Cross-cultural validation of the Cancer Stigma Scale in the general Japanese population

Abstract

<jats:title>Abstract</jats:title> <jats:sec id="S1478951520000486_sec_a1" sec-type="other"> <jats:title>Background</jats:title> <jats:p>The stigma associated with cancer has negative impacts on cancer patients as well as the general public, who have a potential risk of cancer. To the best of our knowledge, a validated measure to assess cancer stigma among the general Japanese population does not exist.</jats:p> </jats:sec> <jats:sec id="S1478951520000486_sec_a2" sec-type="methods"> <jats:title>Method</jats:title> <jats:p>We translated the Cancer Stigma Scale (CASS) — a 25-item self-administered scale to evaluate stigma related to cancer — into Japanese and examined its psychometric properties. The Japanese version of CASS (J-CASS) was validated among a sample of the general Japanese population through an online survey to validate its test–retest reliability, internal consistency, and concurrent validity.</jats:p> </jats:sec> <jats:sec id="S1478951520000486_sec_a3" sec-type="results"> <jats:title>Results</jats:title> <jats:p>A total of 319 responses were included in the analysis. An exploratory factor analysis eliminated two original items but showed a six-factor model (<jats:italic>Awkwardness, Severity, Avoidance, Policy Opposition, Personal Responsibility,</jats:italic> and <jats:italic>Financial Discrimination</jats:italic>), which was similar to the original scale. Cronbach's alpha for each factor was satisfactory, ranging from 0.81 to 0.91. The internal correlation coefficients were above 0.70, except for Policy Opposition. The total and subtotal scores of each factor of the J-CASS were significantly associated with respondents’ age, gender, familiarity with cancer patients, and social desirability, demonstrating the scales’ good concurrent validity. A substantial proportion of the participants selected “unsure” for some items of the scale, suggesting a further need for refining the scale.</jats:p> </jats:sec> <jats:sec id="S1478951520000486_sec_a4" sec-type="other"> <jats:title>Significance of results</jats:title> <jats:p>This study demonstrated that J-CASS is a reliable and valid measure for evaluating misconceptions and stigma toward cancer in the general Japanese population.</jats:p> </jats:sec>

COVID-19-related stigma and its relationship with mental wellbeing: A cross-sectional analysis of a cohort study in Japan

“…First, the scale used to measure the COVID-19 stigma was not validated in advance. Developing and validating a new scale for the COVID-19 stigma takes time, and thus we attempted to measure COVID-19 stigma using a validated stigma scale in Japanese for cancer (J-CASS) by changing the disease name ( 22 , 28 ). Nevertheless, our findings demonstrated that the validity measures of the score were satisfactory, suggesting that the scale could be perceived as indicating COVID-19 stigma.…”

“…We measured stigma related to COVID-19 based on the Japanese version of the Cancer Stigma Scale (J-CASS) ( 28 ), which is a translated version of the original CASS consisting of 25 items ( 22 ). J-CASS was provided by researchers at the Center for Cancer Control and Information Services, National Cancer Center, Japan.…”

“…J-CASS was provided by researchers at the Center for Cancer Control and Information Services, National Cancer Center, Japan. The participants of the J-CASS study were selected from the general population with an age range of 20–69 years who could read Japanese ( 28 ). The scale comprises 25 items on a 6-point Likert scale (1: Strongly disagree to 6: Strongly agree) along with “not sure,” and the score is calculated by averaging the scores obtained.…”

“…The scale comprises 25 items on a 6-point Likert scale (1: Strongly disagree to 6: Strongly agree) along with “not sure,” and the score is calculated by averaging the scores obtained. Respondents who answered “not sure” for more than 20% of the total answers (~30% of respondents) were excluded from the analysis ( 28 ). We adapted the CASS according to our hypothesis that we can measure stigma related to COVID-19 by replacing “cancer” with “COVID-19” in the CASS, based on previous research indicating that the underlying concept of stigma scales are common.…”

“…The reliability and validity of the COVID-19 stigma were checked in accordance with COnsensus-based Standards for the selection of health Measurement INstruments reporting guideline ( 34 ). We conducted a confirmatory factor analysis (CFA) using the cfa function in the R lavaan (version 0.6–9) package using a robust maximum likelihood model with oblique rotation (Promax), as was done in previous studies ( 22 , 28 , 35 ), assuming that stigma related to COVID-19 would have the same structure as the CASS and J-CASS. We included the correlation of the residual errors between items 5 and 8, 10 and 14, 13 and 16, 14 and 15, and 19 and 19a, as these questions had similar wording (refer to Table 2 for the item numbers).…”