Adaption and Validation of Scales to Measure COVID-19 Stigma Attitudes and Perceptions

Stark racial and socioeconomic disparities in COVID-19 case rates manifested across the U.S. during the COVID-19 pandemic and were also observed in rates of COVID-19 testing. Targeted testing of populations at greatest risk for COVID-19, while effective in containing the spread of COVID-19, could propagate stigma and discrimination, especially when directed toward already marginalized communities. As is known from other health areas, stigmatization can drive people to deny or hide their illness, prevent or delay timely healthcare seeking, and can discourage people from adopting healthy behaviors, such as testing or precautions. In this study we sought to adapt and validate two scales from the HIV stigma literature to measure aspects of COVID-19 stigma, including measures of 1) negative attitudes toward people who get COVID-19 and 2) perceptions of stigma faced by people who get COVID-19 in the community. After working with stigma experts and community partners to adapt the scales, we implemented the items in a community-based survey of African American residents of neighborhoods with high social vulnerability in two counties in Alabama (n=302). Analytic methods included internal reliability testing and scale item reduction, construct validity examination, and bivariable and multivariable linear regression analyses to examine associations with conceptually important and statistically significant predictors. The final COVID-19 stigma scales developed through this process have good reliability and validity and can be used in future research and programs to understand and address disparities in uptake of testing and precautions for COVID-19 and future pandemics.