Reviewer's report
Title:Preliminary development of a scale to measure stigma relating to sexually
transmitted infections among women in a high risk neighbourhood
Version: 1Date:2 May 2008
Reviewer: Bronwen Lichtenstein
Reviewer's report:
Research Question
The research question is well defined. The authors correctly note that
gender-specific stigma scales for STIs do not exist (at least, I have not seen any
scales that could be defined as gender-specific). The paper has the potential to
make an important contribution to the literature.
Data and Methods
I am not a statistician, have not developed quantitative scales, and would prefer
not to comment on the soundness of the methodology.
COMPULSORY REVISIONS
Rationale
What led to the study being conducted? The rationale for the research should be
stated in methods or introduction.
Sample
The paper needs to include a table or description about the sample. The authors
mention sampling from women at a local community health clinic in a high risk
neighborhood but specifics are needed on ethnicity, age, income, risk category,
and so on. On page 7, the authors state that the 27-item survey was used to
gather sociodemographics and other information. Why were the women
attending the clinic?
Comments
The authors are correct in noting that Goffman organized stigma into three
categories (physical, individual, and tribal). It is logical to organize the paper and
scales in this way. However, the “tribal” descriptor is confusing (not to mention
outdated), especially when appearing with statements about Aboriginal women. I
suggest using the tribal descriptor once in the introduction (page 4), followed by
“group” or “group-specific” in parenthesis. “Group-specific” could then be used
throughout the paper except when discussing Nack’s “tribes of womanhood” on
page 5.
However, this leads to the main difficulty I have with the manuscript. I would like
to know why “sleeps around,” “should know better,” “damaged goods,” and “Isn’t
careful,” (i.e. judgemental statements) are considered tribal when “bad person” is
not (see Table 2, columns 1 and 2). Goffman distinguished between felt stigma
(shame – internalized stigma) and enacted stigma (blame – social stigma)
regarding discrediting behavior, and reserved the “tribal” category for stigmas of
race, nation, and religion (see Goffman’s book Stigma, page 4). Perhaps the item
labels could be re-labeled to clarify this point, or the authors could justify why the
“tribal” category is being applied to social identities rather than to race/ethnicity,
religion, and national origin, which are much broader categories. I might begin
with arguing that sexual orientation results in a group-specific stigma for gay men
and women, but the “tribes of womanhood” category is a fuzzier concept to justify
in a conceptual model. This conceptual difficulty could have led to the tribal
stigma scale not being significantly different among participants (page 11).
MINOR ESSENTIAL REVISIONS
Tables
Table 1: This table does not appear to be indexed in the text.
Table 3: “Item” is missing from the top row.
Writing
The writing is acceptable. I suggest the following minor edits:
1) Abstract: Results: judgement by others, not judgement from others.
2) Introduction: write sexually transmitted infections in full on the first occasion,
abbreviate thereafter.
3) Page 4: write “foundational” rather than “seminal.” Page 4 needs further
editing (e.g., “that” is missing between “soldiers” and “some states;” there are
instances of awkward phrasing in paragraph 2.
4) Page 4: Which previous century – 19th or 20th?
5) The Nack reference on page 5 may be incorrect – is the date 2000 or 2002?
(The latter seems likely).
6) Page 11, paragraph 2: “affected” not “effected.”
7) Page 12, paragraph 1: “This” is mentioned twice in the first sentence.
8) The last sentence of the paper is rather weak. A more pointed
recommendation would be useful.
DISCRETIONARY REVISIONS
It might have been useful to compare women who had been diagnosed with STIs
and those who had not for stigma differences.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests.