Coronavirus Disease 2019–Induced Perceived Stigmatization in Physicians Scale

Abstract

The Coronavirus Disease 2019–Induced Perceived Stigmatization in Physicians Scale (C-PSPS) is a 10-item, self-report instrument developed by Önsüz et al. in 2023. This measure was specifically designed to quantify the extent of perceived stigmatization experienced by physicians during the Coronavirus Disease 2019 (COVID-19) pandemic. The creation of the C-PSPS addressed a critical gap in existing measures, which often failed to capture the unique stigma faced by frontline healthcare workers.

The development process was rigorous, beginning with an initial pool of 35 items derived from a comprehensive literature review. Expert review by four specialists and content validation by 14 specialists refined the initial set to 18 items. Following a pilot study among physicians in Turkey, the final scale was optimized to 10 items. Subsequent factor analysis, encompassing both exploratory (EFA) and confirmatory (CFA) methods, confirmed a robust, underlying two-factor structure for the instrument.

Keywords

Coronavirus Disease 2019–Induced Perceived Stigmatization, COVID-19-Induced Stigmatization, Differential Validity, Environmental Perceived Stigmatization, Personally Perceived Stigmatization, Physicians’ Perceptions, Scale Development, Psychometric Evaluation.

Authors

Önsüz, Muhammed Fatih, Oktar, Didem, Gedik, Sevil Aydoğan, Sungur, Sevda, Metintaş, Selma, Köşger, Ferdi, Altınöz, Ali Ercan.

Purpose

The chief purpose of the C-PSPS is to provide a standardized, quantitative measure of the psychological and social distress associated with perceived stigmatization among medical professionals. By focusing specifically on physicians, the scale aims to capture the unique pressures and social exclusion experienced by this cohort during the pandemic era.

This measurement tool allows researchers and public health officials to assess the mental health burden related to professional identity and exposure to the COVID-19 virus, aiding in the development of targeted support interventions.

Construct

The C-PSPS measures the latent construct of Coronavirus Disease 2019–Induced Perceived Stigmatization. This construct is operationalized through a two-factor structure identified during the scale development process.

The two primary dimensions measured by the 10 items are: Environmental Perceived Stigmatization, which relates to external societal pressures and judgments, and Personally Perceived Stigmatization, which addresses internalized feelings of shame, exclusion, or self-blame related to their exposure or role during the pandemic.

Validity

The validity of the C-PSPS was established through several rigorous methods:

• Content Validity: The initial 18-item version of the scale demonstrated acceptable content validity. The calculated content validity index (CVI) was 0.69, based on the assessment by 14 subject matter specialists.
• Criterion Validity: A statistically significant relationship was observed between the C-PSPS scores and scores obtained from the established Stigma Scale (Yaman & Güngör, 2013). The observed Spearman’s correlation coefficient was 0.345 (P < .001), indicating a meaningful relationship between the measures.
• Differential Validity: The scale successfully differentiated between groups of physicians expected to experience higher levels of stigma. Specifically, significantly higher scores were found among physicians who had been diagnosed with COVID-19, those with infected individuals in their immediate environment, and those who reported considering resignation during the pandemic.

Reliability

The C-PSPS demonstrated strong reliability across multiple dimensions of psychometric evaluation:

• Internal Consistency: The measure exhibited excellent internal consistency, with an overall Cronbach’s alpha coefficient of 0.88. Furthermore, all item-total correlation coefficients exceeded the threshold of 0.3, supporting the coherence of the items. For the individual sub-factors, internal consistency remained high, with Factor 1 achieving a Cronbach’s alpha of 0.875, and Factor 2 achieving 0.766.
• Test-retest Reliability: The scale showed high stability over time. A two-week interval test-retest administration yielded a correlation coefficient of 0.91 (P = .125), suggesting that the scores are highly consistent upon repeated measurement.

Factor Analysis

The scale’s underlying structure was rigorously evaluated using both Exploratory and Confirmatory Factor Analysis to ensure dimensional integrity.

• Exploratory Factor Analysis (EFA): The EFA process systematically refined the scale. Items with factor loadings below 0.30 were removed, along with one cross-loading item. Following subsequent refinement, the final 10-item scale demonstrated a clear two-factor structure. These two factors collectively accounted for 61.66% of the total variance, with strong individual factor loads ranging from 0.66 to 0.85.
• Confirmatory Factor Analysis (CFA): The hypothesized two-factor model was tested using CFA and showed strong goodness-of-fit indices, supporting the factor structure derived from the EFA. Key fit statistics included: Chi-square (χ²) = 152.30 (df = 34; χ²/df = 4.47), CFI (Comparative Fit Index) = 0.96, and SRMR (Standardized Root Mean Square Residual) = 0.051. These indices suggest a good fit of the model to the observed data.

Instrument

Test Type: Original Inventory/Questionnaire specifically designed to measure COVID-19-Induced Stigmatization.

Format: The C-PSPS is a self-report measure consisting of 10 items. Responses are anchored on a 5-point Likert-type scale with the following options: “strongly disagree,” “disagree,” “no idea,” “agree,” and “strongly agree.” Scoring is cumulative, where a higher total score indicates a greater level of perceived stigmatization among physicians.

Language Available: The scale was developed and validated in Turkish.

Population Group: Human (Male and Female) physicians.

Age Group: Adulthood (18 years and older), covering Young Adulthood (18-29 yrs), Thirties (30-39 yrs), Middle Age (40-64 yrs), and Aged (65 yrs & older).

Population Details: The validation study sample consisted exclusively of practicing physicians located in Turkey.

Test Methodology: The scale development utilized comprehensive psychometric evaluation, including Test Validity (Content Validity, Criterion Validity, Differential Validity), Test Reliability (Internal Consistency using Cronbach’s alpha, Test-Retest Reliability), and Factor Analysis (Exploratory Factor Analysis and Confirmatory Factor Analysis).

Keywords

Coronavirus Disease 2019–Induced Perceived Stigmatization, COVID-19-Induced Stigmatization, Differential Validity, Environmental Perceived Stigmatization, Personally Perceived Stigmatization, Physicians’ Perceptions, Healthcare Worker Stress.

Authors

Corresponding Author: Önsüz, Muhammed Fatih

Author ORCID Identifier: No data is Available

Affiliation Email addresses: [email protected] (Affiliation: Department of Public Health, Eskisehir Osmangazi University, School of Medicine)

Correspondence Address: [email protected]

Permissions & Fee and Test Year

Permissions: To obtain permission for the use or adaptation of the Coronavirus Disease 2019–Induced Perceived Stigmatization in Physicians Scale, researchers should contact the Corresponding Author.

Fee: No fee is required for the use of this scale, suggesting it is available for non-commercial academic research.

Test Year: 2023.

Reference’s

Önsüz, M. F., Oktar, D., Gedik, S. A., Sungur, S., Metintaş, S., Köşger, F., & Altınöz, A. E. (2023). Development and validation of Coronavirus disease 2019-Induced Perceived Stigmatization in Physicians Scale. Alpha Psychiatry, 24(4), 138–145. https://doi.org/10.1055/a-2005-7269

Items of the Coronavirus Disease 2019–Induced Perceived Stigmatization in Physicians Scale

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

This measure consists of 10 items. Specific item content is not provided, but the scale includes two factors: Environmental perceived stigmatization and Personally perceived stigmatization.