Development of a 12-item short version of the HIV stigma scale

Abstract

BackgroundValid and reliable instruments for the measurement of enacted, anticipated and internalised stigma in people living with HIV are crucial for mapping trends in the prevalence of HIV-related stigma and tracking the effectiveness of stigma-reducing interventions. Although longer instruments exist, e.g., the commonly used 40-item HIV Stigma Scale by Berger et al., a shorter instrument would be preferable to facilitate the inclusion of HIV stigma in more and broader surveys. Therefore, the aim of this work was to develop a substantially shorter, but still valid, version of the HIV Stigma Scale.MethodsData from a psychometric evaluation of the Swedish 40-item HIV Stigma Scale were reanalysed to create a short version with 12 items (three from each of the four stigma subscales: personalised stigma, disclosure concerns, concerns with public attitudes and negative self-image). The short version of the HIV stigma scale was then psychometrically tested using data from a national survey investigating stigma and quality of life among people living with HIV in Sweden (n = 880, mean age 47.9 years, 26% female).ResultsThe hypothesized factor structure of the proposed short version was replicated in exploratory factor analysis without cross loadings and confirmatory factor analysis supported construct validity with high standardised effects (>0.7) of items on the intended scales. The χ2 test was statistically significant (χ2 = 154.2, df = 48, p < 0.001), but alternate fit measures indicated acceptable fit (comparative fit index: 0.963, Tucker-Lewis index: 0.950 and root mean square error of approximation: 0.071). Corrected item-total correlation coefficients were >0.4 for all items, with a variation indicating that the broadness of the concept of stigma had been captured. All but two aspects of HIV-related stigma that the instrument is intended to cover were captured by the selected items in the short version. The aspects that did not lose any items were judged to have acceptable psychometric properties. The short version of the instrument showed higher floor and ceiling effects than the full-length scale, indicating a loss of sensitivity in the short version. Cronbach’s α for the subscales were all >0.7.ConclusionsAlthough being less sensitive in measurement, the proposed 12-item short version of the HIV Stigma Scale has comparable psychometric properties to the full-length scale and may be used when a shorter instrument is needed.

Development of an 18‐item abbreviated Chinese version of Berger's HIV Stigma Scale

“…The two negatively phrased items were deleted from the original Berger's HSS because the phrasing, from the Chinese linguistic perspective, could cause confusion for participants. This finding is consistent with the results from Franke et al (), Jeyaseelan et al (), and Reinius et al (). Furthermore, HIV‐related stigma was positively correlated with depression.…”

“…This finding is consistent with Berger et al () and colleagues' results and results from other studies (Chang, Ko, Lai, & Jeng, ; Steward et al, ; Steward et al, ). The internal consistency of the 18‐CHSS ( r = 0.92) was acceptable and similar to other language versions of the HIV Stigma Scale (Spanish version = 0.84, Tamil version = 0.88, Swedish version subscale range 0.80 to 0.88; Franke et al, ; Jeyaseelan et al, ; Reinius et al, ).…”

“…The results of this study may be compared with six studies pub- Bunn et al (2007), to 21 items by Franke et al (2010), to 25 items by Jeyaseelan et al (2013), and to 12 items by Reinius et al (2017). Our study results also suggested the need for item deletion.…”

“…Five of the six studies used Berger's HSS for cross‐cultural testing. The number of Berger's HSS items (40 items) was reduced to 32 items by Bunn et al (), to 21 items by Franke et al (), to 25 items by Jeyaseelan et al (), and to 12 items by Reinius et al (). Our study results also suggested the need for item deletion.…”

“…Thus, the authors translated Berger's HSS into Chinese and established its validity and reliability. Berger's HSS has been abridged (Bunn, Solomon, Miller, & Forehand, ; Kipp et al, ; Reinius et al, ; Wright, Sylvie, Lam, Templin, & Frey, ) and translated into three languages: Spanish (Franke et al, ), Tamil (Jeyaseelan et al, ), and Swedish (Lindberg, Wettergren, Wiklander, Svedhem‐Johansson, & Eriksson, ; Reinius et al, ; Wiklander et al, ). The above studies showed that abridgement of Berger's HSS reduced the scale to 3 to 4 domains and 8 to 40 items with good internal consistency ( α = 0.81‐0.96).…”