J Clin Epidemiol. 2024 Aug 17:111505. doi: 10.1016/j.jclinepi.2024.111505. Online ahead of print.

Brodie McGhie-Fraser ¹, Aranka Ballering ², Peter Lucassen ³, Caoimhe McLoughlin ⁴, Evelien Brouwers ⁵, Jon Stone ⁴, Tim Olde Hartman ³, Sandra van Dulmen ⁶

Author information

¹Radboud university medical center, Radboud Institute for Health Services Research, Department of Primary and Community Care, Nijmegen, the Netherlands. Electronic address: brodie.mcghiefraser@radboudumc.nl.

²University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands.

³Radboud university medical center, Radboud Institute for Health Services Research, Department of Primary and Community Care, Nijmegen, the Netherlands.

⁴Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom.

⁵Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, the Netherlands.

⁶Radboud university medical center, Radboud Institute for Health Services Research, Department of Primary and Community Care, Nijmegen, the Netherlands; Nivel (Netherlands institute for health services research, Utrecht, the Netherlands; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden.

Abstract

Objective: Persistent somatic symptoms (PSS) describe recurrent or continuously occurring symptoms such as fatigue, dizziness, or pain that have persisted for at least several months. These include single symptoms such as chronic pain, combinations of symptoms, or functional disorders such as fibromyalgia or irritable bowel syndrome. While many studies have explored stigmatisation by healthcare professionals towards people with PSS, there is a lack of validated measurement instruments. We recently developed a stigma scale, the Persistent Somatic Symptom Stigma scale for Healthcare Professionals (PSSS-HCP). The aim of this study is to evaluate the measurement properties (validity and reliability) and factor structure of the PSSS-HCP.

Study design and setting: The PSSS-HCP was tested with 121 healthcare professionals across the United Kingdom to evaluate its measurement properties. Analysis of the factor structure was conducted using principal component analysis. We calculated Cronbach's alpha to determine the internal consistency of each (sub)scale. Test re-test reliability was conducted with a sub-sample of participants with a two-week interval. We evaluated convergent validity by testing the association between the PSSS-HCP and the Medical Condition Regard Scale (MCRS) and the influence of social desirability using the short form of the Marlowe Crowne Social Desirability Scale (MCSDS).

Results: The PSSS-HCP showed sufficient internal consistency (Cronbach's alpha = 0.84) and sufficient test-retest reliability, intraclass correlation = 0.97 (95% CI 0.94 to 0.99, p<0.001). Convergent validity was sufficient between the PSSS-HCP and the MCRS, and no relationship was found between the PSSS-HCP and the MCSDS. A three factor structure was identified (othering, uneasiness in interaction, non-disclosure) which accounted for 60.5% of the variance using 13 of the 19 tested items.

Conclusion: The PSSS-HCP can be used to measure PSS stigmatisation by healthcare professionals. The PSSS-HCP has demonstrated sufficient internal consistency, test-retest reliability, convergent validity and minimal influence of social desirability bias. The PSSS-HCP has demonstrated potential to measure important aspects of stigma and provide a foundation for stigma reduction intervention evaluation.