We aimed to develop and validate two self-report measures to assess perceived and experienced diabetes stigma among adults with type 1 (T1D) and type 2 diabetes (T2D). For each measure, an item pool was drafted based on: a) qualitative interviews with adults with diabetes (T1D: N=27, T2D: N=25), and b) content from other stigma scales. A 5-point response scale (strongly disagree-strongly agree) was used. Twenty-five adults (T1D: n=12, T2D: n=13) completed the draft measures and took part in cognitive debriefing interviews. Based on participant feedback, the T1D measure was reduced from 46 to 41 items, and the T2D measure was reduced from 57 to 48 items. 

A total of 2,342 respondents (T1D: n=1,078, T2D: n=1,264) completed surveys including the new stigma measures and validated scales. Using principal components analysis, both scales were reduced to 19 items. Unforced three-factor solutions were evident for both scales. The three subscales for the Type 1 Diabetes Stigma Assessment Scale (DSAS-1) were: Treated Differently (6 items, α=0.89), Blame and Judgement (6 items, α=0.88), Affective Responses (7 items, α=0.89). The three subscale scores for the Type 2 Diabetes Stigma and Assessment Scale (DSAS-2) were: Treated Differently (6 items, α=0.88), Blame and Judgement (7 items, α=0.90), Internalised Stigma (6 items, α=0.90). A forced one-factor solution with satisfactory internal consistency reliability (α=0.93 and 0.95 for the DSAS-1 and DSAS-2 respectively) was evident for both scales, supporting the calculation of total scores. Satisfactory concurrent, convergent (all correlations medium-large) and discriminant validity (all correlations small-negligible) were demonstrated for both scales.

The novel Type 1 and Type 2 Diabetes Stigma Assessment Scales (DSAS-1 and DSAS-2) are reliable and valid measures of perceived and experienced diabetes stigma, and are now available to facilitate research in this field.