Development and validation of Screening Tool for Excessive and Problematic uSe of Internet and Digital Devices (STEPS-IDD) based on the WHO framework (ICD-11) for addictive behaviours

YATAN PAL SINGH BALHARA^1*Swarndeep Singh²Ilika Guha Majumdar³Ayesha Ayoob³Aastha Singh³

• ¹All India Institute of Medical Sciences, New Delhi, India
• ²Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
• ³CHRIST (Deemed to be University), Bengaluru, India

Background The widespread use of internet and digital devices has been accompanied by growing concern regarding harms associated with their excessive or problematic use. The World Health Organization has also formally included some of these in its latest classificatory system (ICD-11) under the category of "disorders due to addictive behaviours". However, a validated, comprehensive screening tool aligned with ICD-11 that screens for these potentially addictive behaviours is lacking. This study aimed to develop and validate the Screening Tool for Excessive and Problematic uSe of Internet and Digital Devices (STEPS-IDD), designed to assess multiple addictive behaviours based on ICD-11 criteria. Methods STEPS-IDD was developed based on the ICD-11 framework for disorders due to addictive behaviours It was applied to assess well-established behavioural addictions like gaming and gambling disorder, as well as less-established but widely researched ones such as problematic use of social media, online shopping/buying, OTT content watching, and pornography watching. Face validity was established through expert review and feedback. Construct validity was evaluated through exploratory factor analysis (EFA), and Cronbach's alpha coefficients were estimated to assess internal consistency. To examine concurrent validity, correlations between scores obtained on the newly developed STEPS-IDD sub-sections and the previously validated Gaming Disorder and Hazardous Gaming Scale (GDHGS) and modified GDHGS for other behaviours were assessed. ROC analyses were conducted to determine optimal STEPS-IDD cut-off scores for different behaviours. Results Data from a total of 112 college students (64.3% female) with a mean age of 20.5 years were analyzed. STEPS-IDD demonstrated good construct validity, with EFA revealing predominantly unidimensional factor structure for most behavioural domains. Internal consistency was excellent (Cronbach's α = 0.86–0.91 across sub-sections). Concurrent validity was supported by moderate to strong positive correlations (r = 0.44–0.76) of STEPS-IDD sub-sections with corresponding GDHGS and modified GDHGS scores. ROC analyses yielded optimal cut-off scores with high sensitivity and acceptable specificity for different behaviours, and fair to excellent overall diagnostic accuracy. Conclusion STEPS-IDD is a psychometrically robust, brief yet comprehensive screening tool grounded in the ICD-11 framework, for the risk stratification in context of addictive behaviours related to the use of the internet and digital devices.