The (Re)-emerging And ePidemic Infectious Diseases (RAPID) Stigma Scales: a cross-outbreak scale development and pyschometric validation study

Abstract

Reducing stigma during infectious disease outbreaks is crucial for delivering an effective response. However, no validated stigma scales exist for use across outbreaks, and outbreak-specific scales are developed too slowly to guide timely interventions. To enable more real-time monitoring and mitigation of stigma across outbreak contexts, we developed and validated the (Re)-emerging and ePidemic Infectious Diseases (RAPID) Stigma Scales. Field testing and psychometric validation were conducted in communities affected by Ebola disease in Uganda, mpox in the UK, and Nipah virus disease in Bangladesh. Content validity was established through cognitive interviews and expert Delphi scoring. 1008 respondents were included across the three countries. The final RAPID Community Stigma Scale (12 items) captures initial social stigma, provider or authority-related stigma, structural stigma, and enduring social stigma. The RAPID Self Stigma Scale (4 items) is unidimensional. Both scales were found to have robust psychometric properties, including content validity, structural validity (factor loadings ≥0·6), and reliability (ordinal alphas 0·79–0·92). High scores on both scales predicted an increased hesitancy to report symptoms and seek care. The RAPID Stigma Scales are validated tools for real-time assessment of stigma across outbreak settings, enabling responders to design targeted interventions to improve health outcomes and promote equitable care.