Development and Psychometric Validation of a Scale for Measurement of Tramadol Abuse

There are indications that the practices or behaviour involving tramadol use have not been measured with valid and reliable tools in the past. A scale that can be used to identify tramadol abuse practices in both clinical and non-clinical settings would be useful for possible intervention efforts. The objective of this study was, therefore, to develop and validate a scale to measure tramadol abuse. The scale items were sourced from the literature and outcomes from focus group discussions (FGDs) with 16 longterm tramadol users who were screened with Q-cup urine drug test kit (Q-CUDTK). Six experts and 30 long-term tramadol users were engaged for content and face validations of the items respectively. For construct validation, 180 tramadol users participated. Exploratory factor analysis (EFA) was applied to identify the underlying factor structure of the scale and Cronbach’s alpha was computed for the scale internal consistency. Two items failed to meet the I-CVI (item-content validity index) cut-off point (I-CVIs < 0.83) and were deleted leaving 18 items with the S-CVI (scale-validity index) of 0.93. Three more items were deleted for having factor loadings below 0.50 leaving 15 items. The EFA resulted in the extraction of three factors: frequency of use (7 items), intensity of use (5 items) and pattern of use (3 items) with the reliability coefficients of 0.95, 0.96 and 0.89 respectively. We named this scale ‘Tram-BEHAV’ because it can be used to identify tramadol abuse behaviour for possible intervention. It can also be used for the evaluation of tramadol abuse intervention programmes.