Abstract
OBJECTIVES: Sexually transmitted and blood-borne infections (STBBIs) are associated with stigmatizing attitudes and beliefs, which can affect the quality of and access to health care, as well as mental health and quality of life. The current study describes the adaptation from an HIV-related stigma scale and pilot testing of a new STBBI Stigma Scale, assessing the stigmatizing attitudes and beliefs of health and social service providers in Canada.
METHODS: 144 health and social service providers from across Canada completed the newly adapted scale assessing stigma associated with HIV, hepatitis C, other viral STBBIs and bacterial STBBIs, as well as demographic information, a scale of social desirability and measures of convergent and divergent validity. Participants were recruited through listservs and completed the scale online.
RESULTS: The new scale, consisting of 21 items for each category, demonstrated excellent internal consistency, reliability, and convergent and divergent validity. The factor structure of the scale supports a tripartite model of stigma consisting of stereotyping, prejudice and discrimination. Stereotyping had the highest relative scores on the subscales, and attitudes regarding other viral STBBIs differed significantly from the other STBBI categories.
CONCLUSION: The new scale provides a contextually relevant and applicable psychometrically valid tool to assess STBBI-related stigma among health and social service providers in Canada. The tool can be used to assess attitudes and beliefs, as well as guide self-assessment and possible trainings for providers.
Key Words: Social stigma, social discrimination, reproductive health, self-assessment, surveys and questionnaires
Mots Clés: stigmate social, discrimination sociale, santé reproductive, auto-évaluation, enquêtes et questionnaires
Résumé
OBJECTIFS : Les infections transmissibles sexuellement et par le sang (ITSS) sont associées à des attitudes et des croyances stigmatisantes qui peuvent avoir un impact sur la qualité des soins de santé, l’accès aux soins, la santé mentale et la qualité de vie. L’étude en cours décrit l’adaptation d’une échelle de stigmatisation liée au VIH et l’essai pilote d’une nouvelle Échelle de stigmatisation des ITSS qui évalue les attitudes et les croyances stigmatisantes des dispensateurs de services sociaux et de santé au Canada.
MÉTHODE : 144 dispensateurs de services sociaux et de santé du Canada ont rempli l’échelle nouvellement adaptée évaluant la stigmatisation associée au VIH, à l’hépatite C, aux autres ITSS virales, aux ITSS bactériennes; les données démographiques, une échelle de désirabilité sociale et des indicateurs de validité convergente et divergente ont aussi été testés. Les participants ont été recrutés à l’aide de gestionnaires de listes de diffusion et ont rempli l’échelle en ligne.
RÉSULTATS : La nouvelle échelle, qui comprend 21 éléments dans chaque catégorie, a affiché d’excellents résultats sur les plans de la cohérence interne, de la fiabilité, ainsi que de la validité convergente et divergente. La structure factorielle de l’échelle appuie un modèle de stigmatisation en trois parties: stéréotypes, préjugés et discrimination. Les stéréotypes ont eu les résultats relatifs les plus élevés des trois sous-échelles, et les attitudes à l’égard des autres ITSS virales ont présenté des écarts significatifs par rapport aux autres catégories d’ITSS.
CONCLUSION : La nouvelle échelle offre un outil psychométriquement valide à la fois contextuellement approprié et applicable pour évaluer la stigmatisation liée aux ITSS chez les dispensateurs de services sociaux et de santé du Canada. Cet outil peut servir à évaluer les attitudes et les croyances, ainsi qu’à guider une auto-évaluation et d’éventuelles formations pour les dispensateurs.
Footnotes
Conflict of Interest: None to declare.
References
- 1.Joint United Nations Programme on HIV/AIDS UNAIDS. UNAIDS Terminology Guidelines. Geneva, Switzerland: Joint United Nations Program on HIV/AIDS; 2015. [Google Scholar]
- 2.Balfe M, Brugha R, O’Donovan D, O’Connell E, Vaughn D. Young women’s decisions to accept chlamydia screening: Influences of stigma and doctorpatient interactions. BMC Public Health 2010;10:425. PMID: 20642845. doi: 10. 1186/1471-2458-10-425. [DOI] [PMC free article] [PubMed]
- 3.Fortenberry JD, McFarlane M, Bleakley A, Bull S, Fishbein M, Grimley DM, et al. Relationships of stigma and shame to gonorrhea and HIV screening. Am J Public Health. 2002;92(3):378–81. doi: 10.2105/AJPH.92.3.378. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Mahajan AP, Sayles JN, Patel VA, Remien RH, Ortiz D, Szekeres G, et al. Stigma in the HIV/AIDS epidemic: A review of the literature and recommendations for the way forward. AIDS. 2008;22(Suppl2):S67–79. doi: 10.1097/01.aids.0000327438.13291.62. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Mill J, Edwards N, Jackson R, Austin W, MacLean L, Reintjes F. Accessing health services while living with HIV: Intersections of stigma. Can J Nurs Res. 2009;41(3):168–85. [PubMed] [Google Scholar]
- 6.Rusch ML, Shoveller JA, Burgess S, Stancer K, Patrick DM, Tyndall MW. Preliminary development of a scale to measure stigma relating to sexually transmitted infections among women in a high risk neighbourhood. BMC Womens Health. 2008;8:21. doi: 10.1186/1472-6874-8-21. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Kinsler JJ, Wong MD, Sayles JN, Davis C, Cunningham WE. The effect of perceived stigma from a health care provider on access to care among a low-income HIV-positive population. AIDS Patient Care STDs. 2007;21(8):584–92. doi: 10.1089/apc.2006.0202. [DOI] [PubMed] [Google Scholar]
- 8.Earnshaw VA, Chaudoir SR. From conceptualizing to measuring HIV stigma: A review of HIV stigma mechanism measures. AIDS Behav. 2009;13:1160–77. doi: 10.1007/s10461-009-9593-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Wagner AC, Hart TA, McShane KE, Margolese S, Girard TA. Health care provider attitudes and beliefs about people living with HIV: Initial validation of the health care provider HIV/AIDS stigma scale (HPASS) AIDS Behav. 2014;18(12):2397–408. doi: 10.1007/s10461-014-0834-8. [DOI] [PubMed] [Google Scholar]
- 10.Gagnon M. Re-thinking HIV-related stigma in health care settings: A qualitative study. J Assoc Nurses AIDS Care. 2015;26(6):703–719. doi: 10.1016/j.jana.2015.07.005. [DOI] [PubMed] [Google Scholar]
- 11.Windsor LC, Benoit E, Ream GL, Forenza B. The provider perception inventory: Psychometrics of a scale designed to measure provider stigma about HIV, substance abuse, and MSM behavior. AIDS Care. 2013;25(5):586–91. doi: 10.1080/09540121.2012.726338. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Rutledge SE, Whyte J, Abell N, Brown KM, Cesnales NI. Measuring stigma among health care and social service providers: The HIV/AIDS provider stigma inventory. AIDS Patient Care STDs. 2011;25(11):673–82. doi: 10.1089/apc.2011.0008. [DOI] [PubMed] [Google Scholar]
- 13.Feyissa GT, Abebe L, Girma E, Woldie M. Stigma and discrimination against people living with HIV by healthcare providers, Southwest Ethiopia. BMC Public Health 2012;12:522. PMID: 22794201. doi: 10.1186/1471-2458-12-522. [DOI] [PMC free article] [PubMed]
- 14.Int J STD AIDS. 2010.
- 15.Public Health Agency of Canada. What is an Integrated, Holistic Approach to Sexually Transmitted and Blood Borne Infections. Ottawa, ON: PHAC; 2014. [Google Scholar]
- 16.Brown T. Confirmatory Factor Analysis. New York, NY: Guilford; 2006. [Google Scholar]
- 17.Froman RD, Owen SV. Further validation of the AIDS attitude scale. Res Nurs Health. 1997;20(2):161–7. doi: 10.1002/(SICI)1098-240X(199704)20:2<161::AID-NUR8>3.0.CO;2-I. [DOI] [PubMed] [Google Scholar]
- 18.Fischer DG, Fick C. Measuring social desirability: Short forms of the Marlowe-Crowne social desirability scale. Educ Psychol Meas. 1993;53:417–24. doi: 10.1177/0013164493053002011. [DOI] [Google Scholar]
- 19.IBM Corp. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp; 2016. [Google Scholar]