Validation of alcohol use disorder identification test (audit) screening tool among medical outpatients at dessie referral hospital, north east Ethiopia , 2018

Abstract

Background: Alcohol use disorder is a major health problem among medical outpatients and remains undetected by clinicians. To identify alcohol use disorder in a busy clinical setting a brief, rapid, and flexible screening tools are important. Alcohol Use Disorders Identification Test (AUDIT) is most commonly used screening tool which is validated in outpatient setting. The psychometric properties of AUDIT have not been validated for Ethiopian population. Objective: To assess the reliability and validity of AUDIT screening tool among medical outpatients at Dessie Referral Hospital, internal medicine outpatient clinic, 2018. Methods: A cross-sectional study was conducted among 325 patients attending internal medicine outpatient department. Psychometric properties of AUDIT were be analyzed against the Mini International Neuropsychiatry Interview (MINI), as the gold standard, to detect AUD based on DSM V. The reliability was determined by examining internal consistency. The receiver operating characteristic curve was established to calculate sensitivity and specificity of the screening tool. Construct Validity was determined using both exploratory and confirmatory factor analysis. Result: The translated version of AUDIT showed language clarity. Internal consistency was excellent (cronbach’s alpha=0.9). AUDIT provide an excellent ROC with cutoff point ≥ 8 for females (sensitivity: 0.92, specificity: 0.87, PPV: 70.2, NPV: 96.9, LR+: 7.16 and LR- of 0.) and ≥ 10 for males (sensitivity of 0.91, specificity of 0.84, PPV: 72.6%, NPV: 95.3%, LR+: 5.57 and LR- of 0.10). Principal component analysis provided a 2- factor structure with 67.3% total variance. Confirmatory factor analysis provided good model fit indices for two and three factor model, with superiority of two factor model. Conclusions and recommendations: The AUDIT has been shown to be a valid instrument for screening AUDs in Amharic speaking medical outpatients.