Cross-Cultural Adaptation and Validation of the (Re)-emerging and ePidemic Infectious Diseases Stigma Scales in Thailand: A Study Protocol

Background Stigma associated with infectious diseases prevents people from seeking healthcare and undermines outbreak control efforts. This problem affects marginalized populations most severely because they face multiple forms of discrimination during health emergencies. Thailand lacks validated instruments to measure how vulnerable groups experience stigma during outbreaks. This study will adapt and validate the (Re)-emerging and ePidemic Infectious Diseases (RAPID) Community and Self Stigma Scales in two communities in Thailand: (1) mpox-related stigma among Thai men who have sex with men (MSM) and (2) COVID-19 related stigma among Myanmar migrants. Methods The study has two phases. Phase 1 takes six months and follows the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines for cultural adaptation and translation. Professional translators will translate the RAPID scales into Thai and Burmese using forward-backward methods. Eight experts per community will complete three rounds of Delphi evaluation. Cognitive interviews with 15 to 20 members of each community will refine the instruments. Phase 2 requires separate ethics approval and will validate the adapted scales with 400 participants (200 per community). Validation will include confirmatory factor analysis, reliability testing, and validity assessment. Expected Outcomes This research will create the first validated tools for measuring how Thai MSM communities and Myanmar migrants experience stigma during infectious disease outbreaks in Southeast Asia. The Thai and Burmese versions of the RAPID scales can be deployed quickly during future outbreaks to monitor stigma in real time. The instruments will help health systems identify barriers to care and design interventions that address structural, interpersonal, and internalized forms of stigma. These tools may prove useful throughout Thailand and other countries in the region.