Validation of the Cancer Stigma Scale in Nepalese Women

Document Type : Research Articles


1 Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal.

2 Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA.

3 Institute for Implementation Science and Health (IISH), Kathmandu, Nepal.

4 Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA.

5 Hera Solutions, Baltimore, MD, USA.

6 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

7 Department of Biostatistics and Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA.

8 Department of Obstetrics and Gynecology, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal.

9 Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark.

10 COBIN, Nepal Development Society, Bharatpur, Nepal.

11 Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.


Background: Cancer stigma is known to have an adverse impact on cancer patients as well as vulnerable groups who are at risk of developing cancer. In Nepal, there is no validated instrument for assessing cancer stigma and there has been relatively little research examining the stigmatization of cancer among the Nepalese population. Objective: We aimed to validate the Cancer Stigma Scale (CASS) among apparently healthy Nepali women. Methods: We interviewed 426 Nepali women after the translation, back-translation, and cross-cultural adaptation of the CASS into Nepali. We assessed internal consistency using Cronbach’s alpha and assessed model fit using confirmatory component analysis. Results: The Nepali CASS had satisfactory internal reliability, Cronbach’s alpha of the overall scale and six components was 0.88 and 0.70–0.89, respectively. Confirmatory factor analysis confirmed the six-factor structure (RMSEA = 0.074, GFI = 0.864, AGFI = 0.825, CFI = 0.901, NFI = 0.866, χ2/df=3.341). Having no formal education was associated with higher levels of stigma related to avoiding cancer patients and attributing cancer to personal responsibility. Conclusions: The Nepali CASS demonstrated sufficient internal consistency, reliability, and model fit indices, making it suitable for assessing cancer stigma among Nepali people.


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