Abstract / Summary
Background: Stigma associated with smoking, chronic obstructive pulmonary disease (COPD) and lung cancer is prevalent and can cause distress and delayed treatment-seeking. Interventions to reduce stigma are becoming more widespread and a variety of stigma scales have been developed, but it is unknown how psychometrically sound and appropriately worded they are.
Purpose: To (1) systematically identify scales that measure stigma in people who smoke, or those living with COPD or lung cancer; (2) analyze the content of items and language used; and (3) evaluate their psychometric properties.
Methods: PubMed, Embase, Web of Science, and Scopus were searched to identify quantitative scales measuring stigma in smoking, COPD, or lung cancer. The Lung Cancer Stigma Communications Assessment Tool was used to assess whether the scales contained language that could exacerbate stigma amongst participants. The COSMIN tool was used to evaluate the psychometric properties of the scales.
Results: We identified 962 articles for screening, of which 28 eligible scales were included. The majority (n = 17) measured lung cancer stigma. The content of items largely aligned with theoretical dimensions of stigma. No scales were free of language that could exacerbate stigma. In relation to psychometrics, the majority of the stigma scales assessed internal consistency (n = 25), construct validity (n = 20), and structural validity (n = 15). All scales were categorized as Class B, meaning that they have potential for use but require further research and psychometric testing.
Conclusion: A comprehensively validated stigma scale is needed that uses non-stigmatizing, bias-free, and person-first language.