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Measurement Instruments Assessing Multi-Faceted Stigma Regarding Sexual and Gender Minorities: A Systematic Review of Psychometric Properties

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Abstract

Stigma against sexual and gender minorities (SGM) populations has serious negative health effects for SGM populations. Despite the growing need for accurate stigma measurement in SGM, there are insufficient valid measurement instruments. Moreover, the lack of consistency in construct usage makes comparisons across studies particularly challenging. A critical review and comparative evaluation of the psychometric properties of the various stigma measures for SGM is necessary to advance our understanding regarding stigma measurement against/among SGMs. Based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive search was conducted in 4 bibliographic databases (MEDLINE, PsycINFO, CINAHL, and Web of Science) for empirical articles published from 2010 to 2022 that evaluated the psychometrics properties of measurement instruments assessing stigma against SGMs. The screening, extraction, and scoring of the psychometric properties and methodological quality of selected instruments were performed by following the established standards and COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) checklist, respectively. Of the 2031 studies identified, 19 studies were included that reported psychometric properties of 17 measurement instruments. All instruments, except two, were developed for SGMs (n = 15/17). Most instruments included men who have sex with men (MSM) or gay men (n = 11/15), whereas less than half of the instruments assessed stigma among SGM women (n = 6/15). Internal consistency (Cronbach’s alpha) and content validity was reported for all instruments (n = 17); construct and structural validity was also reported for majority of the instruments (n = 15 and 10, respectively). However, test-retest reliability and criterion validity was reported for very few instruments (n = 5 each). Based on the COSMIN checklist, we identified the most psychometrically and methodologically robust instruments for each of the five stigma types: combined stigma, enacted stigma, internalized stigma, intersectional stigma, and perceived stigma. For each stigma type, except anticipated stigma, at least one instrument demonstrated strong promise for use in empirical research; however, the selection of instrument depends on the target population and context of the study. Findings indicated a growing use of instruments assessing multiple stigma types. Future studies need to develop intersectional stigma instruments that account for the multiple and intersecting social identities of SGMs. Additionally, most existing instruments would benefit from further psychometric testing, especially on test-retest reliability, criterion validity, adaptability to different LGBTQIA + populations and cultures.

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Funding

This work was supported by R01MH127961 and R21TW011064.

Author information

Authors and Affiliations

  1. Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA

    Abhishek Aggarwal, Shan Qiao & Xiaoming Li

  2. College of Arts and Sciences, University of South Carolina, Columbia, USA

    Shannon D. O’Leary

  3. Arnold School of Public Health, University of South Carolina Honors College, Columbia, USA

    Katrina N. Schlekat

Authors
  1. Abhishek Aggarwal
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  2. Shan Qiao
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  3. Shannon D. O’Leary
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  4. Katrina N. Schlekat
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  5. Xiaoming Li
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Corresponding author

Correspondence to Shan Qiao.

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Supplementary Material 1

Appendices

Appendix 1. Search string

Databases

Search Strategy

PubMed

(LGB) OR (transgender) OR (bisexual*) OR (lesbian) OR (gay) OR (queer) OR (non-binary) OR (gender non-conforming) OR (homosexual*) OR (sexual minorit*) OR (gender minorit*) OR (sexual and gender minorit*) OR (MSM) OR (WSW) AND (stigma) AND (measure*)

PsycINFO

(LGB) OR (transgender) OR (bisexual*) OR (lesbian) OR (gay) OR (queer) OR (non-binary) OR (gender non-conforming) OR (homosexual*) OR (sexual minorit*) OR (gender minorit*) OR (sexual and gender minorit*) OR (MSM) OR (WSW) AND (stigma) AND (measure*)

CINAHL Complete

(LGB) OR (transgender)) OR (bisexual*) OR (lesbian) OR (gay) OR (queer) OR (non-binary) OR (gender non-conforming) OR (homosexual*) OR (sexual minorit*) OR (gender minorit*)) OR (sexual and gender minorit*) OR (MSM)) OR (WSW) AND (stigma) AND (measure*)

Web of Science

ALL=(LGB) OR ALL=(transgender) OR ALL=(bisexual*) OR ALL=(lesbian) OR ALL=(gay) OR ALL=(queer) OR ALL=(non-binary ) OR ALL=(gender non-conforming) OR ALL=(homosexual) OR ALL=(sexual minorit*) OR ALL=(gender minorit*) OR ALL=(sexual and gender minorit*) OR ALL=(MSM) OR ALL=(WSW) AND ALL=(stigma) AND ALL=(measure)

Appendix 2. Quality criteria used to assess psychometric properties of measures [51, 52]

Psychometric property

Definition

Rating

Quality criteria

Internal consistency

The extent to which the items correlate, indicating that the overall instrument is measuring the same construct

+

Data from adequate sample used to conduct factor analysis and Cronbach’s α > 0.70

?

Cronbach’s α not reported

−

Cronbach’s α < 0.70 on any one factor

Test-retest Reliability

The degree to which the scores are free from measurement error

+

Significant ICC/weighted kappa ≥ 0.70 or significant Pearson’s correlation for all factors

?

ICC/weighted kappa or Pearson’s correlation not reported

−

ICC/weighted kappa < 0.70 or Pearson’s correlation insignificant for at least one factor

Content validity

The extent to which the items reflect the construct being assessed

+

Extensive literature review, item selection with experts, and involvement of target population (qualitative surveys, cognitive interviewing)

?

Only literature review conducted but target population not involved

−

No information on literature review, expert panel, and involvement of target population

Structural validity

The degree to which the scores of the instrument adequately reflect the dimensions of the construct being assessed

+

Factor analysis demonstrates that combined set of factors explain ≥ 50% of total variance in the model

?

Proportion of variance explained not reported

−

< 50% of the total variance explained by model

Criterion validity

The extent to which scores on a particular questionnaire relate to a gold standard

+

More than half the correlations with “gold” standards are significant

?

Criterion validity not reported

−

Less than half the correlations with “gold” standards are not significant

Construct validity

The extent to which scores on a particular questionnaire relate to other measures in a manner that is consistent with theoretically derived hypotheses

+

At least 75% of the results are in accordance with hypotheses

?

Construct validity not reported

−

Less than 75% of hypotheses were confirmed.

  1. Psychometric property ratings: + indicates positive; ? indicates indeterminate; − indicates negative
  2. ICC Intraclass correlation coefficient

Appendix 3. Scoring system used to compare overall properties of the instruments

Psychometric Quality Rating

Methodological Quality Rating

Scores Assigned

+

Strong

+ 3

+

Moderate

+ 2

+

Limited

+ 1

-

Strong

-1

-

Moderate

-2

-

Limited

-3

  1. Psychometric Quality (PQ) ratings: + indicates positive;  − indicates negative; # indicates not reported
  2. Methodological Quality (MQ) ratings: On a scale of 1–10, a methodological rating of 1–3 was “limited,” 3.1-7 was “moderate”, and 7.1–10 was “strong”

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Aggarwal, A., Qiao, S., O’Leary, S.D. et al. Measurement Instruments Assessing Multi-Faceted Stigma Regarding Sexual and Gender Minorities: A Systematic Review of Psychometric Properties. AIDS Behav (2024). https://doi.org/10.1007/s10461-024-04305-2

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