COVID-19 related stigma among the general population in Iran

Masoomeh Faghankhani, Hossein Nourinia, Ali Ahmad Rafiei-Rad, Aliyeh Mahdavi Adeli, Mohammad Reza Javadi Yeganeh, Hamid Sharifi, Hamidreza Namazi, Shaghayegh Khosravifar, Alaleh Bahramian, Mahdi Fathimakvand, Elnaz Golalipour, Fatemeh Sadat Mirfazeli, Hamid Reza Baradaran, Graham Thornicroft, Amir Hossein Jalali Nadoushan*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)
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Background: COVID-19 related stigma has been identified as a critical issue since the beginning of the pandemic. We developed a valid and reliable questionnaire to measure COVID-19 related enacted stigma, inflicted by the non-infected general population. We applied the questionnaire to measure COVID-19 related enacted stigma among Tehran citizens from 27 to 30 September 2020. Methods: A preliminary questionnaire with 18 items was developed. The total score ranged from 18 to 54; a higher score indicated a higher level of COVID-19 related stigma. An expert panel assessed the face and content validity. Of 1637 randomly recruited Tehran citizens without a history of COVID-19 infection, 1064 participants consented and were interviewed by trained interviewers by phone. Results: Item content validity index (I-CVI), Item content validity ratio (I-CVR), and Item face validity index (I-FVI) were higher than 0.78 for all 18 items. The content and face validity were established with a scale content validity index (S-CVI) of 0.90 and a scale face validity index (S-CVI) of 93.9%, respectively. Internal consistency of the questionnaire with 18 items was confirmed with Cronbach’s alpha of 0.625. Exploratory factor analysis revealed five latent variables, including “blaming”, “social discrimination”, “dishonor label”, “interpersonal contact”, and “retribution and requital attitude”. The median of the stigma score was 24 [25th percentile: 22, 75the percentile: 28]. A large majority (86.8%) of participants reported a low level of stigma with a score below 31. None of the participants showed a high level of stigma with a score above 43. We found that the higher the educational level the lower the participant’s stigma score. Conclusion: We found a low level of stigmatizing thoughts and behavior among the non-infected general population in Tehran, which may be due to the social desirability effect, to the widespread nature of COVID-19, or to the adaptation to sociocultural diversity of the large city.

Original languageEnglish
Article number1681
JournalBMC Public Health
Early online date5 Sept 2022
Publication statusPublished - Dec 2022

Bibliographical note

Funding Information:
GT is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration South London at King’s College London NHS Foundation Trust, and by the NIHR Asset Global Health Unit award. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. GT is also supported by the Guy’s and St Thomas’ Charity for the On Trac project (EFT151101), and by the UK Medical Research Council (UKRI) in relation to the Emilia (MR/S001255/1) and Indigo Partnership (MR/R023697/1) awards.

Publisher Copyright:
© 2022, The Author(s).


  • COVID-19
  • Cross-sectional studies
  • Enacted stigma
  • Iran
  • Mental health
  • Pandemics
  • Social stigma
  • Surveys and questionnaires
  • Urban population


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