The (Re)-emerging And ePidemic Infectious Diseases (RAPID) Stigma Scales: a cross-outbreak scale development and pyschometric validation study

Amy Paterson¹, Kondwani K Mughogho², Ashleigh Cheyne³, Olive Kabajaasi⁴, Tonmoy Sarkar⁵, Kkunsa Hadson Dimitrios⁶, Harun Tulunay⁷, Frances N Adiukwu⁸, Saad S Alatrany⁹, Ebrahim Aliafsari Mamaghani¹⁰, Lorena G Barberia¹¹, He Bu¹², Precious Chikura-Dlamini¹³, Jake Dunning³, Ernesto R Gregorio Jr¹⁴, Md Zakiul Hassan¹⁵, Mohammad B Hossain¹⁶, Euzebiusz Jamrozik¹⁷, Sabuj Kanti Mistry¹⁸, Gerald A Mwima¹⁹, Surapon Nochaiwong²⁰, Will Nutland²¹, Chloe Orkin²², Dewan I Rahman⁵, Keetie Roelen²³, Soomin Ryu²⁴, Stefan Schilling²⁵, Hafsa L Sentongo²⁶, Musoke T Sekikongo²⁷, Anne L Stangl²⁸, Yasin Ssewankambo²⁹, Evi Sukmaningrum³⁰, Rayner K J Tan³¹, Steven Taylor³², Thiago S Torres³³, Samuel Tomczyk³⁴, Xiaomin Wang³⁵, Benjamin Jones³⁶, Kamal I A Chowdhury⁵, Md Sharful I Khan³⁷, Wasik R Aquib⁵, Syed M Satter⁵, Nathan Kenya-Mugisha⁴, Jeni Stolow³⁸, Nina Gobat³⁹, Piero Olliaro³, Amanda Rojek³

Affiliations

¹ Pandemic Sciences Institute, University of Oxford, Oxford, UK. Electronic address: amy.paterson@ndm.ox.ac.uk.
² Psychometrics Centre, Judge Business School, University of Cambridge, Cambridge, UK.
³ Pandemic Sciences Institute, University of Oxford, Oxford, UK.
⁴ Social Sciences Department, World Alliance for Lung and Intensive Care Medicine in Uganda, Kampala, Uganda.
⁵ Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
⁶ St Nikolas Pharmacy, Kampala, Uganda.
⁷ Positively UK, London, UK.
⁸ Department of Mental Health, University of Port Harcourt, Choba, Nigeria.
⁹ Department of Clinical Psychology, Imam Ja'afar Al-Sadiq University, Baghdad, Iraq; College of Education for Human Sciences Ibn Reshed, University of Baghdad, Baghdad, Iraq.
¹⁰ Maragheh University of Medical Sciences, Maragheh, Iran.
¹¹ Department of Political Science, University of São Paulo, São Paulo, Brazil.
¹² Social and Public Administration School, East China University of Science and Technology, Xuhui District, Shanghai, China.
¹³ Nuffield Department of Medicine, University of Oxford, Oxford, UK.
¹⁴ College of Public Health, University of the Philippines Manila, Manila, Philippines.
¹⁵ Pandemic Sciences Institute, University of Oxford, Oxford, UK; Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
¹⁶ Department of Population Sciences, University of Dhaka, Dhaka, Bangladesh.
¹⁷ Pandemic Sciences Institute, University of Oxford, Oxford, UK; Department of Infectious Diseases, and Royal Melbourne Hospital Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Ethox Centre, University of Oxford, Oxford, UK; Monash Bioethics Centre, Monash University, Melbourne, VIC, Australia.
¹⁸ School of Population Health, University of New South Wales, Sydney, NSW, Australia.
¹⁹ Baylor College of Medicine, Kampala, Uganda.
²⁰ Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
²¹ The Love Tank, London, UK.
²² SHARE Collaborative, Blizard Institute, Queen Mary University of London, London, UK.
²³ Centre for the Study of Global Development, Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, UK.
²⁴ Department of Epidemiology, School of Public Health, University of Michigan, MI, USA.
²⁵ Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
²⁶ Mental Health and Control of Substance Use, Ministry of Health Uganda, Kampala, Uganda.
²⁷ Internal Medicine, Mulago National Specialised Hospital, Kampala, Uganda.
²⁸ Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
²⁹ Entebbe Isolation Centre, Entebbe, Uganda.
³⁰ Faculty of Psychology, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.
³¹ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
³² Department of Psychiatry, University of British Columbia, BC, Canada.
³³ Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
³⁴ Department of Health and Prevention, Institute of Psychology, University of Greifswald, Greifswald, Germany; German Center for Child and Adolescent Health, Greifswald, Germany.
³⁵ School of Public Health, Hangzhou Normal University, Hangzhou, China.
³⁶ Health Systems Collaborative, University of Oxford, Oxford, UK; Menzies School of Health Research, Darwin, NT, Australia.
³⁷ Health Systems & Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
³⁸ Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
³⁹ Nuffield Department of Primary Care Health Services, University of Oxford, Oxford, UK.

PMID: 40456231
DOI: 10.1016/S1473-3099(25)00161-6

The (Re)-emerging And ePidemic Infectious Diseases (RAPID) Stigma Scales: a cross-outbreak scale development and pyschometric validation study

Amy Paterson et al. Lancet Infect Dis. 2025 Nov.

. 2025 Nov;25(11):e635-e644.

doi: 10.1016/S1473-3099(25)00161-6. Epub 2025 May 30.

Authors

Affiliations

¹ Pandemic Sciences Institute, University of Oxford, Oxford, UK. Electronic address: amy.paterson@ndm.ox.ac.uk.
² Psychometrics Centre, Judge Business School, University of Cambridge, Cambridge, UK.
³ Pandemic Sciences Institute, University of Oxford, Oxford, UK.
⁴ Social Sciences Department, World Alliance for Lung and Intensive Care Medicine in Uganda, Kampala, Uganda.
⁵ Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
⁶ St Nikolas Pharmacy, Kampala, Uganda.
⁷ Positively UK, London, UK.
⁸ Department of Mental Health, University of Port Harcourt, Choba, Nigeria.
⁹ Department of Clinical Psychology, Imam Ja'afar Al-Sadiq University, Baghdad, Iraq; College of Education for Human Sciences Ibn Reshed, University of Baghdad, Baghdad, Iraq.
¹⁰ Maragheh University of Medical Sciences, Maragheh, Iran.
¹¹ Department of Political Science, University of São Paulo, São Paulo, Brazil.
¹² Social and Public Administration School, East China University of Science and Technology, Xuhui District, Shanghai, China.
¹³ Nuffield Department of Medicine, University of Oxford, Oxford, UK.
¹⁴ College of Public Health, University of the Philippines Manila, Manila, Philippines.
¹⁵ Pandemic Sciences Institute, University of Oxford, Oxford, UK; Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
¹⁶ Department of Population Sciences, University of Dhaka, Dhaka, Bangladesh.
¹⁷ Pandemic Sciences Institute, University of Oxford, Oxford, UK; Department of Infectious Diseases, and Royal Melbourne Hospital Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Ethox Centre, University of Oxford, Oxford, UK; Monash Bioethics Centre, Monash University, Melbourne, VIC, Australia.
¹⁸ School of Population Health, University of New South Wales, Sydney, NSW, Australia.
¹⁹ Baylor College of Medicine, Kampala, Uganda.
²⁰ Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
²¹ The Love Tank, London, UK.
²² SHARE Collaborative, Blizard Institute, Queen Mary University of London, London, UK.
²³ Centre for the Study of Global Development, Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, UK.
²⁴ Department of Epidemiology, School of Public Health, University of Michigan, MI, USA.
²⁵ Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
²⁶ Mental Health and Control of Substance Use, Ministry of Health Uganda, Kampala, Uganda.
²⁷ Internal Medicine, Mulago National Specialised Hospital, Kampala, Uganda.
²⁸ Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
²⁹ Entebbe Isolation Centre, Entebbe, Uganda.
³⁰ Faculty of Psychology, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.
³¹ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
³² Department of Psychiatry, University of British Columbia, BC, Canada.
³³ Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
³⁴ Department of Health and Prevention, Institute of Psychology, University of Greifswald, Greifswald, Germany; German Center for Child and Adolescent Health, Greifswald, Germany.
³⁵ School of Public Health, Hangzhou Normal University, Hangzhou, China.
³⁶ Health Systems Collaborative, University of Oxford, Oxford, UK; Menzies School of Health Research, Darwin, NT, Australia.
³⁷ Health Systems & Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
³⁸ Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
³⁹ Nuffield Department of Primary Care Health Services, University of Oxford, Oxford, UK.

PMID: 40456231
DOI: 10.1016/S1473-3099(25)00161-6

Abstract

Reducing stigma during infectious disease outbreaks is crucial for delivering an effective response. However, no validated stigma scales exist for use across outbreaks, and outbreak-specific scales are developed too slowly to guide timely interventions. To enable more real-time monitoring and mitigation of stigma across outbreak contexts, we developed and validated the (Re)-emerging and ePidemic Infectious Diseases (RAPID) Stigma Scales. Field testing and psychometric validation were conducted in communities affected by Ebola disease in Uganda, mpox in the UK, and Nipah virus disease in Bangladesh. Content validity was established through cognitive interviews and expert Delphi scoring. 1008 respondents were included across the three countries. The final RAPID Community Stigma Scale (12 items) captures initial social stigma, provider or authority-related stigma, structural stigma, and enduring social stigma. The RAPID Self Stigma Scale (4 items) is unidimensional. Both scales were found to have robust psychometric properties, including content validity, structural validity (factor loadings ≥0·6), and reliability (ordinal alphas 0·79-0·92). High scores on both scales predicted an increased hesitancy to report symptoms and seek care. The RAPID Stigma Scales are validated tools for real-time assessment of stigma across outbreak settings, enabling responders to design targeted interventions to improve health outcomes and promote equitable care.

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Conflict of interest statement

Declaration of interests EJ's research is funded in whole, or in part, by the Wellcome Trust (203132; 221719). The Trust and Confidence research programme at the Pandemic Sciences Institute at the University of Oxford is supported by an award from the Moh Foundation. CO has received lecture fees, honoraria, and travel scholarships from ViiV healthcare, Gilead Sciences, Medical Sciences Division, Janssen, and Bavarian Nordic. WN has received funding for mpox education and research activities from UK Health Security Agency, National Health Service England, the University of Edinburgh, and Queen Mary University, all paid to The Love Tank; travel funding from Preventx; and participated in the ViiV HIV PrEP Community Advisory Board (unpaid). DIR has received grants and travel funding from US Centers for Disease Control and Prevention (CDC). STo has received funding from The Federal Ministry of Education and Research, Germany, for a separate stigma-related research project. WRA has received grants from US CDC and support for travel from CEPI. KIAC and SMS have received institutional funding through an agreement with US CDC. AP is funded by a Rhodes Scholarship. All other authors declare no competing interests.

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The (Re)-emerging And ePidemic Infectious Diseases (RAPID) Stigma Scales: a cross-outbreak scale development and pyschometric validation study

Affiliations

The (Re)-emerging And ePidemic Infectious Diseases (RAPID) Stigma Scales: a cross-outbreak scale development and pyschometric validation study

Authors

Affiliations

Abstract

Conflict of interest statement

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