcourt, D. (2004). Body image and disfigurement: Issues and interventions. Body Image, 1(1), 83–97. https://doi.org/10.1016/S1740-1445(03)00005-6
- Thompson, A. R., & Kent, G. (2001). Adjusting to disfigurement: Processes involved in dealing with being visibly different. Clinical Psychology Review, 21(5), 663–682. https://doi.org/10.1016/S0272-7358(00)00056-8
- Van Loey, N. E., & Van Son, M. J. (2003). Psychopathology and psychological problems in patients with burn scars: epidemiology and management. American journal of clinical dermatology, 4(4), 245-272.
- Walde, P., & Völlm, B. A. (2023). The TRAPD approach as a method for questionnaire translation. Frontiers in Psychiatry, 14, 1199989. https://doi.org/10.3389/fpsyt.2023.1199989
- Willemse, H., Geenen, R., & Van Loey, N. E. (2021). Reliability and structural validity of the Dutch version of the perceived stigmatization questionnaire in adults with burns. Burns, 47(6), 1381-1388. https://doi.org/10.1016/j.burns.2020.11.017
- Wu, X., Hu, Y., & Hu, A. (2023). Living with Stigma and low self-esteem among individuals with burn injuries: a cross-sectional study. Journal of Burn Care & Research, 44(3), 573-579. https://doi.org/10.1093/jbcr/irac023