Abstract
BackgroundStigma around hepatitis C virus (HCV) infection is an important and understudied barrier to HCV prevention, treatment, and elimination. To date, no validated instrument exists to measure patients’ experiences of HCV stigma. This study aimed to revise the Berger (2001) HIV stigma scale and evaluate its psychometric properties among patients with HCV infection.MethodsThe Berger HIV stigma scale was revised to ask about HCV and administered to patients with HCV (n = 270) in Philadelphia, Pennsylvania. Scale reliability was evaluated as internal consistency by calculating Cronbach’s alpha. Exploratory factor analysis was performed to evaluate construct validity by comparing item clustering to the Berger HIV stigma scale subscales. Item response theory was employed to further evaluate individual items and to calibrate items for simulated computer adaptive testing sessions in order to identify potential shortened instruments.ResultsThe revised HCV Stigma Scale was found to have good reliability (α = 0.957). After excluding items for low loadings, the exploratory factor analysis indicated good construct validity with 85% of items loading on pre-defined factors. Analyses strongly suggested the predominance of an underlying unidimensional factor solution, which yielded a 33-item scale after items were removed for low loading and differential item functioning. Adaptive simulations indicated that the scale could be substantially shortened without detectable information loss.ConclusionsThe 33-item HCV Stigma Scale showed sufficient reliability and construct validity. We also conducted computer adaptive testing simulations and identified shortened six- and three-item scale alternatives that performed comparably to the original 40-item scale.
Highlights
Over 4.5 million people in the United States (US) have chronic hepatitis C virus (HCV) infection [1]
The Berger human immunodeficiency virus (HIV) stigma scale was revised to ask about HCV and administered to patients with HCV (n = 270) in Philadelphia, Pennsylvania
After excluding items for low loadings, the exploratory factor analysis indicated good construct validity with 85% of items loading on pre-defined factors
Summary
Over 4.5 million people in the United States (US) have chronic hepatitis C virus (HCV) infection [1]. HCV-associated mortality exceeds death from 60 other combined notifiable infectious diseases, including human immunodeficiency virus (HIV) infection [2]. Stigmatization is a social phenomenon that can be an immense burden for patients by impacting self-esteem, quality of life [15,16,17], and personal identity [18], impacting access to effective and equitable health care. Clinical care that recognizes and addresses patient experiences of stigma can improve patient-provider communication, disease management, and health-related quality of life [6, 22,23,24,25,26,27]. Stigma around hepatitis C virus (HCV) infection is an important and understudied barrier to HCV prevention, treatment, and elimination. This study aimed to revise the Berger (2001) HIV stigma scale and evaluate its psychometric properties among patients with HCV infection
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