Online Exclusive Article

Measuring Stigma in People With Lung Cancer: Psychometric Testing of the Cataldo Lung Cancer Stigma Scale

Janine Cataldo

Robert Slaughter

Thierry M. Jahan

Voranan L. Pongquan

Won Ju Hwang

lung cancer stigma
ONF 2010, 38(1), E46-E54. DOI: 10.1188/11.ONF.E46-E54

Purpose/Objectives: To develop an instrument to measure the stigma perceived by people with lung cancer based on the HIV Stigma Scale.

Design: Psychometric analysis.

Setting: Online survey.

Sample: 186 patients with lung cancer.

Methods: An exploratory factor analysis with a common factor model using alpha factor extraction.

Main Research Variables: Lung cancer stigma, depression, and quality of life.

Findings: Four factors emerged: stigma and shame, social isolation, discrimination, and smoking. Inspection of unrotated first-factor loadings showed support for a general stigma factor. Construct validity was supported by relationships with related constructs: self-esteem, depression, social support, and social conflict. Coefficient alphas ranging from 0.75-0.97 for the subscales (0.96 for stigma and shame, 0.97 for social isolation, 0.9 for discrimination, and 0.75 for smoking) and 0.98 for the 43-item Cataldo Lung Cancer Stigma Scale (CLCSS) provided evidence of reliability. The final version of the CLCSS was 31 items. Coefficient alpha was recalculated for the total stigma scale (0.96) and the four subscales (0.97 for stigma and shame, 0.96 for social isolation, 0.92 for discrimination, and 0.75 for smoking).

Conclusions: The CLCSS is a reliable and valid measure of health-related stigma in this sample of people with lung cancer.

Implications for Nursing: The CLCSS can be used to identify the presence and impact of lung cancer stigma and allow for the development of effective stigma interventions for patients with lung cancer.

Jump to a section

    References

    Akin, S., Can, G., Aydiner, A., Ozdilli, K., & Durna, Z. (2010). Quality of life, symptom experience, and distress of lung cancer patients undergoing chemotherapy [Epub ahead of print]. European Journal of Oncology Nursing.
    Balduyck, B., Hendriks, J., Lauwers, P., Nia, P. S., & Van Schil, P. (2009). Quality-of-life evolution after lung cancer surgery in septuagenarians: A prospective study. European Journal of Cardio-Thoracic Surgery, 35, 1070-1075. doi: 10.1016/j.ejcts.2009.01.050
    Bayer, R., & Stuber, J. (2006). Tobacco control, stigma, and public health: Rethinking the relations. American Journal of Public Health, 96, 47-50. doi: 10.2105/AJPH.2005.071886
    Bell, K., Salmon, A., Bowers, M., Bell, J., & McCullough, L. (2010). Smoking, stigma and tobacco "denormalization:" Further reflections on the use of stigma as a public health tool. A commentary on Social Science and Medicine's Stigma, Prejudice, Discrimination, and Health Special Issue. Social Science and Medicine, 70, 795-799. doi: 10.1016/j.socscimed.2009.09.060
    Berger, B., Ferrans, C., & Lashley, F. (2001). Measuring stigma in people with HIV: Psychometric assessment of the HIV stigma scale. Research in Nursing and Health, 24, 518-529. doi: 10.1002/nur.10011
    Bottorff, J., Robinson, C., Sullivan, K., & Smith, M. (2009). Continued family smoking after lung cancer diagnosis: The patient's perspective [Online exclusive]. Oncology Nursing Forum, 36, E126-E132. doi: 10.1188/09.ONF.E126-E132
    Brown, L., Macintyre, K., & Trujillo, L. (2003). Interventions to reduce HIV/AIDS stigma: What have we learned? AIDS Education and Prevention, 15, 49-69. doi: 10.1521/aeap.15.1.49.23844
    Cantrell, M., & Lupinacci, P. (2007). Methodological issues in online data collection. Journal of Advanced Nursing, 60, 544-549. doi: 10.1111/j.1365-2648.2007.04448.x
    Carlsen, K., Jensen, A., Jacobsen, E., Krasnik, M., & Johansen, C. (2005). Psychosocial aspects of lung cancer. Lung Cancer, 47, 293-300. doi: 10.1016/j.lungcan.2004.08.002
    Carmack, C., Badr, H., Lee, J., Fossell, F., Pisters, K., & Gritz, E. (2008). Lung cancer patients and their spouses: Psychological and relationship functioning within one month of treatment initiation. Annals of Behavioral Medicine, 36, 129-140. doi: 10.1007/s12160-008-9062-7
    Cataldo, J., Jahan, T., & Pongquan, V. (2010). Lung cancer stigma, depression, and quality of life among ever and never smokers. Unpublished manuscript.
    Centers for Disease Control and Prevention. (2010). United States cancer statistics: 1999-2006 cancer incidence and mortality data. Retrieved from http://www.cdc.gov/uscs
    Chapple, A., Ziebland, S., & McPherson, A. (2004). Stigma, shame, and blame experienced by patients with lung cancer: Qualitative study. BMJ, 328, 1470-1475.
    Corrigan, P., & Watson, A. (2007). The stigma of psychiatric disorders and the gender, ethnicity, and education of the perceiver. Community Mental Health Journal, 43, 439-458. doi: 10.1007/s10597-007-9084-9
    Dziuban, C., & Shirkey, E. (1974) When is a correlation matrix appropriate for factor analysis? Some decision rules. Psychological Bulletin, 81, 358-361. doi: 10.1037/h0036316
    Else-Quest, N., LoConte, N., Schiller, J., & Hyde, J. (2009). Perceived stigma, self-blame, and adjustment among lung, breast, and prostate cancer patients. Psychology and Health, 24, 949-964. doi: 10.1080/08870440802074664
    Ferketich, S., & Muller, M. (1990). Factor analysis revisited. Nursing Research, 39, 59-62. doi: 10.1097/00006199-199001000-00012
    Ferrell, B., Wisdom, C., & Wenzl, C. (1989). Quality of life as an outcome variable in the management of cancer pain. Cancer, 63, 2321-2327. doi: 10.1002/1097-0142(19890601)63:11<2321::AID-CNCR2820631142>3.0.CO;2-T
    Gorusch, R. (1983). Factor analysis (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.
    Greene, K., & Banerjee, S. (2006). Disease-related stigma: Comparing predictors of AIDS and cancer stigma. Journal of Homosexuality, 50, 185-209. doi: 10.1300/J082v50n04_08
    Gritz, E., Dresler, C., & Sarna, L. (2005). Smoking, the missing drug interaction in clinical trials: Ignoring the obvious. Cancer, Epidemiology, Biomarkers, and Prevention, 14, 2287-2293. doi: 10.1158/1055-9965.EPI-05-0224
    Hamer, M., Chida, Y., & Molloy, G. (2009). Psychological distress and cancer mortality. Journal of Psychosomatic Research, 66, 255-258. doi: 10.1016/j.jpsychores.2008.11.002
    Hegarty, P., & Golden, A. (2008). Attributional beliefs about the controllability of stigmatized traits: Antecedents or justifications of prejudice? Journal of Applied Social Psychology, 38, 1023-1044. doi: 10.1111/j.1559-1816.2008.00337.x
    Heijnders, M., & Van Der Meij, S. (2006). The fight against stigma: An overview of stigma-reduction strategies and interventions. Psychology, Health and Medicine, 11, 353-363. doi: 10.1080/13548500600595327
    Henoch, I., Bergman, B., Gustafsson, M., Gaston-Johansson, F., & Danielson, E. (2007). The impact of symptoms, coping capacity, and social support on quality-of-life experience over time in patients with lung cancer. Journal of Pain and Symptom Management, 34, 370-379. doi: 10.1016/j.jpainsymman.2006.12.005
    Holland, J., Andersen, B., Breitbart, W., Compas, B., Dudley, M., Fleishman, S., … Zevon, M. A. (2010). Distress management. Journal of the National Comprehensive Cancer Network, 8, 448-485.
    Hoover, D., Saah, A., Bacellar, H., Murphy, R., Visscher, B., Anderson, R., … Kaslow, R. A. (1993). Signs and symptoms of "asymptomatic" HIV-1 infection in homosexual men. Journal of Acquired Immune Deficiency Syndromes, 6, 66-71.
    Kaiser, H. (1981). A revised measure of sampling adequacy for factor-analytic data matrices. Educational and Psychological Measurement, 41, 379-381. doi: 10.1177/001316448104100216
    Lebel, S., & Devins, G. (2008). Stigma in cancer patients whose behavior may have contributed to their disease. Future Oncology, 4, 717-733. doi: 10.2217/14796694.4.5.717
    LoConte, N., Else-Quest, N., Eickhoff, J., Hyde, J., & Schiller, J. (2008). Assessment of guilt and shame in patients with non-small-cell lung cancer compared with patients with breast and prostate cancer. Clinical Lung Cancer, 9, 171-178. doi: 10.3816/CLC.2008.n.026
    Lynch, J., Goodhart, F., Saunders, Y., & O'Connor, S. (2010). Screening for psychological distress in patients with lung cancer: Results of a clinical audit evaluating the use of the patient distress thermometer [Epub ahead of print]. Supportive Care in Cancer.
    Lynn, M. (1986). Determination and quantification of content validity. Nursing Research, 35, 382-385. doi: 10.1097/00006199-198611000-00017
    Major, B., & O'Brien, L. (2005). The social psychology of stigma. Annual Review of Psychology, 56, 393-421. doi: 10.1146/annurev.psych.56.091103.070137
    Marlow, L., Waller, J., & Wardle, J. (2010). Variation in blame attributions across different cancer types. Cancer, Epidemiology, Biomarkers, and Prevention, 19, 1799-1805. doi: 10.1158/1055-9965.EPI-09-1298
    McBride, C., Pollak, K., Garst, J., Keefe, F., Lyna, P., Fish, L., & Hood, L. (2003). Distress and motivation for smoking cessation among lung cancer patients' relatives who smoke. Journal of Cancer Education, 18, 150-156. doi: 10.1207/S15430154JCE1803_08
    Montazeri, A., Milroy, R., Hole, D., McEwen, J., & Gillis, C. (2001). Quality of life in lung cancer patients: As an important prognostic factor. Lung Cancer, 31, 233-240. doi: 10.1016/S0169-5002(00)00179-3
    Nunnally, J., & Bernstein, I. (1994). Psychometric theory. New York, NY: McGraw-Hill.
    O'Brien, K., Wortman, C., Kessler, R., & Joseph, J. (1993). Social relationships of men at risk for AIDS. Social Science and Medicine, 36, 1161-1167. doi: 10.1016/0277-9536(93)90236-W
    Qi, Y., Schild, S., Mandrekar, S., Tan, A., Krook, J., Rowland, K., … Sloan, J. A. (2009). Pretreatment quality of life is an independent prognostic factor for overall survival in patients with advanced stage non-small-cell lung cancer. Journal of Thoracic Oncology, 4, 1075-1082. doi: 10.1097/JTO.0b013e3181ae27f5
    Raleigh, Z. (2010). A biopsychosocial perspective on the experience of lung cancer. Journal of Psychosocial Oncology, 28, 116-125.
    Rhodes, S., Bowied, D., & Hergenrather, K. (2003). Collecting behavioral data using the World Wide Web: Considerations for researchers. Journal of Epidemiology Community Health, 57, 68-73. doi: 10.1136/jech.57.1.68
    Rosman, S. (2004). Cancer and stigma: Experience of patients with chemotherapy-induced alopecia. Patient Education and Counseling, 52, 333-339. doi: 10.1016/S0738-3991(03)00040-5
    Sarna, L., Brown, J., Cooley, M., Williams, R., Chernecky, C., Padilla, G., & Danao, L. L. (2005). Quality of life and meaning of illness of women with lung cancer [Online exclusive]. Oncology Nursing Forum, 32, E9-E19. doi: 10.1188/05.ONF.E9-E19
    Sarna, L., Padilla, G., Holmes, C., Tashkin, D., Brecht, M., & Evangelista, L. (2002). Quality of life of long-term survivors of non-small-cell lung cancer. Journal of Clinical Oncology, 20, 2920-2929. doi: 10.1200/JCO.2002.09.045
    Software Q. (1990). Right writer [v.4.0]. Indianapolis, IN: MacMillan Computer Publishing.
    Stuber, J., Galea, S., & Link, B. (2008). Smoking and the emergence of a stigmatized social status. Social Science and Medicine, 67, 420-430. doi: 10.1016/j.socscimed.2008.03.010
    Stutterheim, S., Pryor, J., Bos, A., Hoogendijk, R., Muris, P., & Schaalma, H. (2009). HIV-related stigma and psychological distress: The harmful effects of specific stigma manifestations in various social settings. AIDS, 23, 2353-2357.
    Sugimura, H., & Yang, P. (2006). Long-term survivorship in lung cancer: A review. Chest, 129, 1088-1097. doi: 10.1378/chest.129.4.1088
    SurveyMonkey®. (2009). Online software and questionnaire tool. Retrieved from http://www.surveymonkey.com/Home_Reasons.aspx
    Van Brakel, W. (2006). Measuring health-related stigma: A literature review. Psychology, Health and Medicine, 11, 307-334. doi: 10.1080/13548500600595160
    Ware, N., Wyatt, M., & Tugenberg, T. (2006). Social relationships, stigma, and adherence to antiretroviral therapy for HIV/AIDS. AIDS Care, 18, 904-910. doi: 10.1080/09540120500330554
    Weiss, M., & Ramakrishna, J. (2006). Stigma interventions and research for international health. Lancet, 367, 536-538. doi: 10.1016/S0140-6736(06)68189-0
    Wiley, R. (1989). Measures of self-concept. Lincoln, NE: University of Nebraska Press.
    Wilson, K., & Luker, K. (2006). At home in hospital? Interaction and stigma in people affected by cancer. Social Science and Medicine, 62, 1616-1627. doi: 10.1016/j.socscimed.2005.08.053
    Zabora, J., BrintzenhofeSzoc, K., Curbow, B., Hooker, C., & Piantadosi, S. (2001). The prevalence of psychological distress by cancer site. Psycho-Oncology, 10, 19-28. doi: 10.1002/1099-1611(200101/02)10:1<19::AID-PON501>3.0.CO;2-6