Cultural Adaptation and Psychometric Validation of the (Re)-emerging and ePidemic Infectious Diseases Stigma Scales in a Representative German Population Sample

Beyond their direct health effects, infectious disease outbreaks have significant social repercussions, with stigmatization emerging as a particularly important concern (Saeed et al., 2020). In this context, stigmatization refers to a social process in which individuals or groups associated with an infectious disease are labeled, stereotyped, and devalued, often resulting in discriminatory treatment and a loss of social status (Link & Phelan, 2001; Stangl et al., 2019). Several infectious diseases, among them SARS, MERS, Influenza (H1N1, H5N1), Zika, Yellow Fever, Ebola, and Viral Haemorrhagic Fever, share defining characteristics: rapid escalation of infection rates, serious implications for public health, and a tendency to provoke stigmatizing attitudes and discriminatory behaviors (Yuan et al., 2022). The COVID-19 pandemic serves as a recent illustration of how stigma can become a central challenge in such contexts. Ambiguity surrounding transmission routes and disease outcomes fueled stigmatizing reactions toward those with confirmed diagnoses, their close contacts, and individuals displaying characteristic symptoms (Bagcchi, 2020; Morens & Fauci, 2020; Peprah & Gyasi, 2021; Ransing et al., 2020; Saeed et al., 2020). Healthcare workers (HCWs) were equally affected during the COVID-19 pandemic, facing stigmatization because of their association with potentially infectious patients (Al Houri et al., 2022; Danqa et al., 2025; Faller et al., 2020; Schubert et al., 2021; Taylor et al., 2020). To prepare for future infectious disease outbreaks, researchers from a consortium led by Oxford University developed the (Re)-emerging and ePidemic Infectious Diseases Stigma Scales (RAPID)(Paterson et al., 2025) as a tool to screen for emerging stigma. The scale is made up of two scales: RAPID community and RAPID self. These assess perceived social stigma towards, and anticipated self stigma of, persons infected with an infectious disease. The disease may be replaced with any infectious disease of current interest. The 12-item RAPID community scale is designed with four subscales (initial social stigma, provider or authority-related stigma, structural stigma, and enduring social stigma), while the 4-item RAPID self is unidimensional. The scales were rigorously tested for their validity and reliability across three outbreak contexts: mpox, Ebola disease, and Nipah virus disease (Paterson et al., 2025). The aim of this study is 1) to translate and culturally adapt the RAPID Stigma Scales for the German general population and 2) to test it’s psychometric properties in a German representative population sample. To a achieve this the scales were translated using the ISPOR guidelines for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) (Wild et al., 2005). After an initial translation the scales underwent rounds of cognitive debriefing with members of the German general public. The so developed versions of the RAPID community and RAPID self were then used in a representative survey of the German general public (N = 1006). The collected data is then used to assess the psychometric properties of both scales. Our aim is to test if the proposed factor structure in Paterson et al. (2025) holds in a German sample and if the scales prove sufficient internal consistency. Additionally, we test the construct validity. To analyze the constructs positions in the nomological network we assess convergent and divergent validity using other scales from the survey.