Assessing Readiness of Health Professions Students to Work With Patients Who Use Drugs: Construct Validity of the REDUCE-HARM Addiction Curricula Survey Tool

Abstract

Background:

The REadiness to Discuss Use, Common Effects, and HArm Reduction Measure (REDUCE-HARM) is a new survey instrument with 2 subscales intended to assess attitudes toward substance use and confidence in core addiction topics among health professions students. Previously, we validated its content via a modified Delphi process with interdisciplinary experts across the United States. This study assessed the construct validity and reliability of REDUCE-HARM among students in health professions to be used in developing and evaluating addiction-related curricula.

Methods:

We sent the REDUCE-HARM to early-training nursing, nurse practitioner, pharmacy, and medical students using class-wide email distribution lists at 7 academic medical centers in the United States from December 2021 to October 2022. We evaluated construct validity and reliability for the complete REDUCE-HARM instrument and the attitudes and confidence subscales using psychometric testing. We used t-tests to compare scores between those with and without prior addiction-related experience.

Results:

Of the 288 participants, 26% were nurses, 9.7% were nurse practitioners, 30.2% were pharmacists, and 34.0% were medical; 52.8% had prior addiction-related experiences. Principal component analysis and confirmatory factor analysis demonstrated a 2-factor structure of the REDUCE-HARM that corresponded with the subscale constructs of attitudes and confidence. Cronbach’s alphas were .912 (95% confidence interval [CI] .896-.925), .798 (95% CI .765-.827), and .938 (95% CI .925-.947) for the complete REDUCE-HARM, attitudes subscale, and confidence subscale, respectively. There were significantly higher mean attitude scores (59.8 vs 57.8; scale: 12-72; P = .021) and mean confidence scores (46.8 vs 37.3; scale: 12-72; P < .001) for students with prior addiction-related experiences compared to students without.

Conclusions:

Our analysis supports the construct validity and reliability of the REDUCE-HARM among early trainee U.S.-based health professions students and the benefit of direct addiction-related experiences. Future research should evaluate responsiveness to addiction-related educational programs and with additional trainee populations.