Development of the Adolescent Opioid Safety and Learning (AOSL) scale using exploratory factor analysis

BACKGROUND: While adolescents in the United States are one of the most affected groups by the opioid crisis, their perceptions on opioid misuse and preferences for education are rarely studied. Although it is critical to educate adolescents on proper opioid use and storage, many educational tools need easy measurement scales to systematically document learning of targeted programs. It is essential to understand adolescents’ knowledge about opioid risks and perceptions about the opioid crisis to design effective preventive interventions. OBJECTIVE: The purpose of this study was to develop an effective scale that measures adolescents’ knowledge about opioid misuse and interest in learning about prescription opioid safety. METHODS: Using survey data from 188 high school students in the Midwest, exploratory factor analysis (EFA) was used to examine the underlying structure of an initial 68 items. Items were adapted from a statewide survey previously designed to document awareness of prescription drug misuse and abuse in the state of Wisconsin. Refinement of the scale used factor analysis iterations and internal consistency measures. Cronbach’s alpha was used to determine internal consistency among the items. RESULTS: Three exploratory factor analysis iterations resulted in a 16-item four-factor structure describing adolescents’ knowledge of misuse and harm, their interest in learning about prescription opioids, and their tendency to practice misuse behaviors. Internal consistency and the correlation among factors were examined and strong (Cronbach’s α > 0.8). The final 16-item instrument was termed the Adolescent Opioid Safety and Learning (AOSL) Scale. CONCLUSIONS: When combined with adolescent opioid education tools, the AOSL Scale can help assess and document medication safety learning. The four subscales could support researchers and practitioners in measuring adolescents’ orientation towards prescription opioid misuse. The AOSL Scale may also be used in developing targeted educational materials on prevention of opioid misuse for adolescents.