Assessing Diabetes Stigma in German People With Diabetes: Psychometric Validation of the German Versions of the Diabetes Stigma Assessment Scales (DSAS-1 and DSAS-2).

AIMS: To develop and evaluate the German versions of the Diabetes Stigma Assessment Scales for type 1 (DSAS-1) and type 2 diabetes (DSAS-2).

METHODS

The questionnaires were translated using a standardized translation and back-translation procedure. Adults with type 1 (N=636) and type 2 diabetes (N=177) completed the DSAS-1 and DSAS-2 via an online panel. Factor analyses, internal consistency (Cronbach's α), and correlations with convergent measures and discriminant constructs were conducted to assess reliability and validity.

RESULTS

For the DSAS-1, the expected three-factor structure was confirmed; for the DSAS-2, a two-factor solution emerged, although a forced three-factor analysis supported the original structure with minor cross-loadings. Scale consistencies were excellent (DSAS-1: 0.94, DSAS-2: 0.95, and subscales: 0.86-0.93). Both scales showed good concurrent, convergent and discriminant validity. The DSAS-2 showed stronger associations with weight self-stigma and self-esteem than the DSAS-1, consistent with its focus on internalized stigma. Three in four persons (type 1 diabetes: 74% and type 2 diabetes: 72%) endorsed at least one stigma item, mostly related to "blame and judgement."

CONCLUSIONS

Diabetes stigma constitutes an important psychosocial problem. The German DSAS-1and DSAS-2 are reliable, valid instruments for assessing diabetes stigma. Blame and judgement appeared as the most common form of stigma experienced in this sample.