# Validation of the Chinese Version of the HPV Stigma Scale: A Multidimensional Analysis in Women With HPV

## TL;DR

This study validates a 12-item HPV Stigma Scale for Chinese women infected with HPV, showing it is reliable and valid for measuring stigma related to HPV infection.

## Contribution

The study provides a validated Chinese version of the HPV Stigma Scale, enabling assessment of HPV-related stigma in Chinese populations.

## Key findings

- A 3-factor model (personalized stigma, public-disclosure concerns, and negative self-image) showed the best fit with good reliability and validity.
- Higher HPV Stigma Scale scores correspond to higher levels of stigma according to item response theory analysis.
- A 2-class model was identified as optimal, with a cut-off score of 35 for high HPV stigma.

## Abstract

Human papillomavirus (HPV) infection is a global public health issue, and HPV‐related stigma can affect cervical cancer prevention. But no validated tools exist to assess HPV stigma in Chinese adult women infected with HPV. This study aimed to adapt and validate the HPVsStigma scale (HPV‐SS) in the Chinese context.

A cross‐sectional study was conducted from December 2024 to February 2025 among 501 HPV‐infected women in Shenzhen, China. The HPV‐SS was adapted from a 12‐item HIV stigma scale. Demographic characteristics, HPV‐related variables, and data on mental health were collected. Factor analyses (FA) were used to assess the scale's factorial structure, reliability, and validity. The bi‐factor model was used to determine the score‐reporting method of the scale. Item response theory (IRT) was employed to assess the relationship between participants’ stigma levels and scale scores. Latent profile analysis (LPA) was conducted to classify the participants with different HPV stigma characteristics and determine the optimal cut‐off value for HPV‐SS.

FA showed that the 3‐factor model (personalized stigma, public‐disclosure concerns, and negative self‐image) had the best fit among the nested models, with good reliability and validity. The bi‐factor model analysis indicated that the total scale score was more meaningful than dimension scores. IRT analysis confirmed that higher HPV‐SS scores represented higher stigma levels. LPA identified a 2‐class model as optimal, and the optimal cut‐off value of the scale for high HPV stigma was 35.

This study validated the 12‐item HPV‐SS for Chinese women infected with HPV, with good reliability and validity. The scale can be used to evaluate HPV stigma levels, facilitating targeted interventions to improve cervical cancer prevention and the psychological well‐being of affected women.

This study employs factor analysis, bi‐factor modeling, item response theory, and latent profile analysis, revealing good reliability and validity of HPV stigma scale among women infected with HPV in China.