Sample Characteristics
Table 1 presents the sociodemographic and clinical characteristics of the sample. The mean age of the sample was 47.10 ± 9.10, ranging from 19 to 75 years old. They were mostly married (81.2%), unemployed (83%) and of Fars (63%) or Turkic (26%) ethnicity. The majority had a poor educational background (77.8%), received chemotherapy (61.4%) and underwent mastectomy (70%).
The rate of Stigmatization
Figure 1 presents the statements of SSCI-8 with respect to the ratings of the patients, along with the descriptive statistics of enacted, internalized and total stigma experienced by patients. The mean of total stigma was 11.75±5.56, from the attainable score range of 8 to 40, which showed a very low rate of stigmatization in the sample. This was also true for both enacted and internalized stigma with mean scores of 6.99±3.44 and 4.77±2.63, respectively. Overall, this indicates that Iranian breast cancer women had experienced a very negligible amount of stigma in association with their condition.
As it is further illustrated in figure 1, about 41.7% (n=93) reported that neither they experienced any sort of enacted stigmatization nor did they internalize the stigma of their condition. However, 58.3% (n=130) of the sample reported that they experienced stigmatization from at least “rarely” up to a more frequent basis of “always” in their course of the disease. Of them, 12% (n=27) had experiences of being avoided by people, 10.7% (n=24) felt that they were abandoned by others, 11.2% (n=25) stated that some people turned their faces away from them, 21.6% (n=48) felt embarrassed by their illness, 14.9% (n=34) stated that there were some people who seemed to feel uncomfortable at the patients’ problems, 21.5% (n=48) were in the shame of their physical limitations, 8% (n=18) were treated unkindly, and 17.9% (n=40) were treated by other people as if the fault of disease lied with the patients. Patients reported these experiences in a frequency range of sometimes to always, indicating that there were a considerable number of women who were still under influence of stigmatization.
Correlates of Stigmatization
As the univariate models are summarized in Table 2, having more children (OR = 1.23, 95%CI = [1.03, 1.47], lower education of father (OR = 1.69, 95%CI = [.99, 2.90]), lower education of spouse (OR = 3.39, 95%CI = [1.82, 6.31]), being of Turkic ethnicity (OR = 1.91, 95%CI = [1.00, 3.65]), being unemployed (OR =1.82, 95%CI = [.90, 3.71], living with spouse (OR = 1.92, 95%CI = [1.00, 3.66]), lower education of patient (OR = 1.92, 95%CI = [.98, 3.78]), higher BMI (OR = 1.06, 95%CI = [.99, 1.22]), menstrual irregularities (OR = 1.30, 95%CI = [.95, 1.78]), previous hospitalization (OR = 1.63, 95%CI = [.95, 2.80]), radiotherapy (OR = 1.75, 95%CI = [1.00, 3.04]), and life history ≥ 2 (OR = 1.72, 95%CI = [.99, 3.01]) significantly associated with the stigmatized group. However, only lower education of father (OR = 1.68, 95%CI = [.97, 2.91]), lower education of spouse (OR = 2.84, 95%CI = [1.55, 5.21]), and radiotherapy (OR = 1.60, 95%CI = [.93, 2.76]) remained as the significant correlates of higher stigma.
Table 3 reports the multi-variable models for the total sample and the subsample merely confined to the patients whose data regarding their spouse’s education was available. In the total sample (n=223), the Turkic ethnicity (OR = 1.94, 95%CI = [.93, 4.03]), living with spouse (OR = 2.15, 95%CI = [1.03, 4.50]), and family history of chronic diseases (OR = 1.69, 95%CI = [.92, 3.10]) were the significant correlates of stigmatization, while no variable was found to be associated with heavily stigmatization. After exclusion of patients with missing data regarding their spouse’s education, in the remaining subsample (n=185), lower education of spouse (OR = 3.23, 95%CI = [1.48, 7.04]), living with spouse (OR = 3.57, 95%CI = [1.10, 11.55]), and family history of chronic diseases (OR = 2.18, 95%CI = [1.06, 4.50]) were the significant correlates of stigmatization. BMI was also a weak yet significant correlate of the latter group (OR = 1.07, 95% CI = [.99, 1.15]). In terms of heavily stigmatization in this subsample, only the lower education of the spouse surfaced as the significant correlate (OR = 2.85, 95%CI = [1.39, 5.86]).