Agreement degree with the content of the Substance Addiction Consequences Scale items - The development of a new instrument.

Background: The Substance Addiction Consequences Scale (SAC) is originated from the Nursing Outcome Classification in 2004(1) but, until 2013, no research was published in the literature. Content validation was then carried out by experts consensus, with the definition of 24 indicators, with an operational definition and measurable criteria(2). Later, a clinical validation study was carried out in which, after analyzing its psychometric properties, the scale was reduced to 16 indicators organized by 4 dimensions (Psycho and Family, Physical and Cognitive, Self-Care, Economic and Work)(3).

The multifactoriality of the scale has aroused interest in clinical research as a way of bringing evidence to the professionals' interventions but, the subjectivity of the items has, as in other instruments, alerted to the need for consensualization(4).

Aim: Determine the agreement degree of the measurable indicators of the content of the SAC scale items.

Methods: A mixed method was used. Quantitative to determine the agreement degree between scale users and qualitative content analysis of the suggestions.
The scale was used in the consultations carried out by 5 nurses in an outpatient treatment unit of drug addicts in the Lisbon area. These nurses have a mean age of 43.6 (SD = 4.93) [37-49] and with the average exercise time with drug addicts 11.2 years (SD = 5.9) [2-16].

They responded to the agreement degree on a likert-scale (1 do not agree at all, 2 do not agree in part, 3 agree, 4 strongly agree, 5 completely agree). The respondents made their assessment 6 months after they started to use in which they applied with 170 users (1/7/2018 to 25/1/2019). It was decided to analyze in this study only indicators content of those with an average of less than or equal to 3.

Results: The quantitative evaluation showed content agreement of most items between 2.60 and 4.60. There were only 2 items with a value equal to or less than 3. Item 6 (3.00) and item 10 (2.60).

In the content suggestions analyses, the need for uniformity and objectivity in the application of the scale emerges, namely in the indicators to ask to greater gravity assignment. For item 6 "Difficulty in memorizing events from the daily routine" it was suggested only more objective formalization of how to ask / validate with the user, with nothing to question in the operational definition.

For item 10 "Maintenance of multiple drug use" it was suggested to value in gravity weighting, other substances such as caffeine and nicotine (nicotine dependence test) and their frequency. It is suggested, as well, that some items could become less subjective if the scale had a range of 1-10.

Conclusions:

The SAC scale at this time is a very useful tool for nursing consultations with drug addicts, namely to support the definition of diagnoses, to facilitate a global view of the person, to monitor in a perspective of treatment or harm reduction and still directing interventions to the most affected areas(3). In this, as in other instruments, researchers and clinicians should standardize the contents of each indicator for better diagnostic accuracy(4).