Courtesy Stigma Scale among Relatives of Drug Users (ECOFAD)

Abstract

The Escala de Estigma de Cortesia entre Familiares de Usuários de Drogas (ECOFAD), also known as the Courtesy Stigma among Family Members of Drug Users Scale, is a psychological instrument developed to assess the specific psychological and social repercussions experienced by family members of individuals with Substance Use Disorder. This instrument focuses exclusively on the detrimental effects inflicted by this form of secondary stigma.

The development of the psychological scale began with an initial pool of items derived from extensive literature reviews. These English items were translated and culturally adapted into Portuguese to fit the context of Brazilian family members dealing with alcohol and other drug use. The final scale comprises 38 items distributed across three distinct dimensions: cognitive, affective, and behavioral. Rigorous content validation was performed by a panel of experts specializing in psychometry, family psychotherapy, and addiction studies, ensuring the instrument’s appropriateness before its successful validation using a sample of family members participating in mutual help groups.

Keywords

Affective, Behavioral, Cognitive, Courtesy Stigma, Drug Users, Family Members, Family Relations, Stigma, Substance Use and Addiction Measures, Substance Use Disorder, Family and Parenting Measures, Addiction (Attitudes Toward).

Authors

Maldonado, Daniel Augusto Costa, Martins, Leonardo Fernandes, da Silveira, Pollyanna Santos, Ronzani, Telmo Mota.

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Purpose

The primary purpose of the ECOFAD scale is to systematically evaluate the prevalence and intensity of courtesy stigma specifically targeting family members of individuals who use drugs. It is tailored for application within the Brazilian cultural and clinical context, providing a standardized measure for researchers and clinicians interested in the indirect impacts of addiction.

Construct

The ECOFAD measures the complex phenomenon of Courtesy Stigma, which is stigma experienced by association with a socially devalued condition (in this case, association with Drug Use). It operationalizes this construct across three components:

• Cognitive: Beliefs and perceptions held by the family member regarding the stigma.
• Affective: Emotional distress and feelings resulting from the stigma.
• Behavioral: Observable actions, avoidance, or coping strategies employed due to the perceived or enacted stigma.

Validity

The scale’s Content Validity was rigorously established through expert review using the Content Validity Coefficient (CVC). The CVCs for the items across the dimensions were high: 0.78 for writing quality, 0.82 for clarity, and 0.87 for relevance to the construct. Although the writing CVC was marginally lower than the ideal threshold, this was attributed to the numerous rewriting suggestions provided by the expert judges during the refinement process.

Despite minor alterations, the majority of items demonstrated superior validity metrics. Specifically, 82% of items achieved a CVC above 0.7 for writing, 89.5% met this standard for clarity, and nearly all items (97.4%) surpassed the 0.7 standard for pertinence to their respective theoretical dimensions. Based on these strong psychometric indicators, all 38 items were retained for the subsequent pilot study involving family members of drug users.

Reliability

The ECOFAD scale exhibits strong internal consistency, confirming its high reliability. The overall Cronbach’s alpha coefficient for the entire 38-item scale was exceptionally high at 0.94. Furthermore, reliability was confirmed at the dimensional level, with all three dimensions yielding coefficients above the acceptable 0.8 threshold:

• The Affective dimension achieved an alpha of 0.89.
• The Cognitive dimension achieved an alpha of 0.88.
• The Behavioral dimension achieved an alpha of 0.82.

In terms of split-half reliability, the Spearman-Brown correlation coefficient was 0.95, indicating excellent consistency between the two halves of the scale. The corrected total item correlation coefficients generally exceeded the criterion value of 0.30, confirming that individual items contribute appropriately to the overall construct score, with the only minor exceptions being items 15 and 25.

Factor Analysis

An Exploratory Factor Analysis (EFA) was conducted, utilizing parallel analysis, which confirmed that a three-factor structure was the most representative model for the collected data. This three-factor solution successfully accounted for 48.7% of the total explained variance. Items belonging to the Affective dimension, along with the majority of the Behavioral dimension items, exhibited high factorial loads and commonalities, supporting the hypothesized factor structure.

Within the Cognitive dimension, a few specific items (15, 18, 19, 24, and 25) displayed comparatively low values relative to the other items on the scale. However, the instrument’s overall adjustment indices were found to be highly adequate, including χ² = 651.457 (gl = 592, p = 0.04528), RMSEA = 0.034, CFI = 0.993, and TLI = 0.992. The measure of replicability for the factorial structure, assessed via the H-index, further supported the model, yielding values of 1.017 for the Affective factor, 1.000 for the Cognitive factor, and 0.941 for the Behavioral factor.

Instrument

Test Type: This is an Original inventory/questionnaire.

Format: The test is administered in an Electronic format.

Language Available: The test is available in Portuguese.

Population Group: The intended population includes human subjects, both male and female, who are family members of drug users.

Age Group: The scale is designed for adults aged 18 and older. The validation sample included individuals across multiple adult age demographics, spanning from 32 to 78 years, covering Adulthood (18 yrs & older), Thirties (30-39 yrs), Middle Age (40-64 yrs), and Aged (65 yrs & older).

Population Details: The study was conducted in Brazil with respondents who were family members of individuals who use drugs, often recruited from mutual help groups.

Test Methodology: The development and validation involved assessments of Test Validity, Content Validity, Test Reliability, Internal Consistency, Split-Half Reliability, Factor Analysis, and Exploratory Factor Analysis.

Keywords

Affective, Behavioral, Cognitive, Courtesy Stigma, Drug Users, Family Members.

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Authors

Maldonaldo, Daniel Augusto Costa: Affiliation: Universidade Federal de Juiz de Fora (UFJF). ORCID: No data is available. Email: No data is available.

Martins, Leonardo Fernandes: Affiliation: Pontifícia Universidade Católica do Rio de Janeiro. ORCID: No data is available. Email: No data is available.

da Silveira, Pollyanna Santos: Affiliation: Universidade Católica de Petrópolis. ORCID: No data is available. Email: No data is available.

Ronzani, Telmo Mota (Corresponding Author): Affiliation: Universidade Federal de Juiz de Fora. ORCID: No data is available. Email: [email protected]. Correspondence Address: Universidade Federal de Juiz de Fora, Instituto de Ciências Humanas, Departamento de Psicologia, Campus Universitário, Bairro Martelos, Juiz de Fora, Minas Gerais, Brazil, 36036-900.

Permissions & Fee and Test Year

The ECOFAD scale was developed in the year 2023. The instrument is classified as non-commercial, and there is no fee required for its use. Parties interested in using the scale must contact the corresponding author, Telmo Mota Ronzani, for formal permission.

Reference’s

Maldonado, D. A. C., Martins, L. F., da Silveira, P. S., & Ronzani, T. M. (2023). Escala de Estigma de Cortesia entre Familiares de Usuários de Drogas (ECOFAD) [Construction of the Courtesy Stigma among Family Members of Drug Users Scale (ECOFAD)]. Avaliação Psicológica, 22(1), 92–102. DOI: https://doi.org/10.15689/ap.2023.2201.25055.10

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Items of the Escala de Estigma de Cortesia entre Familiares de Usuários de Drogas (ECOFAD)

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

This measure is composed of 38 items. The items themselves are not available in this record but can be found in the source publication cited above, specifically in Table 3 on pages 97-98. The scale is structured into three distinct dimensions: Affective, Cognitive, and Behavioral.