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Testing an instrument to measure multidimensional treatment entry pressures in patients undertaking methadone maintenance treatment

First published: 10 May 2019 | Last updated: 20 May 2019

Aims: While methadone maintenance treatment (MMT) has been shown to be effective in reducing opioid drug harm less is known about what encourages people to enter and remain in this treatment.  A literature review indicated that multidimensional pressures to enter treatment, e.g. deteriorating physical health or family conflict, might be important.  While efforts have been made to measure these pressures, further work was required to enhance the reliability and validity of an instrument which had been developed, i.e. the STEP-UP.  The aim of the study was therefore to undertake an examination of psychometric properties of the STEP-UP.

Design: The study used a test re-test design to analyse test re-test reliability and internal consistency. Content validity was determined from the examination of the STEP-UP by members of an expert panel.

Setting: The setting comprised three NHS drug treatment services in the West of Scotland

Participants: Twenty six participants were recruited all of whom all had been undertaking MMT for at least six weeks.

Measurement: The original version of the STEP-UP comprised 121 items in 20 subscales.  Each item invited one of four responses yielding a score of 0, 1, 2 or 3. The STEP-UP was administered to the study participants on two occasions two weeks apart

Findings: The analyses of the reliability and internal consistency of the STEP UP resulted in the deletion of 51 items. The content validity analysis resulted in the deletion of some items and the rewording of others.  This resulted in a substantially modified questionnaire comprising 46 items with demonstrable reliability and validity.  This shorter questionnaire should be easier to administer and should reduce the risk of bias due to participant fatigue.

Co-Authors

Professor Hazel Watson, Glasgow Caledonina University Dr Angus McFadyen, AKM-Stats Dr Dave Johnson, Consultant Psychiatrist, NHS Highland Dr Susan Kerr, Glasgow, Caledonian University

Conflicts of interest:

Part funded by Argyll and Clyde Health Board and part self funded, no declaration of interest.

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Report Author

Dr David Greenwell

Independent Researcher


David Greenwell graduated from the University of Hull in  1977 and later undertook mental  health nurse training completing this in 1985.  David worked at the alcohol unit at Gartnavel Hospital in Glasgow then at the therapeutic community at Charing Cross in Glasgow completing a post graduate diploma in alcohol studies.  He started work as a Community Psychiatric Nurse (Addictions) in 1990 and went on to be the Clinical Coordinator for local addiction services in the Dumbarton area.  He was appointed Addiction Network Coordinator and Directorate Lead Nurse for Argyll and Clyde Health Board in 2002.  David became a Professional Lead for Addictions with NHS Highland in 2006 and graduated with a PhD from Glasgow Caledonian University in 2013. During his career David has a leadership role in the development of several new alcohol and drug services and has recently been involved in the development of the new Alcohol and Drug Information System for Scotland (DAISy).

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