Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
Medical Unit Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden.
PLoS One. 2023 Jun 21;18(6):e0287341. doi: 10.1371/journal.pone.0287341. eCollection 2023.
BACKGROUND: Epidemics have historically been accompanied by stigma and discrimination. Disease-related stigma has often been shown to have severe consequences for physical, mental and social wellbeing and lead to barriers to diagnosis, treatment and prevention. The aims of this study were to investigate if a HIV-related stigma measure could be adapted and valid and reliable to measure COVID-19-related stigma, and also to investigate levels of self-reported stigma and related factors among people in Sweden with experience of COVID-19 and compare levels of COVID-19-related stigma versus HIV-related stigma among persons living with HIV who had experienced a COVID-19 event. METHODS: Cognitive interviews (n = 11) and cross-sectional surveys were made after the acute phase of the illness using a new 12-item COVID-19 Stigma Scale and the established 12-item HIV Stigma Scale in two cohorts (people who had experienced COVID-19 (n = 166/209, 79%) and people living with HIV who had experienced a COVID-19 event (n = 50/91, 55%). Psychometric analysis of the COVID-19 Stigma Scale was performed by calculating floor and ceiling effects, Cronbach's α and exploratory factor analysis. Levels of COVID-19 stigma between groups were analysed using the Mann-Whitney U test. Levels of COVID-19 and HIV stigma among people living with HIV with a COVID-19 event were compared using the Wilcoxon signed-rank test. RESULTS: The COVID-19 cohort consisted of 88 (53%) men and 78 (47%) women, mean age 51 (19-80); 143 (87%) living in a higher and 22 (13%) in a lower income area. The HIV + COVID-19 cohort consisted of 34 (68%) men and 16 (32%) women, mean age 51 (26-79); 20 (40%) living in a higher and 30 (60%) in a lower income area. The cognitive interviews showed that the stigma items were easy to understand. Factor analysis suggested a four-factor solution accounting for 77% of the total variance. There were no cross loadings, but two items loaded on factors differing from the original scale. All subscales had acceptable internal consistency, showed high floor and no ceiling effects. There was no statistically significant difference between COVID-19 stigma scores between the two cohorts or between genders. People living in lower income areas reported more negative self-image and concerns about public attitudes related to COVID-19 than people in higher income areas (median score 3 vs 3 and 4 vs 3 on a scale from 3-12, Z = -1.980, p = 0.048 and Z = -2.023, p = 0.024, respectively). People from the HIV + COVID-19 cohort reported more HIV than COVID-19 stigma. CONCLUSIONS: The adapted 12-item COVID-19 Stigma Scale may be valid and reliable for measurement of COVID-19-related stigma. However, specific items may need to be rephrased or replaced to better correspond to the COVID-19 context. People who had experienced COVID-19 reported low levels of COVID-19-related stigma in general but people from lower income areas had higher levels of negative self-image and concerns about public attitudes related to COVID-19 than people from areas with higher income, which may call for targeted interventions. Although exhibiting more pronounced HIV stigma levels, people living with HIV who had experienced COVID-19 reported COVID-19-related stigma of the same low magnitude as their peers not living with HIV.
背景:历史上,传染病伴随着污名化和歧视。疾病相关的污名化通常会对身心健康和社会福利产生严重影响,并导致诊断、治疗和预防方面的障碍。本研究的目的是调查是否可以对一种与 HIV 相关的污名化测量工具进行改编,使其能够有效可靠地测量与 COVID-19 相关的污名化,同时调查在瑞典经历过 COVID-19 的人群中自我报告的污名化程度和相关因素,并比较经历过 COVID-19 事件的 HIV 感染者中与 HIV 相关的污名化与 COVID-19 相关的污名化程度。
方法:在疾病的急性期过后,我们使用新的 12 项 COVID-19 污名量表和已建立的 12 项 HIV 污名量表,对两个队列(经历过 COVID-19 的人群(n=166/209,79%)和经历过 COVID-19 事件的 HIV 感染者(n=50/91,55%)进行了认知访谈(n=11)和横断面调查。通过计算地板效应和天花板效应、Cronbach's α 和探索性因素分析对 COVID-19 污名量表进行了心理计量学分析。使用 Mann-Whitney U 检验分析组间 COVID-19 污名化程度。使用 Wilcoxon 符号秩检验比较经历过 COVID-19 事件的 HIV 感染者中 COVID-19 和 HIV 污名化的程度。
结果:COVID-19 队列由 88 名(53%)男性和 78 名(47%)女性组成,平均年龄为 51 岁(19-80 岁);143 人(87%)居住在高收入地区,22 人(13%)居住在低收入地区。HIV + COVID-19 队列由 34 名(68%)男性和 16 名(32%)女性组成,平均年龄为 51 岁(26-79 岁);20 人(40%)居住在高收入地区,30 人(60%)居住在低收入地区。认知访谈表明,污名化项目易于理解。因子分析表明,四因子解可解释总方差的 77%。没有交叉负荷,但有两个项目加载到与原始量表不同的因子上。所有子量表的内部一致性均可接受,显示出较高的地板效应和无天花板效应。两个队列或性别之间的 COVID-19 污名化评分没有统计学差异。居住在低收入地区的人比居住在高收入地区的人对 COVID-19 相关的自我形象和公众态度更负面(中位数评分为 3 分与 3 分和 4 分与 3 分,在 3-12 分的量表上,Z = -1.980,p = 0.048 和 Z = -2.023,p = 0.024)。来自 HIV + COVID-19 队列的人报告了更多的 HIV 污名化而不是 COVID-19 污名化。
结论:改编后的 12 项 COVID-19 污名量表可能是一种有效的 COVID-19 相关污名化测量工具,但可能需要重新措辞或替换特定的项目,以更好地对应 COVID-19 背景。经历过 COVID-19 的人总体上报告 COVID-19 相关污名化程度较低,但来自低收入地区的人对 COVID-19 相关的自我形象和公众态度更负面,这可能需要有针对性的干预措施。尽管 HIV 感染者表现出更明显的 HIV 污名化程度,但经历过 COVID-19 的 HIV 感染者报告的 COVID-19 相关污名化程度与未感染 HIV 的同龄人相同,且程度较低。
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