Development and Validation of Khawajasira Stigma Scale

Abstract

Background. Gender non-conforming individuals or locally called Khawajasiras/Hijras experience social and institutional stigma in Pakistan. To measure their perceptions of societal stigma we designed and validated a culturally grounded Khawajasira Stigma Scale.

Method. A mixed-methods sequential exploratory design was employed. In Phase I, an initial pool of perceived stigma items was created by employing qualitative content analysis to investigate semi-structured interviews with ten GNC individuals. There were 49 items instead of 59 after expert assessments and Lawshe's Content Validity Ratio (CVR) were used. For Phase II psychometric validation, 300 GNC participants were chosen by snowball sampling. Reliability analysis, exploratory factor analysis (EFA) utilizing Principal Axis Factoring, item-total correlations, and convergent validity were all performed.

Results. Convergent validity was supported by a concluded 35-item scale that showed moderate positive correlation with the Victimization Scale (r =.25, p <.01) and strong internal consistency (Cronbach's ? =.82). The lack of a distinct multidimensional factor structure in the factor analysis suggested that stigma is a unidimensional phenomenon.

Conclusion. The KSS is a psychometrically valid and culturally appropriate tool that measures the perceived stigma that GNC people in Pakistan undergo. By capturing environmental, interpersonal, institutional, and intra-community stigma, the measure provides a reliable tool for research, clinical assessment, and policy interventions aimed at enhancing the well-being of the Khawajasira   community.