Measuring Stigma Cultures in Healthcare Settings: Development and Testing of a New Measure

Abstract Background Organizational cultures represent the norms, values, and assumptions underlying day to data activities and interactions. People with a mental or substance use disorder experience considerable stigma when interacting with healthcare cultures such as feeling patronized, humiliated, and excluded from treatment decisions. The management of healthcare cultures, and specifically stigma cultures, is increasingly viewed as a key aspect of healthcare reform. To evaluate the effectiveness of interventions to reduce stigma cultures in healthcare, valid and reliable measures are needed. Numerous measures assess aspects of the quality of care provided to people with a mental or substance use disorder, but none specifically addresses stigma cultures. To fill this gap, we developed and tested a new mental illness related stigma measure to be used in healthcare organizations to assess stigma cultures of care. Methods Item generation was grounded in the lived experiences of people (n = 20) with a mental or substance use disorder and reflect their personal experiences with healthcare encounters for physical or emotional health care. Items are rated on a 4-point agreement scale with higher scores indicating higher stigma. Following the qualitative analysis, national survey data (n = 2,476) were collected to conduct an exploratory and confirmatory factor analysis on split halves of the sample. Results The analyses provided statistical support for a 23-item unidimensional scale that could be used in any healthcare setting to assess the presence of a stigma culture. Reliability was high (.92) and the resulting scale scores (ranging from 0 to 92) were approximately normal. Conclusions The resulting Stigma Cultures in Healthcare scale can be used across a range of physical and mental healthcare settings to assess the extent to which the culture of care is experienced as stigmatizing by clients with mental or substance use disorders.