Breast Cancer Stigma Scale: A Reliable and Valid Stigma Measure for Patients With Breast Cancer

Abstract

PurposeThis study aims to develop and validate a stigma scale for Chinese patients with breast cancer.MethodsPatients admitted to the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, for breast cancer treatment participated in this study. Development of the Breast Cancer Stigma Scale involved the following procedures: literature review, interview, and applying a theoretical model to generate items; the Breast Cancer Stigma Scale’s content validity was assessed by a Delphi study (n = 15) and feedback from patients with breast cancer (n = 10); exploratory factor analysis (n = 200) was used to assess the construct validity; convergent validity was assessed with the Social Impact Scale (n = 50); internal consistency Cronbach’s α (n = 200), split-half reliability (n = 200), and test–retest reliability (N = 50) were used to identify the reliability of the scale.ResultsThe final version of the Breast Cancer Stigma Scale consisted of 15 items and showed positive correlations with the Social Impact Scale (ρ = 0.641, P < 0.001). Exploratory factor analysis (EFA) revealed four components of the Breast Cancer Stigma Scale: self-image impairment, social isolation, discrimination, and internalized stigma, which were strongly related to our perceived breast cancer stigma model and accounted for 69.443% of the total variance. Cronbach’s α for the total scale was 0.86, and each subscale was 0.75–0.882. The test–retest reliability with intra-class correlation coefficients of the total scale was 0.947 (P < 0.001), and split-half reliability with intra-class correlation coefficients of the total scale was 0.911 (P < 0.001). The content validity index (CVI) was 0.73–1.0.ConclusionThe newly developed Breast Cancer Stigma Scale offers a valid and reliable instrument for assessing the perceived stigma of patients with breast cancer in clinical and research settings. It may be helpful for stigma prevention in China.

The stigma in patients with breast cancer: A concept analysis

“…Similarly, Zheng 27 proposed that breast cancer stigma is an internal shame experience of BCPs due to illness, which makes BCPs develop feelings of humiliation and guilt. According to the conceptual model of lung cancer-related stigma, Bu et al 28 adapted a model of perceived stigma in BCPs to describe the perceived stigma process, including precursors, poor image and esteem, social insulation, limited opportunities, negative changes in identity, and possible responses.…”

“…Moreover, the process, manifestations, and consequences of stigma in BCPs were seldom mentioned. Furthermore, Bu et al 28 described the process of stigma in BCPs as a perceived stigma model, which was adapted from the conceptual stigma model of lung cancer. It would be deeply affected by the original lung cancer stigma model and the characteristics of BCPs were not fully considered, lacking systematic research on the stigma of BCPs.…”

“…Scholars have applied universal or particular disease stigma models to BCPs, and inapplicable problems are encountered in the research practice. Take Bu et al 28 for example, who constructed a model of perceived stigma for BCPs based on the model of perceived lung cancer stigma. There are some similarities in the stigma concept of different diseases, but different disease sites induce different stigma manifestations and processes.…”

Demand analysis of health care services for community-dwelling breast cancer survivors based on the Kano model: A cross-sectional study

“…Research studies showed that physical changes (e.g., breast loss, hair loss, skin scarring, pigmentation, and limb dysfunction) can negatively impact the perception of survivors regarding their female identity and attractiveness. These changes can lead to decreased sexual interest, feelings of stigma, and negative emotions, such as anxiety, depression, inferiority complex, and fear [ [37] , [38] , [39] ]. Therefore, it is vital to prioritize body image management services for breast cancer survivors.…”

Demand analysis of home care services among breast cancer survivors based on the Kano model

“…Studies have revealed that physical changes such as breast loss, hair loss, skin scars, pigmentation, and limb dysfunction can lead survivors to question their feminine identity and attractiveness. This, in turn, can result in a decrease in sexual interest, a strong sense of stigma, and the experience of negative emotions such as anxiety, depression, inferiority, and fear [33][34][35]. Given these ndings, it is crucial to prioritize the provision of body image management services for breast cancer survivors.…”