NIH PROMIS Alcohol
NIH PROMIS for Alcohol is an electronic standard assessment patient reported subjective outcomes. The electronic delivery is often beneficial compared to paper assessments as they reduce data entry errors and increase enrollment. Qolty PROMIS anxiety is the ePRO system, and can be configured as a PRO tool that provides a short and reliable assessment for emotional distress with only the most informative items for an individual patient from an item bank based on the prior answers given by the patient.
Alcohol is one of the most abused substances worldwide and drinking often leads to accidents, assaults, and alcohol-related deaths. Thus, assessing alcohol consumption, abuse, and attitudes towards drinking is crucial in today’s society. Therefore, the Patient-Reported Outcomes Measurement Information System (PROMIS) focuses on alcohol use as one of the major aspects of mental health.
PROMIS Alcohol Use is a Survey designed to evaluate alcohol use, consequences and expectancies in the general population and alcohol abusers in order to tackle a wide range of medical conditions in adults.
The questionnaire was developed by Pilkonis and colleagues (2012). The final version of the survey consists of 108 items in total: alcohol use (37 items), negative consequences (31 items), positive consequences (20 items), negative expectancies (11 items), and positive expectancies (9 items). In addition, CATs and short forms (with 7 items for each scale) are also available (Pilkonis, et al., 2013).
The survey has a lot of implications within various health and social settings. From research to predicting treatment outcomes, assessing patients for their alcohol use and attitudes is critical.PROMIS Alcohol Use items have been created after the analysis and calibration of 5241 items; following the conceptual organization of items, focus groups, qualitative review, standardization on promoting internal consistency (DeWalt, et al., 2007), and interviews, the collected items were reduced for field testing purposes.
The item pool was calibrated after testing of 1000 online participants from the general population and 407 clients across various treatment centers. Note that only subjects who had consumed alcohol 30 days prior testing were considered, so item response theory (IRT) calibrations were analyzed in the context of this specific “floor” of exposure to alcohol.
The questionnaire contains items that evaluate alcohol use (37 items), positive consequences (20 items) and negative consequences (31 items), which are written in a first person, past tense (30 days back) with 5 response options to assess frequency (e.g.: “In the past 30 days, I lied about my drinking: never, rarely, sometimes, often, almost always.”). On the other hand, the items for positive (9 items) and negative (11 items) expectancies are in third person, present tense with 5 options assessing intensity (e.g.: “Drinking puts people in a bad mood: not at all, a little bit, somewhat, quite a bit, very much.”).As mentioned above, the survey is widely used to assess 1) alcohol use: consumption, cravings, triggers, and efforts to control drinking; 2) negative and 3) positive consequences of alcohol use, and 4) negative and 5) positive expectancies regarding drinking.
It focuses on people who have used alcohol 30 days prior testing and who not necessarily suffer from alcohol addiction. The items are designed to evaluate adults (over 18) from various ethnic and socio-economic groups.
The popularity of the survey lies in the fact that it can be used within treatment, observational and epidemiological settings.The impact of therapeutic intervention in treating alcohol abuse can be visualized by a sample graph. The evident reduction in scores after treatment depicts the efficacy of therapeutic intervention (Figure 1).
Three constructs (alcohol Use, positive consequences, and negative consequences) evaluate the alcohol use frequency. On the contrary, two constructs (positive and negative ) focus on the alcohol use intensity (Figure 2).
Based on PROMIS Alcohol Use, seven-item static short forms were also developed for each scale. Short forms have always been in demand due to time limitations and cognitive overload.
In addition, various PROMIS CAT’s with 4-6 items in each scale exist, which is a necessity in this technology-based society (Pilkonis, et al., 2016).
Compared to other forms, such as Alcohol Use Disorders Identification Test (AUDIT) (Saunders et al., 1993), the CAGE Questionnaire (Ewing, 1984), the 6-item set of “recommended alcohol questions” developed by a National Institute on Alcohol Abuse and Alcoholism (NIAAA) task force (2003), and the Comprehensive Alcohol Expectancy Questionnaire (CAEQ; Nicolai et al., 2010), PROMIS Alcohol Use shows excellent applications, validity, and reliability.
Not surprisingly, PROMIS Alcohol Use is becoming a popular tool for patients and health experts – a tool that everyone can access on their Smartphones.The item banks and short forms are also available in Spanish.Internal consistency
PROMIS Alcohol Use showed good internal consistency. In addition, the internal consistency of the short forms was very high. Correlations between the scores of the short forms and the full item banks were high: .93 for Alcohol Use, .95 for negative consequences, .97 positive consequences, .99 for negative expectancies, and .99 for positive expectancies.
Regardless of the strong characteristics of the questionnaire and its wide usage, it should be noted that PROMIS Alcohol Use Short Forms is not very suitable to test a progress of treatment programs (Gibbons, et al., 2016).
Comprehensive literature searches have ensured the content validity of the test (Pilkonis, et al., 2013).
The largest correlation reported can be observed between the PROMIS Alcohol Use score and the Alcohol Use Disorders Identification Test (r = .79 at intake).Strengths
PROMIS Alcohol Use provides reliable and valid measurements for assessing alcohol consumption, outcomes and expectations regarding drinking. In addition, the banks show good comparability to other legacy measures. We should note that combing the survey with a follow-up feedback interview has a beneficial effect on long-term abstinence and self-efficacy (Pilkonis, et al., 2016). Co-morbid disorders have also been evaluated.
Some limitations of the study should be considered. For instance, the PROMIS Alcohol Use Short Forms cannot substitute AUDIT-C in clinical settings as the surveys cannot identify at-risk alcohol use, track treatment outcomes or test willingness to enrol in treatment centers. In addition, as research has focused mainly on people living with HIV (Gibbons, et al., 2016), more data is needed regarding multiple variables (gender, nationalities, socio-economic status, etc.) and across other medical conditions.
Still, the electronic version of PROMIS Alcohol Use reduces social desirability (Fairley et al., 2010), which is crucial in testing, and makes surveys easily applicable.
- PROMIS Alcohol Use assesses alcohol use, negative and positive expectancies towards alcohol, and negative and positive outcomes of drinking.
- The questionnaire was developed by Pilkonis and colleagues (2012).
- PROMIS: Alcohol Use consists of 108 items in total.
- CATs and 7-item short forms are also available (Pilkonis, et.al., 2013).
- The questionnaire shows good reliability, validity, and responsiveness.
- Assessing alcohol use and attitude towards drinking is vital in order to improve one’s mental health.
DeWalt, D.A., Rothrock, N., Yount, S., & Stone, A., On behalf of the PROMIS Cooperative Group, (2007). Evaluation of item candidates: the PROMIS qualitative item review. Med. Care, 45, S12–S21.
Ewing, J.A. (1984). Detecting alcoholism: the CAGE questionnaire. JAMA, 252, 1905–1907.
Gibbons, L., Fredericksen, R., Merrill, J., McCaul, M., Chander, G., Hutton, H., Lober, W., Mathews, C., Mayer, K., Burkholder, G., Willig, J., Mugavero, M., Saag, M., Kitahata, M., Edwards, T., Patrick, D., Crane, H., & Crane, P. (2016). Suitability of the PROMIS alcohol use short form for screening in a HIV clinical care setting. Drug and Alcohol Dependence, 164, 113–119.
Nicolai, J., Demmel, R., Moshagen, M. (2010). The comprehensive alcohol expectancy questionnaire: confirmatory factor analysis, scale refinement, and further validation. J. Pers. Assess, 92, 400–409.
Pilkonis, P., Yu, L. Colditz, J., Dodds, N., Johnston, K., Maihoefer, C., Stover, A., Daley, D., & McCarty, D. (2013). Item banks for alcohol use from the Patient-Reported Outcomes Measurement
Information System: Use, consequences, and expectancies. Drug and Alcohol Dependence, 130, 167–177.
Pilkonis, P., Yu, L., Dodds, N., Johnston, K., Lawrence, S., & Daley, D. (2016). Validation of the alcohol use item banks from the Patient-Reported Outcomes Measurement Information System (PROMIS®). Drug and Alcohol Dependence, 161, 316-322.
Saunders, J.B., Aasland, O.G., Babor, T.F., Delafuente, J.R., Grant, M., 1993. Development of the Alcohol-Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption. Addiction, 88, 791–804.