Public Knowledge and Perceptions of Fentanyl Test Strips: A National Cross-Sectional Survey Informed by the Health Belief Model.

Background/Objectives: Fentanyl test strips (FTS) are a harm reduction tool used to detect fentanyl in illicit substances. However, little is known regarding Americans' beliefs regarding FTS. Therefore, the purpose of this study was to assess the U.S. general public's FTS knowledge and perceptions. Methods: This study utilized a cross-sectional design. Adults ≥18 residing in the U.S. were recruited to participate in an anonymous online survey via Amazon Mechanical Turk (MTurk). Participants received $5 upon survey completion. The survey instrument was informed by the Health Belief Model, and primary outcome measures included: (1) FTS knowledge (13-items); (2) perceived susceptibility to fentanyl exposure (8-items); (3) perceived severity of fentanyl exposure (10-items); (4) perceived FTS benefits (9-items); (5) perceived barriers to FTS access (13-items); (6) comfort using and accessing FTS (15-items); (7) confidence using and accessing FTS (11-items); and (8) FTS utilization intentions (6-items). Outcomes were measured via 5-point Likert-type scales (1 = strongly disagree, 5 = strongly agree). Data were analyzed using descriptive statistics and Mann-Whitney U tests to compare differences in scale scores across participant sociodemographics. Predictors of FTS utilization intentions were assessed via multiple linear regression, controlling for participant age, race, sex, geographic setting (rural/urban), and recreational drug use history (yes/no) (α = 0.05). Results: Of n = 206 respondents, the majority were male (55.8%) and White (83.0%) with a mean age of 46.4. Approximately 81% resided in urban areas and 58.5% reported a history of recreational drug use. Participants who identified as Black, Asian, Indigenous, Pacific Islander, or Multiracial reported significantly higher mean (SD) perceived susceptibility compared to White participants (2.06 [0.54] vs. 1.91 [0.58]; p = 0.034). Participants residing in urban areas reported significantly higher comfort using and accessing FTS (3.61 [0.86]) than those in rural areas (3.29 [0.92]; p = 0.048), and younger individuals (≤44.5 years) were more confident in their ability to access FTS (3.75 [0.73]) compared to their older counterparts (3.60 [0.64]; p = 0.048). Perceived susceptibility (β = 0.442; p < 0.001), benefits (β = 0.250; p = 0.020), and comfort (β = 0.453; p < 0.001) were positive predictors of FTS utilization intention (R2 = 0.417). Conclusions: Perceptions regarding FTS varied across race, geographic setting, and age. Perceived susceptibility, perceived benefits, and comfort positively predicted the U.S. general public's FTS utilization intentions. Future interventions may leverage these influential factors to enhance FTS uptake.