Stigma related to male-factor infertility in China: a scale development and validation study

Stigma is a prevalent and serious issue among infertile men, yet no culturally appropriate tools are available to assess their experiences in China. This study aimed to develop and validate the Male Infertility Stigma Scale (MISS) to measure stigma among Chinese men with male-factor infertility. This study employed a sequential exploratory mixed-methods design. The scale was developed through literature review, semi-structured interviews with patients (n = 10) and healthcare professionals (n = 5), and two rounds of expert consultation (n = 9). Following pilot testing (n = 20), a cross-sectional survey of 432 infertile men was conducted at the Center of Reproductive Medicine, Third Affiliated Hospital of Guangzhou Medical University between February and May 2019. The sample was randomly divided for exploratory factor analysis (EFA, n = 216) and confirmatory factor analysis (CFA, n = 216). Reliability analyses, including internal consistency and test-retest analysis (n = 18), were performed using IBM SPSS Statistics 21.0 and AMOS Statistics 24.0. The final 18-item MISS comprises three dimensions: social marginalization (9 items), self-devaluation (6 items), and psychological insecurity (3 items). EFA indicated that these three dimensions explained 60.14% of the total variance. CFA demonstrated good model fit (χ²/df = 3.230, RMSEA = 0.076, CFI = 0.918, GFI = 0.893). The scale exhibited excellent internal consistency (Cronbach’s α = 0.951), split-half reliability (0.884), and test-retest reliability (ICC = 0.945). Content validity was strong (I-CVI: 0.800–1.000, S-CVI = 0.988), and convergent validity was supported by significant negative correlations with the Self-Esteem Scale (SES) (r=-0.209 to -0.443, all p < 0.01). The MISS demonstrates satisfactory reliability and validity, providing a culturally appropriate tool for assessing stigma among Chinese men with male-factor infertility. This instrument can facilitate early identification of individuals experiencing high stigma levels, guide targeted interventions, and advance research on male infertility stigma reduction.