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Table 2 Modifications and adaptation of selected stigma instrument

From: Adaptation and preliminary psychometric properties of three self-stigma outcome measures for people living with dementia


Stigma Stress Scale

Self-stigma of Mental Illness Scale

Secrecy Scale

Stigma Impact Scale

Scale Description

8 item Likert scale from 1 •(strongly disagree) to 7 (strongly agree). Four items are design to measure the harm caused by stigma and four focus on the impact of stigma on one’s resources to cope with such harm.

4 subscales answered on a 9-point likert scale representing: awareness of stereotypes, agreement with stereotypes, applying stereotypes to self and suffer harm from self-applied stereotypes. Each subscale has five items

9 items are answered on a 4-point Likert scale from 1 (strongly disagree) to 4 (strongly agree). Assess the extent to which an individual endorses concealment as a means of avoiding stigma related rejection.

21 items are rated from 1 (‘strongly disagree’) to 4 (‘strongly agree’) with the addition of 0 for those items participants found ‘not applicable’. The scale has four subscales, namely, social rejection (9 items), internalised shame (5 items) and social isolation (7 items).

Comments from lived experience experts

Just call it stigma rather than prejudice—in an UK population stigma is more colloquial than prejudice

The term “less confidence” should be used rather than “less respect”

No comments

No comments

Comments from research experts

Define prejudice in the instructions

Item 6 wording is complicated

Items 7 & 8 similar

Supplement challenges for the word demands

Using “most people” and “the public” to describe the same thing is confusing.

The perspective change between subscales was problematic in the past.

This scale relies on stereotypes of mental health, therefore these also need to be relevant to dementia

Removal of recovery and employability item.

Issues with the term impairment – maybe use “diagnosis”

Change the use of the word “impairment”, for example replace with “dementia”

Drop dimension


All dimension dropped

Dropped four of five dimensions from the original Stigma Coping Orientation Scale to leave only the secrecy subscale


Items Removed



Items 6 and 8 removed




“people with mental illness” changed to “people living with dementia” .

“prejudice” changed to “stigma” .


“mental illness” changed to “dementia” for the purposes client group adaptation




“Prejudice” was replaced with “stigma” in the instructions, the definition was left unchanged on the premise that prejudice and stigma are interchangeable terms yet stigma is the most colloquially appropriate



The term “dementia” was inserted into the instructions to be used interchangeably with “impairment”. The instructions read “dementia or neurological impairment …”