Measuring Stigma Among Health Care Providers: The HIV/AIDS Provider Stigma Inventory

Background and Purpose: The HIV/AIDS Provider Stigma Inventory (HAPSI), a trio of scales, was developed in conjunction with a larger research effort designed to diminish stigmatizing attitudes and behaviors of health care professionals directed at people living with HIV/AIDS (PLHA) or those suspected of bearing that status. The Awareness scale prompts providers to deeply examine their thoughts and feelings and listen well to PLHA. The Acceptance scale measures providers' acknowledgement of the potential for negative effects on their clients resulting from their stigmatizing attitudes and behaviors. The Action scale measures the extent to which a provider acts intentionally and with compassion to override their potential for stigmatizing their clients.

Methods: Initial validation of the HAPSI, piloted on a sample of 174 nursing students, supported the psychometric qualities of a suite of measures capturing the experience and expression of stigmatizing and discriminating tendencies toward PLHA. The second wave of validation will add social service and other health care providers. Emphasizing constructs derived from social psychological and mindfulness theories, separate scales addressing awareness, acceptance, and action were designed to include notions of labeling, stereotyping, distancing, and discriminating. These were further enhanced to capture differences associated with PLHA personal characteristics triggering secondary stigma (sexual orientation, injection drug use, or multiple sex partners), fears regarding occupational exposure, and concerns about diminished social standing for being associated with PLHA. Data analyses examined evidence of content validity, reliability, factor structure, and convergent construct validity.

Results: Reliabilities were strong (coefficients alpha for 16 of the 19 resulting measures ranged from .80-.98). The global Cronbach's alpha for the Awareness scale is .97, (SEM = .16); for the Acceptance scale is .98, (SEM = .19); and for the Action scale is .96, (SEM = .23). Confirmatory factor analyses indicated good model fit for two multidimensional (Awareness and Acceptance) and one unidimensional (Action) measure. The statistical results of the confirmatory factor analysis are as follows. For Awareness: χ2 /df= 2.24, CFI = .96, NNFI (TLI) = .96, RMSEA = .076, SRMR = .072; for Acceptance: χ2 /df = 1.70, CFI = .99, NNFI (TLI) = .98, RMSEA = .063, SRMR = .047; and for Action: χ2 /df = 2.67, CFI = .98, NNFI (TLI) = .97, RMSEA = .092, SRMR = .046.Evidence of convergent construct validity included associations with the AIDS Attitudes Survey, and supported accuracy of primary constructs, with fairly good effect sizes.

Conclusions and Implications: While the initial aim for developing the HAPSI measures was to facilitate outcome measurement in provider stigma interventions, it may also be adapted to early training and efforts to increase the understanding of providers regarding the connections between their personal fears and tendencies and the impact of such qualities on service delivery. Our hope is that the HAPSI will be a valuable tool in reducing stigma as a barrier to more successful HIV/AIDS prevention and treatment.