# Development and psychometric properties of a general cancer stigma scale

## TL;DR

This paper introduces a new scale to measure cancer stigma across cultures, which can help improve patient outcomes and reduce stigma.

## Contribution

The paper presents a validated, cross-cultural tool for measuring cancer stigma with three domains: anticipated, internalized, and enacted.

## Key findings

- A 28-item scale was developed and validated across high- and low-income settings.
- The scale demonstrated strong reliability and validity with Cronbach's alpha ranging from 0.92 to 0.97.
- Confirmatory factor analysis supported a three-factor model fit with acceptable fit indices.

## Abstract

Cancer stigma negatively impacts diagnosis, quality of life, and survival outcomes, yet stigma reduction efforts are hindered by the lack of a valid and universal scale to measure cancer stigma. This study aimed to develop and validate a global cancer stigma scale, the Cross‐Cultural Oncology Measure for Perception and Awareness of Stigma Scale (COMPASS), which measures internalized, anticipated, and enacted stigma. The scale was developed using mixed methods in two phases: (1) feedback from experts and people with cancer on an initial pool of items, and (2) psychometric validation with people with cancer. Data were collected from two cancer centers in Salt Lake City, Utah, USA, and Lilongwe, Malawi. We examined the scale's initial psychometric properties, including item‐total correlation, reliability, factorial validity, and construct validity. Initial qualitative interviews informed the generation and refinement of 50 items, which were then administered to 209 individuals with cancer. Psychometric analysis reduced the scale to 28 items distributed across three stigma domains: anticipated (8 items), internalized (8 items), and enacted (12 items). The refined scale demonstrated satisfactory psychometric properties, with confirmatory factor analysis supporting a three‐factor model fit (CFI = 0.859, RMSEA = 0.112, SRMR = 0.063) and strong reliability (Cronbach's alpha: 0.92 to 0.97). Validity was confirmed through strong correlations with related constructs. COMPASS offers a reliable, valid, and cross‐culturally applicable tool to measure the magnitude and impact of cancer stigma globally and facilitate the evaluation of stigma reduction interventions.

Cancer‐related stigma can fuel anxiety and depression and lead to self‐isolation, delayed treatment, and decreased quality of life. The extent to which stigma impacts cancer patients, however, remains uncertain. This study applied mixed methods in high‐ and low‐income settings, with cohorts in the U.S. state of Utah and Lilongwe, Malawi, to explore a novel means of evaluating stigma. Through cultural adaptation, psychometric testing, and refinement, a 28‐item scale was developed. Items were distributed across three domains: anticipated, internalized, and enacted. The scale is a promising tool for measuring stigma's impact on cancer patients and evaluating progress in stigma reduction programs.