Assessment of a "Transgender Identity Stigma" scale among trans women in India: Findings from exploratory and confirmatory factor analyses

Background: Sexual minority stigma has been shown to influence mental health and sexual risk, but limited research is available on measuring transgender-identity stigma among trans women in India. We adapted an Exposure to Transphobia scale to the Indian context and tested a 14-item Transgender Identity Stigma Questionnaire (TGISQ) among trans women in India. We aimed to assess and validate the factor structure of the TGISQ and to assess its reliability. Methods: Data were from a cross-sectional survey among 300 trans women (including hijras/thirunangais) from six urban/semi-urban sites in India. The TGISQ consisted of self-reported ratings on 14 items. We initially conducted exploratory factor analysis, using principal axis factoring (PAF) and promax rotation, and assessed reliability (internal consistency) using Cronbach's alpha; we then conducted confirmatory factor analysis to assess construct validity (factorial validity). Construct validity of the final 13-item Transgender Identity Stigma Scale (TGISS) was also examined by computing Pearson's correlations between TGISS and relevant theoretical constructs (e.g., depression, social support). Results: PAF identified two factors: enacted stigma (5 items) and felt normative stigma (8 items). The final 13-item TGISS had high reliability and acceptable construct validity. Conclusions: The TGISS was found to have adequate psychometric properties, making it the first valid and reliable scale to measure stigma and discrimination faced by trans women in India. Future studies can further refine TGISS, which might help in comparing the differences in stigma experiences among diverse subgroups of trans women, and in monitoring and evaluating the success of stigma reduction programs.