COVID-19 Public Stigma Scale (COVID-PSS): development, validation, psychometric analysis and interpretation

Abstract

ObjectiveAmid the COVID-19 pandemic, social stigma towards COVID-19 infection has become a major component of public discourse and social phenomena. As such, we aimed to develop and validate the COVID-19 Public Stigma Scale (COVID-PSS).Design and settingNational-based survey cross-sectional study during the lockdown in Thailand.ParticipantsWe invited the 4004 adult public to complete a set of measurement tools, including the COVID-PSS, global fear of COVID-19, perceived risk of COVID-19 infection, Bogardus Social Distance Scale, Pain Intensity Scale and Insomnia Severity Index.MethodsFactor structure dimensionality was constructed and reaffirmed with model fit by exploratory and confirmatory factor analyses and non-parametric item response theory (IRT) analysis. Psychometric properties for validity and reliability were tested. An anchor-based approach was performed for classifying the proper cut-off scores.ResultsAfter factor analysis, IRT analysis and test for model fit, we created the final 10-item COVID-PSS with a three-factor structure: stereotype, prejudice and fear. Face and content validity were established through the public and experts’ perspectives. The COVID-PSS was significantly correlated (Spearman rank, 95% CI) with the global fear of COVID-19 (0.68, 95% CI 0.66 to 0.70), perceived risk of COVID-19 infection (0.79, 95% CI 0.77 to 0.80) and the Bogardus Social Distance Scale (0.50, 95% CI 0.48 to 0.53), indicating good convergent validity. The correlation statistics between the COVID-PSS and the Pain Intensity Scale and Insomnia Severity Index were <0.2, supporting the discriminant validity. The reliability of the COVID-PSS was satisfactory, with good internal consistency (Cronbach’s α of 0.85, 95% CI 0.84 to 0.86) and test–retest reproducibility (intraclass correlation of 0.94, 95% CI 0.86 to 0.96). The proposed cut-off scores were as follows: no/minimal (≤18), moderate (19–25) and high (≥26) public stigma towards COVID-19 infection.ConclusionsThe COVID-PSS is practical and suitable for measuring stigma towards COVID-19 in a public health survey. However, cross-cultural adaptation may be needed.

Disparities and Factors Associated with Coronavirus Disease-2019-Related Public Stigma: A Cross-Sectional Study in Thailand

“…This study was based on a nationwide survey with a large sample size. Unlike previous studies, we used the validated COVID-PSS to measure COVID-19-related public stigma among the Thai population [ 11 ]. However, our results should be used with consideration of some limitations.…”

“…The sample sizes for both prevalence and factors related to public stigma in the Thai population were estimated using (i) the overall mean ± standard deviation (SD) of COVID-19-related public stigma (based on the validated COVID-19 Public Stigma Scale (COVIDSS)) of 24.2 ± 7.6 [ 11 ], specified type I error at 0.05, and d equal to 0.5, a total sample size of 891; and (ii) linear multiple regression, R 2 deviation from zero with a small effect size of 0.02, type I error of 0.05, 90% of power, and anticipated total predictors equal to 15, with a sample size needed of 1192 [ 12 ]. The sample size of our survey met both requirements and was sufficient to address the research questions.…”

“…The COVID-PSS revealed acceptable psychometric properties in the Thai population, with Cronbach’s α of 0.85. The degree of public stigma was established and classified as no/minimal (≤18 points), moderate (19–25 points), or high (≥26 points) [ 11 ]. Perceived social support: The Multidimensional Scale of Perceived Social Support (MSPSS-12) consists of 12 items that measure individual perceptions of external social support.…”

“…The COVID-PSS revealed acceptable psychometric properties in the Thai population, with Cronbach’s α of 0.85. The degree of public stigma was established and classified as no/minimal (≤18 points), moderate (19–25 points), or high (≥26 points) [ 11 ].…”

Long Covid stigma: estimating burden and validating scale in a UK-based sample

“…The new LCSS is an important addition to the growing number of existing scales for measuring stigma among people with acute COVID-19 infection (44)(45)(46) or at risk of such infection (47) . The stigma associated with Long Covid is unique, requiring its own measurement tool; unlike acute COVID-19, Long Covid is a chronic, less well understood condition, often psychologised, and has serious implications for people's long-term health and productivity.…”