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Journal of General Internal Medicine

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Substance abuse, Interdisciplinary approach in education, Higher Education, Surveys and studies in adult education


Background: As health profession schools implement addiction curricula, they need survey instruments to evaluate the impact of the educational interventions. However, existing measures do not use current non-stigmatizing language and fail to capture core concepts.

Objective: To develop a brief measure of health profession student readiness to work with people who use drugs (PWUDs) and establish its content validity.

Methods: We conducted a literature review of existing instruments and desired clinical competencies related to providing care to PWUD and used results and expert feedback to create and revise a pool of 72 items. We conducted cognitive interviews with ten pre-clinical health profession students from various US schools of nursing, pharmacy, and medicine to ensure the items were easy to understand. Finally, we used a modified Delphi process with twenty-four health professions educators and addiction experts (eight each from nursing, pharmacy, and medicine) to select items for inclusion in the final scale. We analyzed expert ratings of individual items and interdisciplinary agreement on ratings to decide how to prioritize items. We ultimately selected 12 attitudes and 12 confidence items to include in the REadiness to Discuss Use, Common Effects, and HArm Reduction Measure (REDUCE-HARM). Experts rated their overall assessment of the final scale.

Results: Twenty-two of twenty-four experts agreed or strongly agreed that the attitudes scale measures student attitudes that impact readiness to work with PWUDs. Twenty-three of twenty-four experts agreed or strongly agreed that the confidence scale measures student self-efficacy in competencies that impact readiness to work with PWUDs. Seven of 72 initial items and none of the 24 selected items had statistically significant differences between disciplines.

Conclusions: The REDUCE-HARM instrument has strong content validity and may serve as a useful tool in evaluating addiction education. Additional research is needed to establish its reliability, construct validity, and responsiveness to change.


© 2022 Springer Nature Switzerland AG. Part of Springer Nature.


This is the author’s final version of a work that was accepted for publication in the Journal of General Internal Medicine. Changes resulting from the publishing process, such as editing, corrections, formatting, and other quality control mechanisms may not be reflected in this document. A definitive version was subsequently published in Journal of General Internal Medicine. Epub 2022 Apr 13.



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