Patient Perceptions of Medical Stigma Related to Smoking: Development of a Patient-Reported Experience Measure

Alison C Brecher, Thomas Jefferson University


Health-related stigma is the broad term for stigma associated with a health condition or behavior. Moreover, medical stigma is health-related stigma experienced in a health care interaction. Across a variety of health conditions, the experience of stigma is associated with poorer quality of life, increased illness related stress, and social, physical, and psychological morbidity. Due to tobacco control policies, public health campaigns, and the negative health impacts, smoking is a stigmatized health behavior. As stigma is a known barrier to help-seeking behavior and a facilitator for delays in treatment for smoking-related illnesses like lung cancer, reducing medical stigma for individuals who smoke is an important goal. Medical stigma is also an important aspect of patient experience. Measuring stigma and examining its role in patient experience is one approach to determining how to address medical stigma. Health-related stigma has been measured in a variety of conditions, but there are no existing measures of general smoking stigma nor any measures of medical stigma. Group concept mapping (GCM) is a mixed-methods approach that has been used to directly engage patients in patient-reported experience measure development. GCM was conducted with 23 current or former smokers to conceptualize the patient experience of individuals who smoke. Participants made 116 unique statements about their experiences with the health care system as an individual who smokes. Of those statements, 100 were negative and 93 indicated an experience of stigma. The statements were sorted by participants into piles of similar statements based on meaning. The aggregate of the sorted data was used to create point and cluster maps to show how the statements were related conceptually. The point and cluster maps were used to guide the development of a measure of medical stigma associated with smoking by adapting the 93 statements associated with stigma. This study found that the patient experience of individuals who smoke is broadly negative, potentially leading to poor clinical outcomes. This study addressed the research and measurement gap of medical stigma associated with smoking by engaging patients directly in the development of a pilot measure through the GCM process.

Subject Area

Public health|Quantitative psychology|Social psychology|Toxicology

Recommended Citation

Brecher, Alison C, "Patient Perceptions of Medical Stigma Related to Smoking: Development of a Patient-Reported Experience Measure" (2022). ETD Collection for Thomas Jefferson University. AAI29064595.