Abstract
Cancer stigma negatively impacts diagnosis, quality of life, and survival outcomes, yet stigma reduction efforts are hindered by the lack of a valid and universal scale to measure cancer stigma. This study aimed to develop and validate a global cancer stigma scale, the Cross-Cultural Oncology Measure for Perception and Awareness of Stigma Scale (COMPASS), which measures internalized, anticipated, and enacted stigma. The scale was developed using mixed methods in two phases: (1) feedback from experts and people with cancer on an initial pool of items, and (2) psychometric validation with people with cancer. Data were collected from two cancer centers in Salt Lake City, Utah, USA, and Lilongwe, Malawi. We examined the scale's initial psychometric properties, including item-total correlation, reliability, factorial validity, and construct validity. Initial qualitative interviews informed the generation and refinement of 50 items, which were then administered to 209 individuals with cancer. Psychometric analysis reduced the scale to 28 items distributed across three stigma domains: anticipated (8 items), internalized (8 items), and enacted (12 items). The refined scale demonstrated satisfactory psychometric properties, with confirmatory factor analysis supporting a three-factor model fit (CFI = 0.859, RMSEA = 0.112, SRMR = 0.063) and strong reliability (Cronbach's alpha: 0.92 to 0.97). Validity was confirmed through strong correlations with related constructs. COMPASS offers a reliable, valid, and cross-culturally applicable tool to measure the magnitude and impact of cancer stigma globally and facilitate the evaluation of stigma reduction interventions.