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Substance use stigma: Reliability and validity of a theory-based scale for substance-using populations.

ABSTRACT: Substance use disorders consistently rank among the most stigmatized conditions worldwide. Thus, substance use stigma fosters health inequities among persons with substance use disorders and remains a key barrier to successful screening and treatment efforts. Current efforts to measure substance use stigma are limited. This study aims to advance measurement efforts by drawing on stigma theory to develop and evaluate the Substance Use Stigma Mechanisms Scale (SU-SMS). The SU-SMS was designed to capture enacted, anticipated, and internalized Substance Use Stigma Mechanisms among persons with current and past substance use disorders, and distinguish between key stigma sources most likely to impact this target population.This study was a cross-sectional evaluation of the validity, reliability, and generalizability of the SU-SMS across two independent samples with diverse substance use and treatment histories.Findings support the structural and construct validity of the SU-SMS, suggesting the scale was able to capture enacted, anticipated, and internalized stigma as distinct stigma experiences. It also further differentiated between two distinct stigma sources (family and healthcare providers). Analysis of these mechanisms and psychosocial metrics suggests that the scale is also associated with other health-related outcomes. Furthermore, the SU-SMS demonstrated high levels of internal reliability and generalizability across two independent samples of persons with diverse substance use disorders and treatment histories.The SU-SMS may serve as a valuable tool for better understanding the processes through which substance use stigma serves to undermine key health behaviors and outcomes among persons with substance use disorders.

SUBMITTER: Smith LR

PROVIDER: S-EPMC5293183 | biostudies-literature | 2016 May

REPOSITORIES: biostudies-literature

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Project description:OBJECTIVES:The aim of this study was to assess the reliability and validity of the Turkish version of the Individual-Level Abortion Stigma Scale. SETTING:Three hospitals affiliated to Public Hospitals Union General Secretariat in Manisa, a city located in Western Turkey. DESIGN:This was a methodological study. PARTICIPANTS:A total of 230 women aged 22-49 years who previously underwent abortion and volunteered to participate in the study. PRIMARY AND SECONDARY OUTCOME MEASURES:Data analysis was performed using the SPSS and LISREL software. The Content Validity Index was calculated based on the values obtained from expert opinions. In the reliability analysis, Cronbach's alpha values were calculated for the overall scale and its subscales. To test the stability of the scale over time, the scale was readministered to 30 women in the study 15 days later and the test-retest values (Pearson's correlation coefficients) were determined. In the validity analysis, the exploratory and confirmatory factor analyses were performed. In the exploratory factor analysis, the principal component analysis was performed using the varimax rotation and the factor loading of the scale was examined. Confirmatory factor analysis was performed to investigate the item-factor construct of the scale. RESULTS:The Content Validity Index was calculated as 0.86. The Cronbach's alpha values ranged between 0.83 and 0.94. The item-total correlation coefficients ranged between 0.36 and 0.72, and the test-retest reliability was 0.96 for the overall scale and its subscales (p<0.05). The total variance revealed by five factors was 75%. Confirmatory factor analysis of the scale revealed an acceptable compliance level (root mean square error of approximation=0.092, χ2/df=2.91, Goodness of Fit Index=0.831, Comparative Fit Index=0.928, p<0.001). CONCLUSIONS:The results suggest that this scale has the potential for use in research and clinical settings to measure abortion stigma among women.

Project description:Background and aimExperience of stigma towards methadone maintenance treatment (MMT) may be a barrier to the use of this treatment by people with opioid use disorder. We evaluated the factor structure, internal reliability, construct and criterion validity of a theory-based stigma measure, the Methadone Maintenance Treatment Stigma Mechanisms Scale (MMT-SMS) and compared this with the Substance Use Stigma Mechanism Scale (SU-SMS).DesignSurveys at the beginning and end of a prospective study together with records of drug use and treatment attendance during that study.SettingCommunity methadone clinic in the Northeastern USA.ParticipantsNinety-three participants who were receiving MMT; the average daily methadone dose was 84.8 mg/day (standard deviation = 28.39 mg/day).MeasurementsThe MMT-SMS uses a self-report questionnaire to assess three dimensions reflecting experiences of anticipated (nine items), enacted (nine items) and internalized stigma (seven items) specifically related to receiving MMT. Anticipated and enacted scales include three stigma source subscales (family, employers, health care workers; three items each). Responses are recorded on a five-point Likert-type scale, then averaged to produce the MMT-SMS scale/subscale scores. The SU-SMS is a self-report questionnaire to assess experiences of anticipated, enacted and internalized stigma regarding substance use history. Both scales were administered at the final parent study visit. Other measures included were assessed in the parent study and used to assess life-time and recent MMT (e.g. current MMT dose) and drug use experiences (e.g. past 30-day heroin injection).FindingsThe MMT-SMS demonstrated good internal reliability (α = 0.806-0.952 for components). Confirmatory factor analysis supported the seven-factor scale structure, distinguishing between experiences of anticipated, enacted and internalized stigma, and anticipated and enacted stigma source subscales (family, employers, health care workers) [root mean square error of approximation (RMSEA) = 0.076, 90% confidence interval (CI) = 0.061-0.090, P-close = 0.003; confirmatory fit index (CFI) = 0.974; Tucker-Lewis index (TLI) = 0.971]. Construct validity helped to distinguish the MMT-SMS from established substance use stigma constructs. Criterion validity observed associations with substance use experiences while on MMT, likely to predict future MMT success. Internalized MMT stigma was uniquely associated with daily MMT dose. Regarding criterion validity: anticipated MMT and enacted substance use stigma were associated with past 30-day heroin injection, MMT stigma uniquely associated with opioid use behaviors while receiving MMT, and substance use stigma broadly associated with injection-related behaviors.ConclusionsThe Methadone Maintenance Treatment Stigma Mechanisms Scale appears to be a reliable measure of methadone maintenance treatment stigma with robust validity in a sample of people with opioid use disorders receiving methadone maintenance treatment.

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Substance use stigma: Reliability and validity of a theory-based scale for substance-using populations.

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