Measuring Stigma Cultures in Healthcare Settings: Development and Testing of a New Measure
Bibliographic record
Abstract
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.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.028 | 0.059 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".