A hindrance to proper health care: psychometric development and validation of opiophobia questionnaire among doctors in Pakistan

• Date: 19 August 2021
• Pages: 221-239
• DOI: https://doi.org/10.1108/IJHRH-12-2020-0127
• Published date: 19 August 2021
• Subject Matter: Health & social care,Vulnerable groups,Inequalities & diverse/minority groups,Sociology,Race & ethnic studies,Minorities,Multiculturalism,Racial identity,Work,economy & organizations
• Author: Faiqa Naz,Kanwar Hamza Shuja,Muhammad Aqeel,Saima Ehsan,Atqa Noor,Dua Butt,Hajra Gul,Ushba Rafaqat,Amna Khan,Shafaq Gulzamir

A hindrance to proper health care:

psychometric development and validation

of opiophobia questionnaire among

doctors in Pakistan

Faiqa Naz, Kanwar Hamza Shuja, Muhammad Aqeel, Saima Ehsan, Atqa Noor, Dua Butt,

Hajra Gul, Ushba Rafaqat, Amna Khan and Shafaq Gulzamir

Abstract

Purpose –There is an ever-increasing number of patients suffering from various forms of acute and

chronic pain and getting treatment for such ailments is a basic human right.Opioid analgesics remain

one way of managing and attending to such patients. However, due to the prevalence of opiophobia,

many doctorsavoid prescribing opioid-based medicines,even at the cost of patients suffering leading to

a hindrance in providingoptimal health care. Up till now, there has been no reliableand valid instrument

to measure the severityof opiophobia in doctors. For this reason,the purpose of this study is to represent

the constructionof a precise and reliable instrument for measuringopiophobia along with its validationfor

doctorsin Pakistan.

Design/methodology/approach –Interviews and theoretical knowledge relating to opiophobia were

used as the basis for the purpose of generating an item pool. The generated item pool was evaluated by

subject matter experts for content validity and inter-rater reliability, followed by Velicer’s minimum average

partial method and maximum likelihood factor analysis for establishing the factorial structure of the scale. As

opiophobia in doctors prevails the most and causes a lower ratio of prescription of opioid analgesics. The

present sample selected for the study was that of n= 100 doctors (men = 50; women = 50) from various

hospitals, treating patients with chronic pain, in Rawalpindi and Islamabad.

Findings –A two-factor structure was suggested by Velicer’s minimum average partial method and

maximum likelihood factor analysis, which were labeled as fear of opioid analgesics and justified

acceptance of opioids. The developed opiophobia questionnaire along with its subscales displayed

appropriate levelsof reliability

a

= 0.733,

a

= 0.760 and

a

= 0.725, respectively,suggesting the scale to

be reliable.

Research limitations/implications –Like any other study, this study also tried to address every

essential aspect, but still lacked at some places which should be considered and catered for in future

studies. In the first place the sample size was very limited which was due to the fact, the study was

conducted during a pandemicand physically going for data collection wasunavailable, thus leading to

consequent sample size. It is recommended a correspondent study can be conducted with larger

sample size, so they can get morereliable results with greater precision and power. Then, theywill have

the advantage of a small margin oferror. The second limitation was the study involved only doctors as

that was the main focusof the present study. However, other hospitalstaff such as nurses should also be

incorporated to assess their levelof opiophobia. The current scale suggests the severity of opiophobia

with higher scoresthough no cutoff point has been suggested.Future studies should try and incorporate

a cutoff point to assess the difference between doctors who have conventional levels of reservations

against opioidsand those suffering from opiophobia. Anotherlimitation was that the present scale did not

establish additional validities such as convergent and divergent validity. Future studies should collect

data froma larger sample to establish these validitiesto further refine the scale.

Practical implications –This instrument can be immensely effective in identifying doctors who have

concerns and fears about prescribing opioids to patients with chronic pain. The findings acquired on

such a scale can help in developing appropriate academic and psychological interventions which can

Faiqa Naz is based at the

Department of Psychology,

Foundation University,

Islamabad, Pakistan.

Kanwar Hamza Shuja is

based at the Department of

Psychology, Capital

University of Science and

Technology, Islamabad,

Pakistan.

Muhammad Aqeel, Saima

Ehsan, Atqa Noor,

Dua Butt, Hajra Gul,

Ushba Rafaqat,

Amna Khan and Shafaq

Gulzamir are all based at

the Department of

Psychology, Foundation

University, Islamabad,

Pakistan.

Received 20 December 2020

Revised 22 March 2021

27 April 2021

2 June 2021

Accepted 25 July 2021

Disclosure statement: The

author(s) declared no potential

conflicts of interest with respect

to the research, authorship

and/or publication of this

article.

DOI 10.1108/IJHRH-12-2020-0127VOL. 16 NO. 3 2023, pp. 221-239, ©Emerald Publishing Limited, ISSN 2056-4902 jINTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE jPAGE 221

help such doctorsto overcome their opiophobia. This canenable more doctors to prescribe appropriate

medicine to their patients insteadof letting them suffer from pain. Additionally, researcherscan equally

benefitfrom the instrument as it can enable them to investigate opiophobiawith other possible variables.

Social implications –Developing such a scale about the fear facedby doctors while treating patients

would be very usefulas it is not possible to take such fear when it comes to a patient’s life. This fear is also

common among patients where they have a fear aboutthe undesirable effects, addiction of drugs and

fear of dying. Better awareness should be given to them which will be helpful for successful and less

painfultreatment in hospitals.

Originality/value –This scale is an original work withthe aim of accessing opiophobia among doctors

toward (chronic) patients with severe pain. There was a lot of research work that has been done on

opiophobia in developedcountries and few Pakistani researchers have also worked on opiophobia and

its impact on pain managementbut still, no scale has been developed to measure the extent or tendency

of opiophobia among doctors or patients. This scale can be used globally on both men and women

doctorsto access the tendency of opiophobia amongthem.

Keywords Opiophobia, Doctors, Velicer’s minimum average partial method, Validity and reliability,

Opioid analgesics, Pain management

Paper type Research paper

Introduction

Opioid-based medications are predominantly used for alleviating severe pain and have

been proven effective based on a multitude number of scientific pieces of evidence

(Caraceni et al., 2012; Gatchel and Okifuji, 2006;Madras et al.,2020;Rosenblum et al.,

2008). Research studies have shown opioid analgesics to be useful in treating acute pain

and pain in terminal cancer (Chapman et al., 2020;Chary, 2020;de la Cruz, 2020;Nesbit

et al., 2020;Wanderman and Hagedorn,2020). Nevertheless, there has been up until now a

debate in the scientific and medical community regarding the use of opioid analgesics in

managing chronic non-malignant pain (Collett, 2001;Fields, 2011;Rhodin, 2006). One

substantial cause of this refusalfor prescribing opioid-based medication representsthe fear

that many physicians experiences of causing opioid addiction and abuse (Dineen and

DuBois, 2016;Gilson et al.,2007;Jain,2020;Webster and Grabois, 2015).

The history of opioids is controversial and somehow it explains opiophobia well (Rhodin,

2006). As the prominent concern about the use of opioids involves the risk of dependence

and authorizing bodies, the public and the physicians all hold rigid views regarding the

usage of opioids for managing pain (Erard and Cantin, 2019). However, if it is under-

prescribed, it can cause millions of patients suffering from chronic and acute pain,

unrelieved suffering (Dunn et al., 2010;Ghei, 2021;Von Korff and Deyo, 2004). This fear

which many physicians have is termed “Opiophobia” which is commonly explained as an

irrational fear of physicians for prescribing opioids to patients who suffer from intense pain

(Bertin et al.,2021;Jain et al.,2013). Eventhough it is a familiar phenomenon it still prevails

in both developing and developed countries at unprecedented rates (Alattas, 2016).

Likewise, not only physicians but even many patientsalso anticipate the undesirable effects

of opioid use such as addiction and fear of dyingby overdose (Graczyk et al., 2018).

Many studies have stated three leading causes for this irrational fear in physicians which

include fear of judicial and disciplinary actions, cultural attitude regarding opioid use and

patients’ fear of opioid usage and addictiondue to lack of knowledge (Montero and Curado,

2017;Swarm et al.,2019). Thus, the prevalence of pain combined with opiophobia actually

remains a barrier for proper pain management in severe pain such as among cancer

patients, severe diabetic patients and joint pain (Cella et al., 2016;Coyne et al., 2020;

Kwon, 2014). Over the years many researchers have attempted to measure opiophobia in

doctors, nurses and patients using survey techniques (Cella et al., 2016;Merrill et al., 2000;

Savas et al.,2020) but as of yet, no validated instrument exists which can accurately

measure the intensity of opiophobia. Moreover, conventional methods for pain assessment

using triage methods in assessing opioid analgesia provision were equally found to

be inadequate (Weng et al.,2010) leading to more probability of opiophobia. These

PAGE 222 jINTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE jVOL. 16 NO. 3 2023