Reliability and validity of the Japanese version of the Self-Stigma Scale in patients with type 2 diabetes

Abstract

BackgroundSelf-stigma has been highlighted and researched in relation to patients with chronic illnesses, as it may have a negative impact on their treatment adherence. However, self-stigma has not yet been investigated in patients with type 2 diabetes. In order to evaluate the extent to which patients with type 2 diabetes experience self-stigma, which may result in their poor self-care management, there is a need for a specific tool to measure self-stigma in patients with type 2 diabetes. This study assessed the psychometric properties of a Japanese version of the Self-Stigma Scale (SSS-J) in patients with type 2 diabetes.MethodsThe reliability and validity of the SSS-J were evaluated using a consecutive sample of 210 outpatients with type 2 diabetes from university hospitals and from hospitals or clinics specializing in diabetes treatment. Confirmatory factor analysis was conducted to assess the factors theorized by the original Self-Stigma Scale. Cronbach’s alpha for internal reliability and Pearson’s correlations for construct validity were used for evaluation of psychometric properties. Pearson’s correlations for test-retest reliability of the SSS-J were also performed.ResultsConfirmatory factor analysis verified the three-factor structure of the SSS-J, consisting of cognitive, affective, and behavioral subscales. The model fit indices were as follows: the goodness-of-fit index was 0.78, the adjusted goodness-of-fit index was 0.70, the comparative fit index was 0.88, and the root mean square error of approximation was 0.07. Cronbach’s alpha of the SSS-J was 0.96 (cognitive: alpha = 0.92; affective: alpha = 0.93; behavioral: alpha = 0.83). The SSS-J was associated with self-esteem (r = −0.43, p < 0.01), self-efficacy (r = −0.38, p < 0.01), and depressive symptoms (r = 0.39, p < 0.01). The 2-week test-retest reliability demonstrated satisfactory stability (r = 0.76, p < 0.01).ConclusionsThe SSS-J is reliable and valid for assessment of the extent of self-stigma in Japanese patients with type 2 diabetes.

Psychological and behavioural patterns of stigma among patients with type 2 diabetes: a cross-sectional study

“…The reliability and validity of the scale's Japanese version (SSS-J) were reported previously 13. The 39-item SSS-J allows four responses on a Likert scale (strongly disagree, disagree, agree and strongly agree) scored 0, 1, 2 and 3, respectively.…”

“…In this study, we decided to use the Self-Stigma Scale that consists of cognitive, affective and behavioural subscales 13. Since the Self-Stigma Scale was specifically designed to evaluate the self-stigma of groups that are not immediately identifiable,14 it is viewed as an appropriate tool for assessing the particularly concealable condition of T2DM.…”

“…17 Previous studies show that self-stigma is associated with self-esteem, which is defined as the degree to which an individual has a favourable or unfavourable opinion of himself/herself and finds himself/herself worthy or unworthy as a whole including their condition 1318–20 Depending on the degree of social participation, adjustment styles to illness differ 16…”

Measuring Type 1 diabetes stigma: development and validation of the Type 1 Diabetes Stigma Assessment Scale (DSAS-1)

“…Approximately 20% of adults with diabetes in the international DAWN-2 study experienced discrimination, a specific form of stigma [19]. Previous studies have used generic health stigma measures [20,21] or unvalidated diabetes-specific items [19,22]; neither approach is optimal. Such research is dependent on self-report and will only be reliable if a validated measure of diabetes stigma is used.…”

Investigation of Stigma Phenomenon in Cancer: A Grounded Theory Study

“…Kato, Takada and Hashimoto identified three aspects of self-stigma: 1) Cognitive factors (patients' beliefs about potential adverse effects of illness); 2) Emotional factors (including all negative emotions); and 3) Behavioral factors (avoiding of making contact with others, hiding illness and restricting social communications) (27). Hence, stigma which is influenced by these factors may adversely affect patients' coping strategies.…”