Development of a scale to assess cancer stigma in the non-patient population.

Laura Av Marlow,Jane Wardle

doi:10.1186/1471-2407-14-285

Abstract

BackgroundIllness-related stigma has attracted considerable research interest, but few studies have specifically examined stigmatisation of cancer in the non-patient population. The present study developed and validated a Cancer Stigma Scale (CASS) for use in the general population.MethodsAn item pool was developed on the basis of previous research into illness-related stigma in the general population and patients with cancer. Two studies were carried out. The first study used Exploratory factor analysis to explore the structure of items in a sample of 462 postgraduate students recruited through a London university. The second study used Confirmatory factor analysis to confirm the structure among 238 adults recruited through an online market research panel. Internal reliability, test-retest reliability and construct validity were also assessed.ResultsExploratory factor analysis suggested six subscales, representing: Awkwardness, Severity, Avoidance, Policy Opposition, Personal Responsibility and Financial Discrimination. Confirmatory factor analysis confirmed this structure with a 25-item scale. All subscales showed adequate to good internal and test-retest reliability in both samples. Construct validity was also good, with mean scores for each subscale varying in the expected directions by age, gender, experience of cancer, awareness of lifestyle risk factors for cancer, and social desirability. Means for the subscales were consistent across the two samples.ConclusionsThese findings highlight the complexity of cancer stigma and provide the Cancer Stigma Scale (CASS) which can be used to compare populations, types of cancer and evaluate the effects of interventions designed to reduce cancer stigma in non-patient populations.

Highlights

Illness-related stigma has attracted considerable research interest, but few studies have examined stigmatisation of cancer in the non-patient population
Patients sometimes feel avoided by others once they have received a cancer diagnosis [7,8,9] and fear of stigmatisation can be a barrier to disclosure of a cancer diagnosis [8,10]
Development of an item pool An item pool was developed on the basis of previous research into illness-related stigma in the general population and patients with cancer

Summary

Introduction

Illness-related stigma has attracted considerable research interest, but few studies have examined stigmatisation of cancer in the non-patient population. Health-related stigma refers to stigmatisation of an illness, which can be applied to an individual or a group of people with the illness, as well as to the illness more generally [3]. It is “characterized by exclusion, rejection, blame or devaluation that results from experience, perception or reasonable anticipation of an adverse social judgment about a person or group” (p.280). Work exploring stigma among cancer patients has focused on lung cancer, with patients who are smokers feeling blamed because of the perception that their illness is selfinflicted [11]

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