Validating a Child Youth Resilience Measurement (CYRM-28) for Adolescents Living With HIV (ALHIV) in Urban Malawi

Blessings N Kaunda-Khangamwa; Innocent Maposa; Rosalia Dambe; Kennedy Malisita; Emmanuel Mtagalume; Lalio Chigaru; Alister Munthali; Effie Chipeta; Sam Phiri; Lenore Manderson

doi:10.3389/fpsyg.2020.01896

Validating a Child Youth Resilience Measurement (CYRM-28) for Adolescents Living With HIV (ALHIV) in Urban Malawi

Front Psychol. 2020 Aug 31:11:1896. doi: 10.3389/fpsyg.2020.01896. eCollection 2020.

Authors

Blessings N Kaunda-Khangamwa^{1

2

3}, Innocent Maposa¹, Rosalia Dambe⁴, Kennedy Malisita⁴, Emmanuel Mtagalume⁴, Lalio Chigaru⁴, Alister Munthali⁵, Effie Chipeta⁶, Sam Phiri^{2

7}, Lenore Manderson^{1

8

9}

Affiliations

¹ School of Public Health, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa.
² School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
³ Malaria Alert Centre, College of Medicine, University of Malawi, Blantyre, Malawi.
⁴ Umodzi Family Centre, Blantyre, Malawi.
⁵ Centre for Social Research, Chancellor College, University of Malawi, Zomba, Malawi.
⁶ Centre for Reproductive Health, College of Medicine, University of Malawi, Blantyre, Malawi.
⁷ Lighthouse Trust, Lilongwe, Malawi.
⁸ School of Social Sciences, Monash University, Clayton, VIC, Australia.
⁹ Institute at Brown for Environment and Society, Brown University, Providence, RI, United States.

Abstract

Resilience as a strength-based notion, measured across cultures, age groups, and sub-populations, contributes to understanding health and well-being. Yet, there is limited evidence of how the construct performs in resource-limited countries. We explored the psychometric properties of the CYRM-28 and validated the scale with adolescents living with HIV (ALHIV), a key sub-population. The participants included members of an advisory panel and 406 ALHIV, aged 15-19 years, attending an antiretroviral therapy and teen-club clinic in Blantyre, Malawi. This study employed a mixed-method study using an exploratory sequential design. The advisory panel discussed the CYRM-28, and select ALHIV then translated it into Chichewa, pilot-tested it using cognitive interviews, and back-translated it for clarity and appropriateness. The resultant CYRM-28 was tested using a survey with purposefully selected ALHIV. The overall median score was 123, with an interquartile range of 110-130. Minimum and maximum scores were 53 and 140. Cronbach's alpha of 0.863 and Kaiser-Meyer-Olkin measure (0.866) confirmed internal consistency and the sample size adequacy, respectively. Bartlett's tests of sphericity (p < 0.001) informed factor analysis. Exploratory factor analysis determined possible dimensions of resilience and the sub-scales. The confirmatory factor analysis (CFA) confirmed the construct validity and supported a three-factor model consistent with the conceptualization of resilience as a multi-dimensional construct. Structural equation modeling was applied to perform CFA to measure model of resilience. Multiple fit indices showed a good fit for the model. The CYRM-28 has good internal consistency, test and re-test reliability, and moderate convergent validity which render it useful as a self-report resilience measure to inform and evaluate interventions for the health and well-being of adolescents in Malawi.

Keywords: Malawi; adolescents living with HIV; mixed methods; psychometric properties; resilience measures; teen-club clinic; validation.

Grants and funding

WT_/Wellcome Trust/United Kingdom