Researchers have developed and tested a set of questionnaires designed to measure stigma linked to COVID-19, Long Covid and choosing not to get vaccinated, and report that five of the six scales performed well in a nationally representative sample of the German population. The study, published in Archives of Public Health, addresses a gap the authors identify both in Germany, where research on COVID-19-related stigma has been scarce, and internationally, where validated and standardized measurement instruments have been lacking.
The work responds to a concern that ran through the pandemic: stigma towards certain groups of people accompanied the spread of COVID-19 widely, and such stigma can weaken disease control efforts while worsening the negative impacts of the disease itself.
To build that toolkit, the team surveyed 1,960 people in a nationally representative cross-sectional survey in Germany. Participants had a mean age of 49.8 years with a standard deviation of 17.3, and 55.8 percent were female. Against this sample, the researchers tested six scales. Four of them measure public stigma, meaning the stigmatizing attitudes held by the general population: one directed at people who have had COVID-19, called COVID-PSS; one at people who had the disease multiple times, called MI-PSS; one at people with Long Covid, called LC-PSS; and one at people who chose not to get vaccinated, called nonVac-PSS.
The remaining two scales capture internalized stigma among the stigmatized groups themselves. One, named COINS, measures internalized stigma in individuals who have had COVID-19 at least once. The other, nonVac-IS, measures internalized stigma among those who chose not to get vaccinated.
Each scale was evaluated for its intended factorial structure using confirmatory factor analysis. The scales were also examined for convergent and discriminant validity. The scales were also tested for reliability.
The results were largely positive. All scales except one showed good to excellent fit indices and factor loadings, supporting their intended factorial structures. The exception was the scale for internalized stigma of unvaccinated individuals, the nonVac-IS, which did not perform to the same standard. For the four public stigma scales, convergent and discriminant validity were established.
The picture was more mixed for the two internalized stigma scales. The COINS scale did not converge with a measure of quality of life, but with depressive symptoms. The nonVac-IS scale did not show convergence with presumed related constructs. Across the scales, reliability coefficients indicated good internal consistency among the items.
Taken together, the authors conclude that five of the six scales proved to be valid tools for measuring stigmatizing attitudes related to COVID-19, Long Covid and non-vaccination in a German sample. They suggest the instruments hold promise for two practical purposes: monitoring stigma during infectious disease outbreaks, so that shifts in public attitudes can be tracked over time, and informing the development of public health interventions designed to counteract health-related stigma. Because the validation was conducted in a German population sample, use of the scales elsewhere would depend on further testing in other contexts, and the non-vaccination internalized stigma scale in particular would need additional work before it can be relied upon.
The study arrives as a peer-reviewed, open access article in Archives of Public Health, published on 30 October 2026. That foundation, the authors argue, is what has been missing both in Germany and internationally, and it is a prerequisite for understanding how stigma shapes the course of infectious disease outbreaks and the lives of the people they affect.
Subject of Research: Validation of stigma measurement scales for COVID-19, Long Covid and non-vaccination in a representative German population sample.
Article Title: Measuring infectious disease stigma in the German population: Psychometric properties of stigma scales related to COVID-19, Long Covid and non-vaccination in a representative population sample
Article References: Menzinger, J., Alpers, C., McLaren, T., Danqa, D., Muehlmann, M., Schmidt, S., & Tomczyk, S. (2026). Measuring infectious disease stigma in the German population: Psychometric properties of stigma scales related to COVID-19, Long Covid and non-vaccination in a representative population sample. Archives of Public Health, 84(1), Article 233. https://doi.org/10.1186/s13690-026-02100-0
Image Credits: AI Generated
DOI: 10.1186/s13690-026-02100-0
Keywords: COVID-19, Long Covid, stigma, non-vaccination, psychometrics, validation, population survey, Germany, public health, measurement instruments, Measuring, infectious
News Source: Ophelia Keating. (November 6, 2026). New stigma scales for COVID-19, Long Covid and non-vaccination validated in German population sample. Scienmag.
