Development and Psychometric Properties of a Novel Food Insecurity Stigma Scale

Introduction and Objective: The goal of this study was to develop, validate, and test the psychometric properties of a novel food insecurity stigma scale. Methods: 62 items from previously validated scales for diabetes stigma, drug use stigma, mental illness stigma, HIV stigma, and help seeking stigma were identified. Items were reworded to focus on food insecurity as the object of stigma with items capturing general stigma, personalized stigma, disclosure concerns, public attitudes, negative self-image, and perceived discrimination. The goal was to create a parsimonious scale that could be included in large survey and clinical trials. The 62 items were administered to 150 food insecure adults enrolled in a food insecurity trial for adults with type 2 diabetes. Items were on a scale of 1 (strongly disagree) to 5 (strongly agree) with higher values suggesting higher food insecurity stigma. Exploratory factor analysis was used to extract items that loaded at >=0.8 on a single factor. Cronbach’s alpha and McDonalds omega were used to assess reliability. Discriminatory power was assessed via independent association with clinical, QOL, and psychosocial variables using multiple linear regression. Results: 12 items loaded at >=0.8 on 1 factor, eigenvalue 9.18, explaining 76.5% of variance. Cronbach’s alpha was 0.971 and McDonalds omega was 0.972. The scale was created by summing item scores (range: 12-60). The mean score was 27 (sd=12.2). After adjustment for age, sex, race, education, income, employment, insurance and comorbidities, the food insecurity stigma scale was significantly associated with higher food insecurity (b=0.04, p=0.003) and depression (b=0.12, p=0.001); lower mental health related quality of life (b=-0.03, p=0.04), empowerment (b=0.015, p=0.002), and diabetes self-efficacy (b=-0.09, p=0.01). Conclusion: The 12-item food insecurity stigma scale is a valid and reliable measure of food insecurity stigma. This scale can be used in research and clinical encounters to identify individuals likely to deny food insecurity due to stigma. Disclosure: J.A. Campbell: None. R.J. Walker: None. L.E. Egede: None. Funding: American Diabetes Association (1-19-JDF-075), National Institutes of Health (R01MD013826)