Application of the Delphi Method for Content Validity Analysis of a Questionnaire to Determine the Risk Factors of the Chemsex

Abstract

Chemsex is understood as “the intentional use of stimulant drugs to have sex for an extended time among gay, bisexual, and other men who have sex with men”. It is a public health problem because of the increased incidence of cases and because of the consequences on the physical and mental health of those who practice it. Aim: This study aimed to analyze, with the help of the Delphi method, the content validity of a new instrument to assess the risk of behaviors associated with the chemsex phenomenon. Method: First, a bank of items identified from the literature was elaborated. Secondly, 50 experts with knowledge of the chemsex phenomenon at the national level were contacted. A Delphi group was formed with them to carry out two rounds of item evaluation. The linguistic evaluation (comprehension and appropriateness) was assessed using a Likert scale from 1 to 5 for each item. Items that did not reach a mean score of 4 were eliminated. Content assessment was calculated using each item’s content validity index (CVI) and Aiken’s V (VdA). A minimum CVI and VdA value of 0.6 was established to include the items in the questionnaire. Results: A total of 114 items were identified in the literature. In the first round of Delphi evaluation, 36 experts evaluated the items. A total of 58 items were eliminated for obtaining a CVI or VdA of less than 0.6, leaving 56 items. In a second Delphi round, 30 experts re-evaluated the 56 selected items, where 4 items were eliminated for being similar, and 10 items were also eliminated for not being relevant to the topic even though they had values higher than 0.6, leaving the scale finally composed of 52 items. Conclusion: A questionnaire has been designed to assess the risk of behaviors associated with the chemsex phenomenon. The items that make up the questionnaire have shown adequate content and linguistic validity. The Delphi method proved to be a helpful technique for the proposed objective.

Descriptive study on substance uses and risk of sexually transmitted infections in the practice of Chemsex in Spain

“…Additionally, mephedrone use has been linked to severe psychiatric symptoms, intoxications, and dependence on injecting drugs (29). This includes a range of adverse effects such as binge drinking, anxiety, binge eating, withdrawal symptoms, and psychotic symptomatology resulting from injecting mephedrone use (6,29,63).…”

“…In recent years, there has been an increase in the intentional use of drugs for sex, which can last for hours or even days, among men who have sex with men (MSM) (1)(2)(3)(4)(5)(6). The recreational uses of substances vary in place or environment.…”

“…According to the latest European online survey for MSM (EMIS -2017), the section on substance use revealed the prevalence of substance use for sexual purposes in the last 12 months was 14.1% (14,15), with Spain being one of the countries with the highest prevalence of chemsex at the European level (16,17). The substances most commonly used in the practice of Chemsex include methamphetamine, mephedrone, and other synthetic cathinones, gamma-hydroxybutyric acid/gamma-butyrolactone (GHB/GBL) (1,2,9,14,15,(18)(19)(20)(21)(22)(23)(24)(25)(26) alkyl nitrites (poppers) (27) medication for erectile dysfunction (6,(28)(29)(30) and less frequently other substances such as cocaine and ketamine (13,22,31). If the consumption of these psychoactive substances is intravenous (19,32) in this context, it is called slamming or slamsex (1,6,14,25,28,29).…”

“…The substances most commonly used in the practice of Chemsex include methamphetamine, mephedrone, and other synthetic cathinones, gamma-hydroxybutyric acid/gamma-butyrolactone (GHB/GBL) (1,2,9,14,15,(18)(19)(20)(21)(22)(23)(24)(25)(26) alkyl nitrites (poppers) (27) medication for erectile dysfunction (6,(28)(29)(30) and less frequently other substances such as cocaine and ketamine (13,22,31). If the consumption of these psychoactive substances is intravenous (19,32) in this context, it is called slamming or slamsex (1,6,14,25,28,29).…”

“…A higher incidence has been observed in PLHIV (People living with HIV) versus MSM who do not have HIV (15,25). As a consequence, PLHIV are at increased risk for mental health problems (6,25,32,34), specifically anxiety and depression (23,36). In the same vein, Chemsex practices have been associated with increased risk of psychosis (6,14) and delusional thoughts due to chronic methamphetamine use (29, 40), suicidal ideation (6, 41) anxiety, depression (14,34), overdose (15), behavioral disturbances (6), substance addiction (26) and reduced adherence to PrEP treatment (6).…”