Reliability and validity of the multidimensional scale of perceived social support in Chinese mainland patients with methadone maintenance treatment
Introduction
Opioid dependence is a chronic maladaptive pattern of heroin or opioid use, which poses adverse effects on individuals and society [1]. Methadone maintenance treatment (MMT) is a long-term opioid replacement therapy with daily methadone administration [2]. In China, it is estimated that about 190,000 drug users are being treated in the total 767 MMT clinics at the end of 2014 [3]. Due to the alternative characteristic and long-term treatment requirement of MMT, the majority of MMT patients cannot sustain the long-term treatment due to various factors, among which the most important one is social support [4], [5], [6], [7], [8].
Social support is a multidimensional and complex construct that has both structural and functional components [9]. The structural component includes quantitative properties of the social network (e.g., size, proximity, range, and accessibility), frequency of contact with members of the network, reciprocal support and quality of the support [10]; while the functional component refers to perceived level of received support, such as emotional support, instrumental support (practical support), informative support and appraisal support [11]. These two components of social support can be broadly distinguished in terms of received and perceived support. Published studies have documented that social support has a buffering effect on stressful life events and depression [12], [13] as well as great impacts on treatment outcomes [14], [15], [16], [17], especially the perceived social support [18], [19], [20].
Perceived social support has been conceptualized as a function of beliefs about self-worth and the availability and responsiveness to others [21]. A promising scale that aims to measure perceived social support is the Multidimensional Scale of Perceived Social Support (MSPSS). The MSPSS is a short 12-item scale assessing both perceived availability and adequacy of emotional and instrumental support from three sources, i.e., family, friends and significant others [22]. The significant others subscale is a unique aspect of the MSPSS, which leaves the definition of who the “significant others” are to the respondent [23].
The MSPSS has been found to be reliable and valid both in its original English version [24] and other language versions across different subgroups, such as university students [25], [26], [27], nursing students [11], females [28], [29], adolescents [30], [31], South Asian migrants [32], schizophrenia patients [21], myocardial infarction patients [33], and psychiatric patients [34]. Being a specific population, MMT patients are characterized by chronic brain dysfunction due to drug addiction, which needs long-term methadone intake and duration for rehabilitation [1]. Thus, social support is very important for these patients maintaining in the treatment [4], [5], [6], [7], [8]. However, evidence regarding MSPSS application in MMT patient population is lacking.
With respect to the MSPSS validation, most of the published studies are conducted using western samples and report acceptable internal consistency reliability, test–retest reliability and construct validity of the translated MSPSS. Only few studies replicate the three-factor model (i.e., family, friends and significant others) of the MSPSS; other two-factor models of MSPSS include friends and combination of family and significant others [35], or family and combination of friends and significant others [36]. Additionally, Akhtar et al. [29] found a single-factor model of the MSPSS in a group of antenatal women. Huang et al. [37] translated the MSPSS into Chinese and validated this instrument in cancer patients with sound psychometric properties. The Chinese MSPSS also has been validated in general populations such as medical students and adolescents [23], [36]. However, psychometric properties of the MSPSS in MMT patient population are still unclear.
The purpose of the study was to examine reliability and validity of the Chinese version MSPSS in MMT patients of mainland China. The hypotheses are (1) the items have satisfied internal consistency and reproducibility; (2) the items consisting of a certain subscale have higher correlations with this subscale and lower correlations with other subscales; (3) the items reflect the three-factor model, i.e., family, friends and significant others. To our knowledge, this is the first study to evaluate MSPSS in Chinese mainland MMT patient population. Findings of the study will provide evidence of psychometric properties of the MSPSS in a specific population and expand the use of the MSPSS in clinical MMT context.
Section snippets
Ethics statement
The study protocol was reviewed and approved by the Human Research Ethics Committee of Xi’an Jiaotong University. The written informed consent was obtained from each recruited patient before the questionnaire survey.
Subjects and data collection
The subjects were admitted patients of the first two largest MMT clinics in Xi’an, China. One is privately funded and the other is publicly funded. Inclusion criteria were aged 18 years or over and Chinese-speaking. If the patients had cognitive disorders or refused to give written
Results
A total of 1212 patients were recruited at baseline, with 851 (70.2%) in the privately funded clinic and 361 (29.8%) in the publicly funded clinic. One thousand and ten patients completed the re-test after 6 months. Two-hundred and two (16.7%) patients did not participate in the re-test because of transferring to other MMT clinics (n = 153, 75.7%), being admitted to hospital (n = 40, 19.8%), or losing contact (n = 9, 4.5%).
The patients aged 42.48 ± 6.24 (range: 21–65) years, with 934 (77.1%) males. Over
Discussion
Findings of the study provide evidence of reliability and validity of the Chinese version MSPSS in patients with MMT of mainland China. Both of the overall MSPSS and three subscales showed good internal consistencies, with Cronbach's α over 0.70. ICC of the overall MSPSS and subscales were over 0.60, except for significant others subscale (ICC = 0.57), indicating moderate (ICC range: 0.41–0.60) to good (ICC range: 0.61–0.80) test–retest reliability [43]. The similar result is also found in a
Acknowledgment
Funding from the National T&S Major Project of China is gratefully acknowledged (grant no. 2012ZX10002001).
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