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Volume 30, Number 3—March 2024
Research

Systematic Review of Scales for Measuring Infectious Disease–Related Stigma

Amy PatersonComments to Author , Ashleigh Cheyne, Benjamin Jones, Stefan Schilling, Louise Sigfrid, Jeni Stolow, Lina Moses, Piero Olliaro, and Amanda Rojek
Author affiliations: University of Oxford, Oxford, UK (A. Paterson, A. Cheyne, B. Jones, S. Schilling, L. Sigfrid, P. Olliaro, A. Rojek); Tulane University, New Orleans, Louisiana, USA (J. Stolow, L. Moses); Global Outbreak Alert and Response Network, World Health Organization, Geneva, Switzerland (J. Stolow, L. Moses); The Royal Melbourne Hospital, Melbourne, Victoria, Australia (A. Rojek)

Main Article

Table 5

Recommendations for future outbreak stigma scales determined by a systematic review of scales for measuring infectious disease–related stigma

Area Recommendations
Design A theoretical framework of stigma should be applied from conception of the scale to ensure all relevant domains of stigma are represented.
Future scales should be co-designed with persons with lived experience of outbreak-associated stigma.
Scale items should be informed by qualitative research alongside existing scales.
When resources allow, scale design should be informed by a range of outbreak diseases and settings to enhance transferability of the scale. This should be facilitated by large public health institutions.
Established best practices for ensuring cross-cultural equivalence (e.g., [23]) should be followed when translating and adapting scales for cross-contextual use.
Validation Scale items should be formally assessed for content validity (including clarity, relevance, and comprehensiveness) by both experts in the field and relevant community members with lived experience of stigma.
Confirmation of the structural validity of scales should precede internal consistency testing. Other forms of reliability, including test-retest reliability, should be routinely assessed alongside internal consistency.
The cross-cultural validity of scales should be assessed across countries, diseases, and respondent profiles using multi-group factor analyses or Differential Item Functioning analyses.
The responsiveness of scales should be assessed to ensure they have the ability to detect changes in stigma over time.
Use Scales should be used in longitudinal and pre- and post-interventional studies to assess stigma trends over the course of an outbreak, rather than limited to cross-sectional use.
When possible, representative sampling techniques should be adopted in administration of stigma scales.
The results of studies assessing stigma during outbreaks, as well as the stigma scales used, need to be rapidly publicly disseminated with minimal access barriers such as paywalls.

Main Article

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Page created: December 31, 2023
Page updated: February 22, 2024
Page reviewed: February 22, 2024
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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