Developing the Psychometric Properties of the Harm Reduction Knowledge and Attitude Scale (HRKAS)

Introduction

Harm reduction (HR) services are not widely adopted. Reasons inhibiting the adoption of these services are knowledge and attitudes toward HR. Yet, validated scales remain scarce in the literature. Using two former scales, Harm Reduction Attitude Scale – Revised (HRAS-R) and the Opioid Use Disorder (OUD) scale; this study aimed to develop a new scale, the Harm Reduction Knowledge and Attitude Scale (HRKAS) by revising items from the former to measure HR attitudes and adding new items for measuring knowledge and attitudes. Based in the theory of reasoned action (TRA), the construct intention to learn about HR was included for testing convergent validity.

Method

To achieve our aim in this ongoing study, we collected a nonprobability sample of 104 college students studying health sciences (e.g., social work, public health) through an online survey from a public university in the Midwest. The HRAS-R and OUD were revised based on feedback from two experts in the field and three providers with a focus to reduce stigmatized language. We retained 27 items categorizing them into either a knowledge statement (11 items) with True/False responses or an attitude statement (16 items) using a 4-point Likert scale ranging from completely disagree to completely agree. A preliminary exploratory factor analysis (EFA) with principal axis and oblique rotation methods was conducted for the attitude items, while an EFA with weighted least squares and orthogonal rotation methods for the knowledge items were conducted. Internal consistency reliability and convergent construct validity were examined.

Results

Our sample was predominately female (90%) and White (86%) students, with 47% undergraduate students and a mean age of 25 years old (SD=7.02). On average, the attitude score was 3.26 (SD =0.48), and students answered the knowledge statements correctly 56% of the time. The knowledge EFA produced a two-factor solution with five items loading on the reducing harms factor (29% variance) and three items on the dispelling myths factor (49% variance). The internal consistency reliability for knowledge was 0.70 (reducing harms) and was 0.69 (dispelling myths). The attitude EFA produced a two-factor solution with seven items loading on the abstinence-based factor (25% variance) and eight items on service access and treatment options (49% variance). The internal consistency reliability for attitude was 0.84 (abstinence-based factor) and was 0.85 (service access and treatment options factor). Regarding convergent validity, consistent with the TRA, both knowledge and attitude factors were significantly and positively correlated with intention.

Discussion

The EFA results indicate the HRKAS captures knowledge and attitudes toward HR. The HRKAS has acceptable internal consistency reliability across all factors. Convergent validity was evidenced by significant correlations between knowledge and attitudes of the HRKAS and intention based in the TRA. Dispelling myths, and service access and treatment both explained 49% of the variance for knowledge and for attitude, indicating that programs focused on HR education should ensure that students are equipped with accurate information and are educated about the evidence for HR services and treatment. Future research should validate the HRKAS with a diverse sample and with recovery providers.