Table 2.

Modifications and adaptation of selected stigma instrument

	Stigma Stress Scale	Self-stigma of Mental Illness Scale	Secrecy Scale	Stigma Impact Scale
Scale Description	8 item Likert scale from 1 •(strongly disagree) to 7 (strongly agree). Four items are design to measure the harm caused by stigma and four focus on the impact of stigma on one’s resources to cope with such harm.	4 subscales answered on a 9-point likert scale representing: awareness of stereotypes, agreement with stereotypes, applying stereotypes to self and suffer harm from self-applied stereotypes. Each subscale has five items	9 items are answered on a 4-point Likert scale from 1 (strongly disagree) to 4 (strongly agree). Assess the extent to which an individual endorses concealment as a means of avoiding stigma related rejection.	21 items are rated from 1 (‘strongly disagree’) to 4 (‘strongly agree’) with the addition of 0 for those items participants found ‘not applicable’. The scale has four subscales, namely, social rejection (9 items), internalised shame (5 items) and social isolation (7 items).
Comments from lived experience experts	Just call it stigma rather than prejudice—in an UK population stigma is more colloquial than prejudice	The term “less confidence” should be used rather than “less respect”	No comments	No comments
Comments from research experts	Define prejudice in the instructions Item 6 wording is complicated Items 7 & 8 similar Supplement challenges for the word demands	Using “most people” and “the public” to describe the same thing is confusing. The perspective change between subscales was problematic in the past. This scale relies on stereotypes of mental health, therefore these also need to be relevant to dementia	Removal of recovery and employability item. Issues with the term impairment – maybe use “diagnosis”	Change the use of the word “impairment”, for example replace with “dementia”
Drop dimension	None	All dimension dropped	Dropped four of five dimensions from the original Stigma Coping Orientation Scale to leave only the secrecy subscale	None
Items Removed	None	None	Items 6 and 8 removed	None
Item Modification	“people with mental illness” changed to “people living with dementia” . “prejudice” changed to “stigma” .	None	“mental illness” changed to “dementia” for the purposes client group adaptation	None
Other Modification	“Prejudice” was replaced with “stigma” in the instructions, the definition was left unchanged on the premise that prejudice and stigma are interchangeable terms yet stigma is the most colloquially appropriate	None	None	The term “dementia” was inserted into the instructions to be used interchangeably with “impairment”. The instructions read “dementia or neurological impairment …”