Table 3. Definitions and example scale items for each domain identified in a systematic review of scales for measuring infectious disease–related stigma*.
Action-oriented stigma domains† | Experiential stigma domains |
||
---|---|---|---|
Prejudice‡ | Discrimination§ | Medically unwarranted avoidance¶ | |
Social: stigmatization by friends and family |
“I feel blamed by relatives or friends,” Self-stigma Scale (SSS-15) |
“[I was] forced to change residence because of social alienation,” 7-item EVD-related stigma index |
“People I cared for stopped calling or interacting after learning that I was infected/suspected,” COVID-19 Stigma Scale |
Public: stigmatization by broader community and strangers |
“Most people think that a person who has had Ebola is disgusting,” Ebola/COVID-19–related Stigma Survey |
“I have been insulted/discriminated because of my history of being infected/suspected,” COVID-19 Stigma Scale |
“Some people avoid touching me even after my recovery once they knew I was infected with/suspected,” COVID-19 stigma scale |
Workplace: stigmatization by colleagues and employers |
“My feeling of job security has been affected by my illness,” COVID-19 Perceived Stigma Scale-22 (CPSS-22) |
“I will dismiss my employee who recovers from COVID-19,” Social stigma and discriminatory attitudes scale |
“Someone refused to buy products from you,” Stigmatization related to EVD and COVID-19 scale |
Provider-related: stigmatization by service providers |
“You feel it is not worthwhile for you to serve persons who contracted COVID-19” - Stigma Discrimination Scale (SDS-11) |
“[I was] treated unfairly by healthcare professionals,” COVID-19 Experienced DISCrimination Scale (CEDISC) |
“I was denied health care services when the doctors found out I was infected /suspected,” COVID-19 Stigma Scale |
Structural: stigmatization by institutions |
NA |
“The first COVID-19 patient in each city should be identified and penalised due to their role in spreading the disease,” COVID-19-related enacted Stigma Questionnaire |
“At the hospital/clinic, I was made to wait until the last,” Ebola-related stigma instrument |
Self: internalization of stigma | “Having had COVID-19 infection makes me feel that I am a bad person,” COVID-19-related Stigma Survey | “I stopped eating with other people,” Ebola-related stigma instrument | NA |
Anticipated; disclosure concerns or avoidance due to fear of stigma |
“I worry that people may judge me negatively when they find out I have long Covid,” Long COVID Stigma Scale (LCSS) |
“You have avoidance behaviours such as staying home for fear of being stigmatised or rejected,” Stigmatization related to EVD and COVID-19 scale |
NA |
Stigma-by-association; stigmatization of those societally associated with the disease or infected persons but not personally infected | “If they knew about it would your neighbors, colleagues or others in your community think less of your family because of your COVID-19 infection?” Arabic Explanatory Model Interview Catalogue (EMIC) | “A school refused to accept your children,” Stigmatization related to EVD and COVID-19 scale | “If a person was infected with COVID-19, it is better to avoid his/her family members,” Community COVID-19 Stigma Scale |
*Framework based on stigma typology from Jones and Corrigan (6). EVD, Ebola virus disease; NA, not applicable. †Domains adopted from Pescosolido and Martin (27). ‡Negative thoughts and feelings toward stigmatized persons. §Enactment of prejudice or differential treatment of stigmatized persons. ¶Neglect of stigmatized persons.