COVID-19 Social Stigma Scale

Abstract

The COVID-19 Social Stigma Scale (CSSS), developed by Juniarti et al. in 2023, is a psychometric instrument designed to quantify and assess the extent of social stigma experienced by individuals in Indonesia specifically related to the COVID-19 pandemic. The scale development began with an extensive literature review to generate items, which were subsequently validated for content validity by an expert panel.

This initial process identified seven distinct dimensions of stigma: social distancing, traditional prejudice, exclusionary sentiments, negative affect, treatment carryover, disclosure carryover, and perceptions of dangerousness. Starting with 123 items, the instrument was refined using Rasch analysis based on data collected from an adult population in Indonesia. The final, parsimonious scale consists of 11 items distributed across the seven original dimensions, demonstrating strong internal consistency and appropriate measurement fit statistics.

Keywords

Social Stigma, COVID-19, Social Distancing, Traditional Prejudice, Exclusionary Sentiments, Negative Affect, Treatment Carryover, Disclosure Carryover, Perception of Dangerousness, Rasch Analysis.

Authors

Juniarti, Neti; Susanti, Raini Diah; Yani, Desy Indra; Nurhasanah, Nurani

Purpose

The primary purpose of the COVID-19 Social Stigma Scale (CSSS) is to accurately measure and quantify the extent of social stigma experienced by individuals residing in Indonesia in the aftermath of the COVID-19 pandemic. This measurement tool aims to capture various behavioral and emotional facets of stigma related to contracting or being associated with the virus.

Construct

The scale measures the complex psychological construct of social stigma specifically arising from the COVID-19 crisis. The construct is conceptualized as multifaceted, encompassing behavioral avoidance, emotional responses, and socio-economic consequences related to the disease.

The theoretical model utilized in the development of the CSSS supports a seven-dimensional structure of COVID-19 social stigma, covering aspects related to fear, judgment, and avoidance behaviors:

• Social distancing
• Traditional prejudice
• Exclusionary sentiments
• Negative affect
• Treatment carryover
• Disclosure carryover
• Perception of dangerousness

Validity

The CSSS underwent rigorous initial validation to ensure its relevance and appropriateness for the target construct. The development process emphasized content validity, which was established through a comprehensive review phase.

Following the generation of the initial item pool via literature review, the items were meticulously evaluated and confirmed by an independent panel of experts. This expert evaluation confirmed that the items adequately represented and covered all seven theoretical dimensions hypothesized to constitute COVID-19 social stigma.

Reliability

The reliability of the COVID-19 Social Stigma Scale was assessed using measures of internal consistency, demonstrating excellent reliability metrics for the final 11-item instrument.

• Internal Consistency (Cronbach’s Alpha): The overall instrument yielded a high Cronbach’s Alpha value of +0.96.
• Person Reliability: The reliability associated with the persons (participants) was reported as +0.94.
• Item Reliability: The reliability associated with the items themselves was also reported as +0.94.

These high values across multiple reliability indicators suggest that the scale is highly consistent and accurately measures the latent trait of social stigma in the targeted population.

Factor Analysis

Scale refinement and confirmation of the measurement model were achieved using Rasch analysis, a form of Item Response Theory (IRT). This analysis was crucial for reducing the initial 123-item pool to a final, robust set of 11 items.

The Rasch analysis confirmed the quality and fit of the final 11 items. The fit statistics, including the INFIT Mean Square (MNSQ) and OUTFIT MNSQ, showed an average person value of 0.99, closely aligning with the ideal value of 1.00, indicating good measurement fit. Furthermore, the INFIT ZSTD and OUTFIT ZSTD values for the person were 0.99 and 0.88, respectively, approaching the ideal value of 0.0. This strong psychometric evidence confirmed that the final set of 11 items provided an infit measure of the seven dimensions without exhibiting any significant item bias.

Instrument

Test Type: Original

Format: Items are rated using a 5-point Likert scale, featuring selections of “strongly agree,” “agree,” “don’t know” (or unsure), “disagree,” and “strongly disagree.”

Language Available: English

Population Group: Human; Male; Female

Age Group: Adulthood (18 years & older)

Population Details: Respondents were adults aged 17 years and above, sampled within Indonesia.

Test Methodology: The development and evaluation methodology involved Test Validity, Content Validity, Test Reliability, Internal Consistency, and Item Response Theory (specifically Rasch Analysis).

Keywords

Psychometric Scale, Indonesia, Public Health, Perception of Dangerousness, Likert Scale, Cronbach’s Alpha, Item Response Theory.

Authors

Author ORCID Identifier: No data is Available for individual authors.

Affiliation:

• Neti Juniarti: Universitas Padjadjaran, Faculty of Nursing Department of Community Health Nursing
• Raini Diah Susanti: Universitas Padjadjaran, Faculty of Nursing Department of Community Health Nursing
• Desy Indra Yani: Universitas Padjadjaran, Faculty of Nursing Department of Community Health Nursing
• Nurani Nurhasanah: Universitas Padjadjaran, Faculty of Nursing Department of Community Health Nursing

Email addresses:

• Neti Juniarti: [email protected]
• Raini Diah Susanti: No data is Available
• Desy Indra Yani: No data is Available
• Nurani Nurhasanah: No data is Available

Correspondence Address: Juniarti, Neti: [email protected]

Permissions & Fee and Test Year

Permissions: May use for Research/Teaching
Commercial Use: No
Fee: No
Test Year: 2023
Web Site: The work is published under a Creative Commons license: https://creativecommons.org/licenses/by/4.0/deed.en

Reference’s

Juniarti, N., Susanti, R. D., Yani, D. I., & Nurhasanah, N. (2023). Psychometric development and evaluation of a COVID-19 social stigma scale in Indonesia. PLoS ONE, 18(4), Article e0283870. https://doi.org/10.1371/journal.pone.0283870

Items of the COVID-19 Social Stigma Scale

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

The COVID-19 Social Stigma Scale is an 11-item measure. The items are available through the Test Location: 2023-63349-001, Supplemental Material.

Factors and Subscales (Dimensions):

• Social distancing
• Traditional prejudice
• Exclusionary sentiments
• Negative affect
• Treatment carryover
• Disclosure carryover
• Perception of dangerousness

Instructions: Please respond to the following items using the scale provided.

Response Scale:
1 = Strongly disagree
2 = Disagree
3 = Unsure
4 = Agree
5 = Strongly agree

---

Dimension 1: Social Distancing

1. People close themselves off because they are afraid of being blamed by others.

Dimension 2: Traditional Prejudice

2. COVID-19 sufferers are afraid of their identity being shared with the public.

3. People feel ashamed when diagnosed with COVID-19.

Dimension 3: Exclusionary Sentiments

4. People do not want to report being exposed to COVID-19 because they are ashamed and afraid of being shunned.

5. People would not admit they are infected with COVID-19 because they are afraid of losing their jobs.

Dimension 4: Negative Affect

6. People still feel that suffering from COVID-19 is a disgrace.

7. People with symptoms of anosmia don’t want to do swab tests for fear of being disgraced.

Dimension 5: Treatment Carryover

8. People hide their status of being exposed to COVID-19 for fear of losing their jobs.

Dimension 6: Disclosure Carryover

9. People do not want to do a rapid test for fear of a positive result.

10. People prefer self-isolation without being tested, but they do not commit to doing self-isolation properly.

Dimension 7: Perception of Dangerousness

11. People do not want to mention their close contacts when tracing for fear of losing other people’s friendship.