Validity and Reliability of a COVID-19 Stigma Scale Using Exploratory and Confirmatory Factor Analysis in a Sample of Egyptian Physicians: E16-COVID19-S

Introduction: To date, a universal validated and specific tool for assessing coronavirus disease 2019 (COVID-19) stigma among healthcare workers is lacking. We adapted a SARS stigma scale that was developed using the Berger HIV scale for use as a COVID-19 stigma scale and evaluated its psychometric properties among Egyptian physicians. Methods: We administered the 17-item SARS stigma scale in an anonymous online questionnaire among 509 Egyptian physicians recruited via convenience sampling during a cross-sectional study in June 2020. Exploratory factor analysis was performed on half of the sample. Confirmatory factor analysis of the resulting model was done using structural equation modeling on the other half. Scale reliability was examined using Cronbach’s alpha for internal consistency. Convergent construct validity was assessed using regression models to examine the association between the adapted COVID-19 stigma scale and relevant factors. Results: Exploratory factor analysis yielded 16 items (E16-COVID19-S) that supported a three-factor structure: personalized stigma (8 items); concerns of disclosure and public attitudes (5 items); and negative experiences (3 items). Cronbach’s α was 0.909 for the total scale and 0.907, 0.663, and 0.789 for the three subscales. E16-COVID19-S was confirmed to have good model fit (comparative fit index = 0.964; root mean squared error of approximation = 0.056). E16-COVID19-S was independently associated with physicians’ younger age, lower qualification, working in an isolation hospital, and self-stigma, whether the scale was treated as categorical or continuous. Conclusions: E16-COVID19-S exhibited good internal consistency and construct validity among this sample of Egyptian physicians. These adequate psychometric properties make the E16-COVID19-S scale appropriate for use by researchers and practitioners.