Translation, Adaptation, and Validation of the Stigma of Occupational Stress Scale Among Swedish Healthcare Workers

Abstract Stigma, i.e., negative social attitudes linked to mental health issues, may hinder help-seeking among healthcare workers. This study aimed to translate and culturally adapt the 11-item Stigma of Occupational Stress Scale for doctors (SOSS-D) to the Swedish context, and to evaluate its psychometric properties among doctors, registered nurses, and nurse assistants in Sweden. In addition, criterion-related validity was examined by assessing associations between the SOSS-D and self-rated burnout. SOSS-D was translated using back-translation with a monolingual test, and culturally adapted through focus group interviews. The Swedish version was subsequently validated among healthcare workers using the 2023 Longitudinal Occupational Health survey of Healthcare in Sweden (LOHHCS), including a representative sample of doctors ( n = 7,780), registered nurses ( n = 7,790), and nurse assistants ( n = 7,748). Confirmatory factor analyses and exploratory structural equation modelling were used to ascertain the most valid factor structure for the data. The statistical validation resulted in a 9-item scale with sub-dimensions: structural (3 items), personal (3 items), and other (3 items) stigma, extending the SOSS-D to include all healthcare workers, i.e., the SOSS-HCW. The dimensions correlated with one another ( r = 0.21–0.47, p < 0.001), and all three were significantly associated with higher levels of burnout (β = 0.09–0.35, p < 0.001). The SOSS-HCW demonstrates satisfactory structural and criterion-related validity in a Swedish healthcare context and can be used to investigate occupational stress stigma and its potential role as a barrier to help-seeking among healthcare workers.