A hindrance to proper health care: psychometric development and validation of opiophobia questionnaire among doctors in Pakistan
Authors: Naz Faiqa , Shuja Kanwar Hamza , Aqeel Muhammad , Ehsan Saima , Noor Atqa , Butt Dua , Gul Hajra , Rafaqat Ushba , Khan Amna , Gulzamir Shafaq 
Published: August 2021

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 doctors avoid prescribing opioid-based medicines, even at the cost of patients suffering leading to a hindrance in providing optimal health care. Up till now, there has been no reliable and valid instrument to measure the severity of opiophobia in doctors. For this reason, the purpose of this study is to represent the construction of a precise and reliable instrument for measuring opiophobia along with its validation for doctors in 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 levels of reliability α = 0.733, α = 0.760 and α = 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 pandemic and physically going for data collection was unavailable, thus leading to consequent sample size. It is recommended a correspondent study can be conducted with larger sample size, so they can get more reliable results with greater precision and power. Then, they will have the advantage of a small margin of error. The second limitation was the study involved only doctors as that was the main focus of the present study. However, other hospital staff such as nurses should also be incorporated to assess their level of opiophobia. The current scale suggests the severity of opiophobia with higher scores though 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 opioids and those suffering from opiophobia. Another limitation was that the present scale did not establish additional validities such as convergent and divergent validity. Future studies should collect data from a larger sample to establish these validities to 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 help such doctors to overcome their opiophobia. This can enable more doctors to prescribe appropriate medicine to their patients instead of letting them suffer from pain. Additionally, researchers can equally benefit from the instrument as it can enable them to investigate opiophobia with other possible variables.

Social implications
Developing such a scale about the fear faced by doctors while treating patients would be very useful as 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 about the undesirable effects, addiction of drugs and fear of dying. Better awareness should be given to them which will be helpful for successful and less painful treatment in hospitals.

Originality/value
This scale is an original work with the 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 developed countries and few Pakistani researchers have also worked on opiophobia and its impact on pain management but 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 doctors to access the tendency of opiophobia among them.