Study protocol summary
Thailand has no validated way to measure stigma during an outbreak — this is the plan to build one in two languages
Summarising the article
Cross-Cultural Adaptation and Validation of the (Re)-emerging and ePidemic Infectious Diseases Stigma Scales in Thailand: A Study Protocol
Assoc. Prof. Dr. Smith Boonchutima · Wellcome Open Research · 2026
Study protocol
This is a research plan published before any data was collected. The journal reviews the method up front so that what gets reported later can be checked against what was announced — so there are no results on this page, only the question, the method, and what the team intends to do.
The question
Stigma keeps people from seeking care and undermines outbreak control, yet Thailand has no validated instrument for measuring how vulnerable groups experience it. This protocol sets out a plan to adapt and validate one for the Thai and Burmese contexts.
How it will be done
The RAPID Community and Self Stigma Scales — 16 items in total — will be translated into Thai and Burmese following ISPOR guidelines, using forward and back translation. The work runs in two phases. Phase 1 puts the translations to two expert panels of eight members each across three Delphi rounds, then to cognitive interviews with 15 to 20 members of each community. Phase 2 validates the adapted scales with 400 participants (200 per community) through confirmatory factor analysis and reliability testing.
What the study will do
- The two communities are Thai men who have sex with men, for mpox-related stigma, and Myanmar migrants, for COVID-19-related stigma.
- The expert panels are designed to include community members from the start, not only academics — each panel of eight comprises two community leaders with lived experience, two health specialists working with that group, two researchers, one language expert and one cultural expert.
- Decision thresholds are declared in advance. Items scoring below 0.78 on the item-level content validity index go back for revision, and the final round targets more than 80% of experts rating face validity highly and an overall scale-level index above 0.90.
- Phase 2 requires a separate ethics approval and uses quota sampling to cover five subgroups in each community: recovered individuals, close contacts, healthcare workers, outbreak support staff and general community members.
Why this plan matters
If the plan runs to completion, Thailand would have an instrument ready to deploy the moment the next outbreak begins, rather than starting to design a questionnaire once events are already moving — which is the authors' stated reason most stigma instruments arrive too late to inform anything. And because the source scales were built to work across diseases, the Thai and Burmese versions would not be tied to any single one.
What to know before citing this
This is a plan, not a result. No data had been collected at publication, the document states that ethics approval was still pending, and Phase 2 requires a separate approval of its own. Sampling is by quota rather than random selection, so the eventual results will speak to the quality of the instrument and not to the level of stigma in the wider population. The published version carries one approving independent peer review.
Cite this work
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Hlaing, P. H., Cheah, P. Y., Poomchaichote, T., Kulpijit, N., Myint, S. T., Mukaka, M., Paterson, A., Pannengpetch, S., Viriyasitavat, W., & Boonchutima, S. (2026). Cross-cultural adaptation and validation of the (Re)-emerging and ePidemic Infectious Diseases stigma scales in Thailand: A study protocol. Wellcome Open Research, 11, 151. https://doi.org/10.12688/wellcomeopenres.26014.1
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