COVID-19 related stigma among the general population in Iran

Masoomeh Faghankhani; Hossein Nourinia; Ali Ahmad Rafiei-Rad; Aliyeh Mahdavi Adeli; Mohammad Reza Javadi Yeganeh; Hamid Sharifi; Hamidreza Namazi; Shaghayegh Khosravifar; Alaleh Bahramian; Mahdi Fathimakvand; Elnaz Golalipour; Fatemeh Sadat Mirfazeli; Hamid Reza Baradaran; Graham Thornicroft; Amir Hossein Jalali Nadoushan

doi:10.1186/s12889-022-14039-2

COVID-19 related stigma among the general population in Iran

BMC Public Health. 2022 Sep 5;22(1):1681. doi: 10.1186/s12889-022-14039-2.

Authors

Masoomeh Faghankhani^#¹, Hossein Nourinia², Ali Ahmad Rafiei-Rad³, Aliyeh Mahdavi Adeli⁴, Mohammad Reza Javadi Yeganeh⁵, Hamid Sharifi³, Hamidreza Namazi^{6

7}, Shaghayegh Khosravifar⁸, Alaleh Bahramian⁹, Mahdi Fathimakvand¹⁰, Elnaz Golalipour¹¹, Fatemeh Sadat Mirfazeli⁹, Hamid Reza Baradaran^{12

13}, Graham Thornicroft¹⁴, Amir Hossein Jalali Nadoushan^#^{15

16}

Affiliations

¹ Mental Health Research Center, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Mansouri Street, Niyayesh Street, Satarkhan Avenue, Tehran, 1445613111, Iran.
² Academic Center for Education, Culture, and Research, Humanities and Social Studies Research Center, 47 Nazari Street, Abureyhan Street, Enghelab Avenue, Tehran, 141554364, Iran.
³ HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Haft-Bagh Highway, Medical University Campus, 7616911320, Kerman, Iran.
⁴ School of Medicine, Iran University of Medical Sciences, Shahid Hemmat Highway, Next to Milad Tower, Tehran, 1449614535, Iran.
⁵ Department of Sociology, Faculty of Social Sciences, University of Tehran, Jalal Al-e Ahmad Highway, Tehran, 1411713118, Iran.
⁶ Department of Medical Ethics, Faculty of Medicine, Tehran University of Medical Sciences, PourSina Street, Qods Street, Tehran, 1417613151, Iran.
⁷ Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, PourSina Street, Qods Street, Tehran, 1417613151, Iran.
⁸ Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Hezar Jerib Street, Isfahan, 8174673461, Iran.
⁹ Department of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Mansouri Street, Niyayesh Street, Satarkhan Avenue, Tehran, 1445613111, Iran.
¹⁰ CEO, Armandar Company, 16 Kambiz Street, West Zartosht Street, Apt. 7., Tehran, Iran.
¹¹ School of Medicine, Shahid Beheshti University of Medical Sciences, Arabi Avenue, Daneshjoo Boulevard, Velenjak, Tehran, 1983963113, Iran.
¹² Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Shahid Hemmat Highway, Next to Milad Tower, Tehran, 1449614535, Iran.
¹³ Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, AB25 2ZD, UK.
¹⁴ Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
¹⁵ Mental Health Research Center, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Mansouri Street, Niyayesh Street, Satarkhan Avenue, Tehran, 1445613111, Iran. [email protected].
¹⁶ Department of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Mansouri Street, Niyayesh Street, Satarkhan Avenue, Tehran, 1445613111, Iran. [email protected].

^# Contributed equally.

Abstract

Background: COVID-19 related stigma has been identified as a critical issue since the beginning of the pandemic. We developed a valid and reliable questionnaire to measure COVID-19 related enacted stigma, inflicted by the non-infected general population. We applied the questionnaire to measure COVID-19 related enacted stigma among Tehran citizens from 27 to 30 September 2020.

Methods: A preliminary questionnaire with 18 items was developed. The total score ranged from 18 to 54; a higher score indicated a higher level of COVID-19 related stigma. An expert panel assessed the face and content validity. Of 1637 randomly recruited Tehran citizens without a history of COVID-19 infection, 1064 participants consented and were interviewed by trained interviewers by phone.

Results: Item content validity index (I-CVI), Item content validity ratio (I-CVR), and Item face validity index (I-FVI) were higher than 0.78 for all 18 items. The content and face validity were established with a scale content validity index (S-CVI) of 0.90 and a scale face validity index (S-CVI) of 93.9%, respectively. Internal consistency of the questionnaire with 18 items was confirmed with Cronbach's alpha of 0.625. Exploratory factor analysis revealed five latent variables, including "blaming", "social discrimination", "dishonor label", "interpersonal contact", and "retribution and requital attitude". The median of the stigma score was 24 [25th percentile: 22, 75^the percentile: 28]. A large majority (86.8%) of participants reported a low level of stigma with a score below 31. None of the participants showed a high level of stigma with a score above 43. We found that the higher the educational level the lower the participant's stigma score.

Conclusion: We found a low level of stigmatizing thoughts and behavior among the non-infected general population in Tehran, which may be due to the social desirability effect, to the widespread nature of COVID-19, or to the adaptation to sociocultural diversity of the large city.

Keywords: COVID-19; Cross-sectional studies; Enacted stigma; Iran; Mental health; Pandemics; Social stigma; Surveys and questionnaires; Urban population.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19* / epidemiology
Humans
Iran / epidemiology
Psychometrics
Reproducibility of Results
Social Stigma
Surveys and Questionnaires

Abstract

Publication types

MeSH terms

Grants and funding