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Validation of the Chinese Version of the Shame and Stigma Scale in Patients with Head and Neck Cancer

Authors Tseng WT, Lee Y, Hung CF, Lin PY, Chien CY, Chuang HC, Fang FM, Li SH, Huang TL, Chong MY, Wang LJ

Received 27 August 2019

Accepted for publication 15 November 2019

Published 9 December 2019 Volume 2019:11 Pages 10297—10305

DOI https://doi.org/10.2147/CMAR.S228843

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Chien-Feng Li


Wei-Ting Tseng,1 Yu Lee,1 Chi-Fa Hung,1 Pao-Yen Lin,1 Chih-Yen Chien,2 Hui-Ching Chuang,2 Fu-Min Fang,3 Shau-Hsuan Li,4 Tai-Lin Huang,4 Mian-Yoon Chong,5 Liang-Jen Wang6

1Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 2Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 3Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; 4Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 5Department of Psychiatry, Chiayi Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Chiayi, Taiwan; 6Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

Correspondence: Liang-Jen Wang
Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital, No.123, Dapi Road, Niaosung District, Kaohsiung City, Taiwan
Tel +886-7-7317123 ext. 8753
Fax +886-7-7326817
Email wangliangjen@gmail.com

Purpose: Head and neck cancer (HNC) patients suffer from perceived shame and stigma due to the illness diagnosis, as well as disfigurement following surgery. To measure HNC patients’ perception of shame and stigma, the Shame and Stigma Scale (SSS) was developed and preliminarily validated. In this study, we aimed to translate, adapt, and validate the SSS in Chinese.
Methods: This study consisted of a cross-sectional design with consecutive sampling and consisted of two stages: (1) translation of the SSS into Chinese by two bilingual professionals and (2) examination of the Chinese version of the SSS (C-SSS) for internal consistency, inter-rater reliability, test-retest reliability, construct validity, and concurrent validity. In total, 159 inpatients with HNC (mean age: 56.8 years, 95% males) were enrolled at a medical center in Southern Taiwan.
Results: The Principal Component Analysis of the C-SSS revealed a five-factor structure: 4 of the 5 factors were replicated in the original SSS, including Shame with Appearance, Regret, Social/Speech Concern, and Sense of Stigma; only factor 4, Self-discrimination, was newly identified in the current study. C-SSS showed acceptable internal validity (Cronbach’s α =0.85), test-retest reliability, inter-rater reliability, and fair concurrent validity with the Taiwanese Depression Questionnaire (TDQ), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), and Explanatory Model Interview Catalogue (EMIC).
Conclusion: The findings of this study indicate that C-SSS is a reliable and valid instrument for evaluating HNC patients’ perception of shame and stigma in the Taiwanese population.

Keywords: head and neck cancer, shame, stigma, assessment, psychometric

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