Skip to main content
Top
Published in: Alzheimer's Research & Therapy 1/2016

Open Access 01-12-2016 | Research

Using the Affiliate Stigma Scale with caregivers of people with dementia: psychometric evaluation

Authors: Chih-Cheng Chang, Jian-An Su, Chung-Ying Lin

Published in: Alzheimer's Research & Therapy | Issue 1/2016

Login to get access

Abstract

Background

In this study, we examined the psychometric properties of the Affiliate Stigma Scale to measure affiliate stigma for caregivers of family members with dementia, a topic scantily covered in the literature.

Methods

Two hundred seventy-one caregivers were recruited. Each completed the Affiliate Stigma Scale, Caregiver Burden Inventory, Taiwanese Depression Questionnaire, Beck Anxiety Inventory, and 28-item World Health Organization Quality of Life questionnaire. The data were evaluated for internal consistency and concurrent validity, and they were analyzed using Rasch statistics and confirmatory factor analysis (CFA).

Results

CFA and Rasch analysis suggested that the Affiliate Stigma Scale contains three underlying unidimensional concepts (cognition, affect, and behavior). The three concepts had satisfactory internal consistency (α = 0.822–0.855) and concurrent validity (r = 0.290–0.628 with caregiver burden, 0.391–0.612 with depression, 0.367–0.467 with anxiety, and −0.590 to −0.365 with quality of life).

Conclusions

The Affiliate Stigma Scale is a promising instrument with sound psychometric properties for measuring affiliate stigma. Healthcare providers might want to use it to understand the caregivers’ perspectives and to design appropriate interventions to decrease their affiliate stigma.
Literature
1.
go back to reference Goffman E. Stigma: notes on the management of spoiled identity. Englewood Cliffs: Prentice Hall; 1963. Goffman E. Stigma: notes on the management of spoiled identity. Englewood Cliffs: Prentice Hall; 1963.
2.
go back to reference Bos AS, Pryor JB, Reeder GD, Stutterheim SE. Sigma: advances in theory and research. Basic Appl Soc Psychol. 2013;35(1):1–9.CrossRef Bos AS, Pryor JB, Reeder GD, Stutterheim SE. Sigma: advances in theory and research. Basic Appl Soc Psychol. 2013;35(1):1–9.CrossRef
3.
go back to reference Werner P, Goldstein D, Heinik J. Development and validity of the Family Stigma in Alzheimer’s Disease Scale (FS-ADS). Alzheimer Dis Assoc Disord. 2011;25:42–8.CrossRefPubMed Werner P, Goldstein D, Heinik J. Development and validity of the Family Stigma in Alzheimer’s Disease Scale (FS-ADS). Alzheimer Dis Assoc Disord. 2011;25:42–8.CrossRefPubMed
4.
go back to reference Schulze B, Angermeyer MC. Subjective experiences of stigma: a focus group study of schizophrenic patients, their relatives and mental health professionals. Soc Sci Med. 2003;56:299–312.CrossRefPubMed Schulze B, Angermeyer MC. Subjective experiences of stigma: a focus group study of schizophrenic patients, their relatives and mental health professionals. Soc Sci Med. 2003;56:299–312.CrossRefPubMed
6.
go back to reference Corrigan PW, Watson AC, Barr L. The self-stigma of mental illness: implications for self-esteem and self-efficacy. J Soc Clin Psychol. 2006;25:875–84.CrossRef Corrigan PW, Watson AC, Barr L. The self-stigma of mental illness: implications for self-esteem and self-efficacy. J Soc Clin Psychol. 2006;25:875–84.CrossRef
7.
go back to reference Corrigan PW, Watson AC, Miller RE. Blame, shame, and contamination: the impact of mental illness and drug dependence stigma on family members. J Fam Psychol. 2006;20:239–46.CrossRefPubMed Corrigan PW, Watson AC, Miller RE. Blame, shame, and contamination: the impact of mental illness and drug dependence stigma on family members. J Fam Psychol. 2006;20:239–46.CrossRefPubMed
8.
go back to reference Mak WW, Cheung RY. Affiliate stigma among caregivers of people with intellectual disability or mental illness. J Appl Res Intellect Disabil. 2008;21:532–45.CrossRef Mak WW, Cheung RY. Affiliate stigma among caregivers of people with intellectual disability or mental illness. J Appl Res Intellect Disabil. 2008;21:532–45.CrossRef
9.
go back to reference Lin CY, Wang JD, Pai MC, Ku LJE. Measuring burden in dementia caregivers: confirmatory factor analysis for short forms of the Zarit Burden Interview. Arch Gerontol Geriatr. 2017;68:8–13.CrossRef Lin CY, Wang JD, Pai MC, Ku LJE. Measuring burden in dementia caregivers: confirmatory factor analysis for short forms of the Zarit Burden Interview. Arch Gerontol Geriatr. 2017;68:8–13.CrossRef
10.
go back to reference Zisman-Ilani Y, Levy-Frank I, Hasson-Ohayon I, Kravetz S, Mashiach-Eizenberg M, Roe D. Measuring the internalized stigma of parents of persons with a serious mental illness: the factor structure of the parents’ internalized stigma of mental illness scale. J Nerv Ment Dis. 2013;210:183–7.CrossRef Zisman-Ilani Y, Levy-Frank I, Hasson-Ohayon I, Kravetz S, Mashiach-Eizenberg M, Roe D. Measuring the internalized stigma of parents of persons with a serious mental illness: the factor structure of the parents’ internalized stigma of mental illness scale. J Nerv Ment Dis. 2013;210:183–7.CrossRef
11.
go back to reference Bogart LM, Cowgill BO, Kennedy D, Ryan G, Murphy DA, Elijah J, et al. HIV-related stigma among people with HIV and their families: a qualitative study. AIDS Behav. 2008;12:244–54.CrossRefPubMed Bogart LM, Cowgill BO, Kennedy D, Ryan G, Murphy DA, Elijah J, et al. HIV-related stigma among people with HIV and their families: a qualitative study. AIDS Behav. 2008;12:244–54.CrossRefPubMed
12.
go back to reference Aminzadeh F, Byszewski A, Molnar FJ, Eisner M. Emotional impact of dementia diagnosis: exploring persons with dementia and caregivers’ perspectives. Aging Ment Health. 2007;11:281–90.CrossRefPubMed Aminzadeh F, Byszewski A, Molnar FJ, Eisner M. Emotional impact of dementia diagnosis: exploring persons with dementia and caregivers’ perspectives. Aging Ment Health. 2007;11:281–90.CrossRefPubMed
13.
go back to reference Chang KH, Horrocks S. Lived experiences of family caregivers of mentally ill relatives. J Adv Nurs. 2006;53:435–43.CrossRefPubMed Chang KH, Horrocks S. Lived experiences of family caregivers of mentally ill relatives. J Adv Nurs. 2006;53:435–43.CrossRefPubMed
14.
go back to reference Liu D, Hinton L, Tran C, Hinton D, Barker JC. Reexamining the relationships among dementia, stigma, and aging in immigrant Chinese and Vietnamese family caregivers. J Cross Cult Gerontol. 2008;23:283–99.CrossRefPubMedPubMedCentral Liu D, Hinton L, Tran C, Hinton D, Barker JC. Reexamining the relationships among dementia, stigma, and aging in immigrant Chinese and Vietnamese family caregivers. J Cross Cult Gerontol. 2008;23:283–99.CrossRefPubMedPubMedCentral
15.
go back to reference Chang CC, Su JA, Tsai CS, Yen CF, Liu JH, Lin CY. Rasch analysis suggested three unidimensional domains for Affiliate Stigma Scale: additional psychometric evaluation. J Clin Epidemiol. 2015;68(6):674–83.CrossRefPubMed Chang CC, Su JA, Tsai CS, Yen CF, Liu JH, Lin CY. Rasch analysis suggested three unidimensional domains for Affiliate Stigma Scale: additional psychometric evaluation. J Clin Epidemiol. 2015;68(6):674–83.CrossRefPubMed
16.
go back to reference Lin CY, Chang CC, Wu TH, Wang JD. Dynamic changes of self-stigma, quality of life, somatic complaints, and depression among people with schizophrenia: a pilot study applying kernel smoothers. Stigma Health. 2016;1(1):29–43.CrossRef Lin CY, Chang CC, Wu TH, Wang JD. Dynamic changes of self-stigma, quality of life, somatic complaints, and depression among people with schizophrenia: a pilot study applying kernel smoothers. Stigma Health. 2016;1(1):29–43.CrossRef
17.
go back to reference American Psychiatric Association. Diagnostic and statistical manual of mental disorders, text rev. 4th ed. Washington, DC: Author; 2000. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, text rev. 4th ed. Washington, DC: Author; 2000.
18.
go back to reference Novak M, Guest C. Application of a multidimensional caregiver burden inventory. Gerontologist. 1989;29(6):798–803.CrossRefPubMed Novak M, Guest C. Application of a multidimensional caregiver burden inventory. Gerontologist. 1989;29(6):798–803.CrossRefPubMed
19.
go back to reference Chou KR, Lin JC, Chu H. The reliability and validity of the Chinese version of the Caregiver Burden Inventory. Nurs Res. 2002;51(5):324–31.CrossRefPubMed Chou KR, Lin JC, Chu H. The reliability and validity of the Chinese version of the Caregiver Burden Inventory. Nurs Res. 2002;51(5):324–31.CrossRefPubMed
20.
go back to reference Lee Y, Lin PY, Hsu ST, Yu YC, Yang LC, Wen JK. Comparing the use of the Taiwanese Depression Questionnaire and Beck Depression Inventory for screening depression in patients with chronic pain. Chang Gung Med J. 2008;31(4):369–77.PubMed Lee Y, Lin PY, Hsu ST, Yu YC, Yang LC, Wen JK. Comparing the use of the Taiwanese Depression Questionnaire and Beck Depression Inventory for screening depression in patients with chronic pain. Chang Gung Med J. 2008;31(4):369–77.PubMed
21.
go back to reference Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56:893–7.CrossRefPubMed Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56:893–7.CrossRefPubMed
22.
go back to reference Che HH, Lu ML, Chen HC, Chang SW, Lee YL. Validation of the Chinese version of the Beck Anxiety Inventory [in Chinese]. Formos J Med. 2006;10:447–54. Che HH, Lu ML, Chen HC, Chang SW, Lee YL. Validation of the Chinese version of the Beck Anxiety Inventory [in Chinese]. Formos J Med. 2006;10:447–54.
23.
go back to reference Yao G, Chung CW, Yu CF, Wang JD. Development and verification of validity and reliability of the WHOQOL-BREF Taiwan version. J Formos Med Assoc. 2002;101:342–51.PubMed Yao G, Chung CW, Yu CF, Wang JD. Development and verification of validity and reliability of the WHOQOL-BREF Taiwan version. J Formos Med Assoc. 2002;101:342–51.PubMed
24.
go back to reference Chang KC, Wang JD, Tang HP, Cheng CM, Lin CY. Psychometric evaluation using Rasch analysis of the WHOQOL-BREF in heroin-dependent people undergoing methadone maintenance treatment: further item validation. Health Qual Life Outcomes. 2014;12:148.CrossRefPubMedPubMedCentral Chang KC, Wang JD, Tang HP, Cheng CM, Lin CY. Psychometric evaluation using Rasch analysis of the WHOQOL-BREF in heroin-dependent people undergoing methadone maintenance treatment: further item validation. Health Qual Life Outcomes. 2014;12:148.CrossRefPubMedPubMedCentral
25.
go back to reference Su CT, Ng HS, Yang AL, Lin CY. Psychometric evaluation of the Short Form 36 Health Survey (SF-36) and the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) for patients with schizophrenia. Psychol Assess. 2014;26(3):980–9.CrossRefPubMed Su CT, Ng HS, Yang AL, Lin CY. Psychometric evaluation of the Short Form 36 Health Survey (SF-36) and the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) for patients with schizophrenia. Psychol Assess. 2014;26(3):980–9.CrossRefPubMed
26.
go back to reference Lin CY, Yang SC, Lai WW, Su WC, Wang JD. Rasch models suggested the satisfactory psychometric properties of the World Health Organization Quality of Life-Brief among lung cancer patients. J Health Psychol. doi:10.1177/1359105315603474. Lin CY, Yang SC, Lai WW, Su WC, Wang JD. Rasch models suggested the satisfactory psychometric properties of the World Health Organization Quality of Life-Brief among lung cancer patients. J Health Psychol. doi:10.​1177/​1359105315603474​.
27.
go back to reference Lin CY, Li YP, Lin SI, Chen CH. Measurement equivalence across gender and education in the WHOQOL-BREF for community-dwelling elderly Taiwanese. Int Psychogeriatr. 2016;28(8):1375–82.CrossRefPubMed Lin CY, Li YP, Lin SI, Chen CH. Measurement equivalence across gender and education in the WHOQOL-BREF for community-dwelling elderly Taiwanese. Int Psychogeriatr. 2016;28(8):1375–82.CrossRefPubMed
28.
go back to reference Linacre JM, Tennant A. More about critical eigenvalue sizes (variances) in standardized residual principal components analysis (PCA). Rasch Meas Trans. 2009;23:1228. Linacre JM, Tennant A. More about critical eigenvalue sizes (variances) in standardized residual principal components analysis (PCA). Rasch Meas Trans. 2009;23:1228.
29.
go back to reference Lin CY, Pakpour AH. Assessing EORTC QLQ-BM22 module using Rasch model and confirmatory factor analysis across East and West countries: a thorough psychometric evaluation in patients with bone metastases. Asian Pac J Cancer Prev. 2016;17(3):1405–10.CrossRefPubMed Lin CY, Pakpour AH. Assessing EORTC QLQ-BM22 module using Rasch model and confirmatory factor analysis across East and West countries: a thorough psychometric evaluation in patients with bone metastases. Asian Pac J Cancer Prev. 2016;17(3):1405–10.CrossRefPubMed
30.
go back to reference Wright BD, Linacre JM. Reasonable mean-square fit values. Rasch Meas Trans. 1994;8:370. Wright BD, Linacre JM. Reasonable mean-square fit values. Rasch Meas Trans. 1994;8:370.
31.
go back to reference Cheng CP, Luh WM, Yang AL, Su CT, Lin CY. Agreement of children and parents scores on Chinese version of Pediatric Quality of Life Inventory 4.0: further psychometric development. Appl Res Qual Life. 2016;11(3):891–906. doi:10.1007/s11482-015-9405-z.CrossRef Cheng CP, Luh WM, Yang AL, Su CT, Lin CY. Agreement of children and parents scores on Chinese version of Pediatric Quality of Life Inventory 4.0: further psychometric development. Appl Res Qual Life. 2016;11(3):891–906. doi:10.​1007/​s11482-015-9405-z.CrossRef
32.
go back to reference Steppan M, Piontek D, Kraus L. The effect of sample selection on the distinction between alcohol abuse and dependence. Int J Alcohol Drug Res. 2014;3(2):159–68.CrossRef Steppan M, Piontek D, Kraus L. The effect of sample selection on the distinction between alcohol abuse and dependence. Int J Alcohol Drug Res. 2014;3(2):159–68.CrossRef
33.
go back to reference Tsai MC, Strong C, Lin CY. Effects of pubertal timing on deviant behaviors in Taiwan: a longitudinal analysis of 7th- to 12th-grade adolescents. J Adolesc. 2015;42:87–97.CrossRefPubMed Tsai MC, Strong C, Lin CY. Effects of pubertal timing on deviant behaviors in Taiwan: a longitudinal analysis of 7th- to 12th-grade adolescents. J Adolesc. 2015;42:87–97.CrossRefPubMed
34.
go back to reference Cook KF, Kallen MA, Amtmann D. Having a fit: impact of number of items and distribution of data on traditional criteria for assessing IRT’s unidimensionality assumption. Qual Life Res. 2009;18(4):447–60.CrossRefPubMedPubMedCentral Cook KF, Kallen MA, Amtmann D. Having a fit: impact of number of items and distribution of data on traditional criteria for assessing IRT’s unidimensionality assumption. Qual Life Res. 2009;18(4):447–60.CrossRefPubMedPubMedCentral
35.
go back to reference Werner P, Mittelman MS, Goldstein D, Heinik J. Family stigma and caregiver burden in Alzheimer's disease. Gerontologist. 2012;52(1):89–97.CrossRefPubMed Werner P, Mittelman MS, Goldstein D, Heinik J. Family stigma and caregiver burden in Alzheimer's disease. Gerontologist. 2012;52(1):89–97.CrossRefPubMed
40.
41.
go back to reference Andrén S, Elmståhl S. Relationships between income, subjective health and caregiver burden in caregivers of people with dementia in group living care: a cross-sectional community-based study. Int J Nurs Stud. 2007;44(3):435–46.CrossRefPubMed Andrén S, Elmståhl S. Relationships between income, subjective health and caregiver burden in caregivers of people with dementia in group living care: a cross-sectional community-based study. Int J Nurs Stud. 2007;44(3):435–46.CrossRefPubMed
42.
go back to reference Gilliam C, Steffen A. The relationship between caregiving self-efficacy and depressive symptoms in dementia family caregivers. Aging Ment Health. 2006;10(2):79–86.CrossRefPubMed Gilliam C, Steffen A. The relationship between caregiving self-efficacy and depressive symptoms in dementia family caregivers. Aging Ment Health. 2006;10(2):79–86.CrossRefPubMed
43.
go back to reference Lysaker PH, Davis LW, Warman DM, Strasburger A, Beattie N. Stigma, social function and symptoms in schizophrenia and schizoaffective disorder: associations across 6 months. Psychiatry Res. 2007;149:89–95.CrossRefPubMed Lysaker PH, Davis LW, Warman DM, Strasburger A, Beattie N. Stigma, social function and symptoms in schizophrenia and schizoaffective disorder: associations across 6 months. Psychiatry Res. 2007;149:89–95.CrossRefPubMed
44.
go back to reference Ritsher JB, Phelan JC. Internalized stigma predicts erosion of morale among psychiatric outpatients. Psychiatry Res. 2004;129:257–65.CrossRefPubMed Ritsher JB, Phelan JC. Internalized stigma predicts erosion of morale among psychiatric outpatients. Psychiatry Res. 2004;129:257–65.CrossRefPubMed
45.
go back to reference Liu CK, Lin RT, Chen YF, Tai CT, Yen TT, Howng SL. Prevalence of dementia in an urban area in Taiwan. J Formos Med Assoc. 1996;95(10):762–8.PubMed Liu CK, Lin RT, Chen YF, Tai CT, Yen TT, Howng SL. Prevalence of dementia in an urban area in Taiwan. J Formos Med Assoc. 1996;95(10):762–8.PubMed
46.
go back to reference Liu HC, Lin KN, Teng EL, Wang SJ, Fuh JL, Guo NW, et al. Prevalence and subtypes of dementia in Taiwan: a community survey of 5297 individuals. J Am Geriatr Soc. 2015;43(2):144–9.CrossRef Liu HC, Lin KN, Teng EL, Wang SJ, Fuh JL, Guo NW, et al. Prevalence and subtypes of dementia in Taiwan: a community survey of 5297 individuals. J Am Geriatr Soc. 2015;43(2):144–9.CrossRef
47.
go back to reference Chang CC, Lin CY, Gronholm PC, Wu TH. Cross-validation of two commonly used self-stigma measures, Taiwan versions of the Internalized Stigma Mental Illness Scale and Self-Stigma Scale–Short, for people with mental illness. Assessment. doi:10.1177/1073191116658547. Chang CC, Lin CY, Gronholm PC, Wu TH. Cross-validation of two commonly used self-stigma measures, Taiwan versions of the Internalized Stigma Mental Illness Scale and Self-Stigma Scale–Short, for people with mental illness. Assessment. doi:10.​1177/​1073191116658547​.
48.
go back to reference Fang SY, Lin YC, Chen TC, Lin CY. Impact of marital coping on the relationship between body image and sexuality among breast cancer survivors. Support Care Cancer. 2015;23(9):2551–9.CrossRefPubMed Fang SY, Lin YC, Chen TC, Lin CY. Impact of marital coping on the relationship between body image and sexuality among breast cancer survivors. Support Care Cancer. 2015;23(9):2551–9.CrossRefPubMed
Metadata
Title
Using the Affiliate Stigma Scale with caregivers of people with dementia: psychometric evaluation
Authors
Chih-Cheng Chang
Jian-An Su
Chung-Ying Lin
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Alzheimer's Research & Therapy / Issue 1/2016
Electronic ISSN: 1758-9193
DOI
https://doi.org/10.1186/s13195-016-0213-y

Other articles of this Issue 1/2016

Alzheimer's Research & Therapy 1/2016 Go to the issue