Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug;59(4):488-501.
doi: 10.23736/S1973-9087.23.07857-7. Epub 2023 Jul 24.

Measuring the determinants of implementation behavior in multiprofessional rehabilitation

Maija Paukkunen  1   2 , Leena Ala-Mursula  3 , Birgitta Öberg  4 , Jaro Karppinen  5   6 , Tuulikki Sjögren  7 , Heidi Riska  7 , Riku Nikander  7   8 , Allan Abbott  4
Affiliations

Measuring the determinants of implementation behavior in multiprofessional rehabilitation

Maija Paukkunen et al. Eur J Phys Rehabil Med. 2023 Aug.

Abstract

Background: The Determinants of Implementation Behavior Questionnaire (DIBQ) measures facilitators or barriers of healthcare professionals' implementation behaviors based on the current implementation research on practice and policy. The DIBQ covers 18 domains of the Theoretical Domains Framework and consists of 93 items. A previously tailored version (DIBQ-t) covering 10 domains and 28 items focuses on implementing best-practice low back pain care.

Aim: To tailor a shortened version of DIBQ to multiprofessional rehabilitation context with cross-cultural adaptation to Finnish language.

Design: A two-round Delphi study.

Setting: National-level online survey.

Population: Purposively recruited experts in multiprofessional rehabilitation (N.=25).

Methods: Cross-cultural translation of DIBQ to Finnish was followed by a two-round Delphi survey involving diverse experts in rehabilitation (physicians, physiotherapists, occupational therapists, psychologists, nursing scientists, social scientists). In total, 25 experts in Round 1, and 21 in Round 2 evaluated the importance of DIBQ items in changing professionals' implementation behavior by rating on a 5-point Likert Scale (1 = Strongly Disagree, 5 = Strongly Agree) of including each item in the final scale. Consensus to include an item was defined as a mean score of ≥4 by ≥75% of Delphi participants. Open comments were analyzed using inductive content analysis. Items with agreement of ≤74% were either directly excluded or reconsidered and modified depending on qualitative judgements, amended with experts' suggestions. After completing an analogous second-round, a comparison with DIBQ-t was performed. Lastly, the relevance of each item was indexed using content validity index on item-level (I-CVI) and scale-level (S-CVI/Ave).

Results: After Round 1, 17 items were included and 48 excluded by consensus whereas 28 items were reconsidered, and 20 items added for Round 2. The open comments were categorized as: 1) "modifying"; 2) "supportive"; and 3) "critical". After Round 2, consensus was reached regarding all items, to include 21 items. After comparison with DIBQ-t, the final multiprofessional DIBQ (DIBQ-mp) covers 11 TDF domains and 21 items with I-CVIs of ≥0.78 and S-CVI/Ave of 0.93.

Conclusions: A Delphi study condensed a DIBQ-mp with excellent content validity for multiprofessional rehabilitation context.

Clinical rehabilitation impact: A potential tool for evaluating determinants in implementing evidence-based multiprofessional rehabilitation interventions.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

Figures

Figure 1
Figure 1
—Cross-cultural adaptation (phase 1) and Delphi procedure (phase 2).
Figure 2
Figure 2
—Professional experience of participants. X-axis describes the number of participants in each field and category.
Figure 3
Figure 3
—The Delphi Process Summary.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Eccles MP, Armstrong D, Baker R, Cleary K, Davies H, Davies S, et al. An implementation research agenda. Implement Sci 2009;4:18. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&l... 10.1186/1748-5908-4-18 - DOI - PMC - PubMed
    1. Grimshaw JM, Eccles MP, Lavis JN, Hill SJ, Squires JE. Knowledge translation of research findings. Implement Sci 2012;7:50. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&l... 10.1186/1748-5908-7-50 - DOI - PMC - PubMed
    1. Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients’ care. Lancet 2003;362:1225–30. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&l... 10.1016/S0140-6736(03)14546-1 - DOI - PubMed
    1. Green LW, Ottoson JM, García C, Hiatt RA. Diffusion theory and knowledge dissemination, utilization, and integration in public health. Annu Rev Public Health 2009;30:151–74. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&l... 10.1146/annurev.publhealth.031308.100049 - DOI - PubMed
    1. Carroll C, Patterson M, Wood S, Booth A, Rick J, Balain S. A conceptual framework for implementation fidelity. Implement Sci 2007;2:40. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&l... 10.1186/1748-5908-2-40 - DOI - PMC - PubMed