Skip to main content
SpringerLink
Log in

Psychometric Evaluation of the Persian Version of the Chronic Illness Anticipated Stigma Scale (CIASS)

  • Published:
International Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Purpose

The present study aimed to evaluate the cross-cultural validation and psychometric properties of the Persian version of the Chronic Illness Anticipated Stigma Scale (CIASS) among the patients with chronic illness in Iran.

Method

Following standard procedures, the questionnaire was administered to a total sample of 186 patients with chronic illness who were recruited from the referral hospital, including hospitalized and clinic outpatients plus several referral clinics. Test–retest reliability and internal consistency were analyzed through intraclass correlation coefficient and Cronbach’s alpha tests, respectively. Validity was evaluated in the areas of content and face validity, convergent, and also structural validity.

Results

Cronbach’s alpha coefficient for the reliability of the scale was 0.88.The results of explanatory factor analysis confirmed extraction of all dimensions in three factors, consisting of family and friends, work colleagues, and healthcare workers. Evaluating convergent validity using Spearman’s correlations showed satisfactory results; the correlation between the domains of the CIASS demonstrated internal agreement of the measure determining additional evidence to suggest the validity of the Persian CIASS.

Conclusion

The preliminary study of the Persian version of the CIASS indicates good reliability and validity of the measure in Iranian patients with chronic illnesses.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Van Brakel WH. Measuring health-related stigma—a literature review. Psychology, health, & medicine. 2006;11(3):307–34.

    Article  Google Scholar 

  2. Perry, et al. Addressing mental health promotion in chronic disease. Am J Public Health. 2010;100(12):2337–9.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Goffman E. Stigma: notes on the management of spoiled identity. New York: Touchstone/Simon and Schuster; 1986. p. 16.

    Google Scholar 

  4. Earnshaw VA, Quinn DM, Kalichman SC, Park CL. Development and psychometric evaluation of the Chronic Illness Anticipated Stigma Scale. J Behav Meb. 2013;36(3):270–82.

    Article  Google Scholar 

  5. Earnshaw VA, Quinn DM. The impact of stigma in healthcare on people living with chronic illnesses. J Health Psychol. 2011;17(2):157–68.

    Article  PubMed  Google Scholar 

  6. Watson AC, Patrick Corrigan P, Jonathon E, Larson JE, Sells M. Self-stigma in people with mental illness. Schizophr Bull. 2007;33(9):1312–8.

    PubMed  PubMed Central  Google Scholar 

  7. Markovitz FE. The effects of stigma on the psychological well-being and life satisfactions of persons with mental illness. J Health Soc Behav. 1998;39(4):335–47.

    Article  Google Scholar 

  8. Link BG, Struening EL, Neese-Todd S, Asmussen S, Phelan JC. Stigma as a barrier to recovery: the consequences of stigma for the self-esteem of people with mental illnesses. Psychiatr Serv. 2001;52:1621–6.

    Article  CAS  PubMed  Google Scholar 

  9. Corrigan P. How stigma interferes with mental health care. Am Psychol. 2004;59(7):614–25.

    Article  PubMed  Google Scholar 

  10. Johnson JL, Campbell AC, Bowers M, Nichol A. Understanding the social consequences of chronic obstructive pulmonary disease. The effects of stigma and gender. Proc Am Thorac Soc. 2007;4(8):680–2.

    Article  PubMed  Google Scholar 

  11. Earnshaw VA, Quinn DM, Park CL. Anticipated stigma and quality of life among people living with chronic illnesses. Chronic Illness. 2011;8(2):79–88.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Molina Y, Choi SW, Cella D, Rao D. The stigma scale for chronic illnesses 8-item version (SSCI-8): development, validation and use across neurological conditions. Int J Behav Med. 2013;20(3):450–60.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Steward WT, Herek GM, Ramakrishna J, Bharat S, Chandy S, Wrubel J, Ekstrand ML. HIV-related stigma: adapting a theoretical framework for use in India. Soc Sci Med. 2008;67(8):1225–35.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Simbayi LC, Kalichman S, Steelm A, Cloete A, Henda N, Mqeketo A. Internalized stigma, discrimination, and depression among men and women living with HIV/ AIDS in Cape Town. South Africa Social Science & Medicine. 2007;64(9):1823–31.

    Article  Google Scholar 

  15. Fernandes PT, Salgado PCB, Noro ALA, Sander JW, Li LM. Stigma scale of epilepsy: validation process. Arq Neuropsiquiatr. 2007;65(Supl 1):35–42.

    Article  PubMed  Google Scholar 

  16. Rao D, Choil SW, Victorson D, Bode R, Peterman A, Heinemann A, Cellal D. Measuring stigma across neurological conditions: the development of the Stigma Scale for Chronic Illness (SSCI). Qual Life Res. 2009;15(5):585–95.

    Article  Google Scholar 

  17. Myung G, Harada ND, Fong SL, Aquino-Beaton C, Fang MA, Geffen D. Characterization of social stigma in rheumatic diseases and correlation with quality of life and medication adherence. Abstract Number: 2107, Health Services Research. 2014.

  18. Riasi H, Rajabpour A, Ghaemi K. The stigma of epilepsy and its effects on marital status. SpringerPlus. 2015;3:762–8.

    Article  Google Scholar 

  19. Abdoli S, Abazari P, Mardanian L. Exploring diabetes type 1-related stigma. Iran J Nurs Midwifery Res. 2013;18(1):65–70.

    PubMed  PubMed Central  Google Scholar 

  20. Borimnejad L, Parsa Yekta Z, Nikbakht NA. Lived experience of women suffering from vitiligo: a phenomenological study. Qual Rep. 2006;11(2):335–49.

    Google Scholar 

  21. Forsgrena L, Ghaneanb H, Jacobssonb L, Richterd J. On the experience of stigma by persons with epilepsy in Sweden and Iran—a comparative study. Seizur. 2013;9(22):748–51.

    Article  Google Scholar 

  22. Abolhassani S, Yazdannik A, Taleghani F, Zamani A. Social aspects of multiple sclerosis for Iranian individuals. Disabil Rehabil. 2015;37(4):319–26.

    Article  PubMed  Google Scholar 

  23. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67(6):361–70.

    Article  CAS  PubMed  Google Scholar 

  24. LaFrance WC, Kanner AM, Hermann B. Psychiatric comorbidities in epilepsy. Int Rev Neurobiol. 2008;83:347–83.

    Article  PubMed  Google Scholar 

  25. Alonso J, Buron A, Bruffaerts R, He Y, Posada-Villa J, Lepine JP, et al. Association of perceived stigma and mood and anxiety disorders: results from the World Mental Health surveys. Acta Psychiatr Scand. 2008;118(4):305–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Montazeri A, Vahdaninia M, Ebrahimi M, Jarvandi S. The Hospital Anxiety and Depression Scale (HADS): translation and validation study of the Iranian version. Health Qual Life Outcomes. 2003;1(14):1–5.

    Google Scholar 

  27. Cook DR. Measuring shame: the internalized shame scale. Alcoholism Treatment Quarterly. 1988;4(2):197–215.

    Article  Google Scholar 

  28. Cook, DR. Internalized shame scale: technical manual. North Tonawanda: Multi-Health Systems, Inc.; 1994, 2001.

  29. Etesam F, Assarian F, Hosseini H, Ghoreishi FS. Stigma and its determinants among male drug dependents receiving methadone maintenance treatment. Arch Iran Med. 2014;17(2):108–14.

    CAS  PubMed  Google Scholar 

  30. Portney L. Statistical measure of reliability. In: Foundations of clinical research: application to practice. 2nd ed. New Jersey: Prentice Hall. Health; 2000.

  31. Stevelink SAM, van Brakel WH. The cross-cultural equivalence of participation instruments: a systematic review. Disability & Rehabilitation. 2013;35(15):1256–68.

    Article  CAS  Google Scholar 

  32. Polit FD, Beck CT. The content validity index: are you sure you know what’s being reported? Critique and recommendations. Research in Nursing & Health. 2006;29:489–97.

    Article  Google Scholar 

  33. Scascighini L, Angst F, Uebelhart D, Aeschlimann A. Translation, transcultural adaptation, reliability and validity of the Patient Satisfaction Questionnaire in German. Physiotherapy. 2008;94:43–55.

    Article  Google Scholar 

  34. Goldena J, Conroyb RM, O’Dwyerc AM, Goldend D, Hardouine JB. Illness-related stigma, mood and adjustment to illness in persons with hepatitis C. Soc Sci Med. 2006;63:3188–98.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Psychosomatic Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Ali-Akbar Nejatisafa, Sahar Mozafari, Ahmad-Ali Noorbala & Farnaz Etesam

  2. Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran

    Fatemeh Sadat Asgarian

  3. Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Valerie A. Earnshaw

  4. MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran

    Mohammad-Ali Sahraian

Authors
  1. Ali-Akbar Nejatisafa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sahar Mozafari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ahmad-Ali Noorbala
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fatemeh Sadat Asgarian
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Valerie A. Earnshaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mohammad-Ali Sahraian
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Farnaz Etesam
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Farnaz Etesam.

Ethics declarations

Ethical Approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Funding

No funding sources were provided.

Conflict of Interest

The authors declare that they have no conflict of interest.

Appendix

Appendix

The Chronic Illness Anticipated Stigma Scale (CIASS)

Instructions: The statements listed below describe some of the ways that people who have chronic illnesses are treated by others. Please read these statements and mark how likely you think that they could happen to you in the future.

First, think about how your friends and family members such as parents, sisters and brothers, and children will treat you in the future. How likely is it that they will treat you in the following ways because of your chronic illness?

  

Very Unlikely

Unlikely

Somewhat Likely

Likely

Very

Likely

1.

A friend or family member will be angry with you.

1

2

3

4

5

2.

A friend or family member will blame you for not getting better.

1

2

3

4

5

3.

A friend or family member will think that your illness is your fault.

1

2

3

4

5

4.

A friend or family member will not think as highly of you.

1

2

3

4

5

Now, think about how your coworkers and employers will treat you in the future. If you are not currently employed, think about coworkers and employers that you might have in the future. How likely is it that they will treat you in the following ways because of your chronic illness?

  

Very Unlikely

Unlikely

Somewhat Likely

Likely

Very

Likely

5.

Your employer will not promote you.

1

2

3

4

5

6.

Someone at work will discriminate against you.

1

2

3

4

5

7.

Your employer will assign a challenging project to someone else.

1

2

3

4

5

8.

Someone at work will think that you cannot fulfill your work responsibilities.

1

2

3

4

5

Finally, think about how healthcare providers such as doctors, nurses, technicians, and secretaries who work at hospitals and doctor’s offices will treat you in the future. How likely is it that they will treat you in the following ways because of your chronic illness?

  

Very Unlikely

Unlikely

Somewhat Likely

Likely

Very

Likely

9.

A healthcare worker will be frustrated with you.

1

2

3

4

5

10.

A healthcare worker will give you poor care.

1

2

3

4

5

11.

A healthcare worker will blame you for not getting better.

1

2

3

4

5

12.

A healthcare worker will think that you are a bad patient.

1

2

3

4

5

Scoring: The scale is scored by averaging items.

  • Total anticipated stigma score: Average items 1 – 12

  • Anticipated stigma from friends and family score: Average items 1 – 4

  • Anticipated stigma from work colleagues score: Average items 5 – 8

  • Anticipated stigma from healthcare workers score: Average items 9 – 12

Reference:

Earnshaw, V. A., Quinn, D. M., Kalichman, S. C., & Park, C. L. (2013). Development and psychometric evaluation of the chronic illness anticipated stigma scale. Journal of Behavioral Medicine, 36, 3: 270-282. doi: 10.1007/s10865-012-9422-4

Spanish version: Stefano Vinaccia, Ph.D.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nejatisafa, AA., Mozafari, S., Noorbala, AA. et al. Psychometric Evaluation of the Persian Version of the Chronic Illness Anticipated Stigma Scale (CIASS). Int.J. Behav. Med. 24, 634–640 (2017). https://doi.org/10.1007/s12529-017-9645-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12529-017-9645-4

Keywords

Search

Navigation